Accuracy of predicting axillary nodal status in patients with breast cancer

ABSTRACTS P84. One Year Analysis Of Sentinel Node Biopsy (Snb) In Operable Breast Cancer M.G. Berry, B. Sigal-Zafrani, S. Alran, V. Fourchotte, X. Sastre-Garau, R. Salmon Institute Curie, 25 Rue D’Ulm, Paris, 75001, France Introduction: SNB is well established for breast cancer staging. This study aimed to validate our technique for per-operative node identification. Patients and methods: SNB identification was performed with a colourimetric and/or isotopic technique. In 2007, 747 SNBs yielded 1657 nodes of which 1153 (1.5/patient) underwent frozen section (FS). Definitive evaluation was subsequently performed on multiple sections with standard dyes, and immunochemistry if no metastatic cells had been visualized. Results: Following definitive histopathological assessment, 77% were negative: there were no false positive results. Positive nodes were seen in 167: macroscopic in 98, microscopic (41) and isolated cells (28). These were identified by FS in 52%, leading to immediate axillary dissection in 84/98 (85%) macroscopic and 3/41 (7%) microscopic. Of 14 positive cases, cryosection was sub-optimal in 7 and missed in 3. The remaining 4 occurred on days with 17 and 12 frozen sections in addition to the routine workload for a single pathologist and technician. Secondary dissection was performed in 66/80 (82.5%) patients with a false-negative result by frozen section, 8.8% of the total. Of these 8 were positive. Discussion: our results confirm the validity of our technique with respect to previous experience and literature reports. Further improvement is limited by logistical constraints, particularly synchronising multiple operative lists. Technical improvements in frozen section examination should reduce the rate of re-operation below 8%. Identification of isolated cells remains unresolved as the new ‘molecular’ techniques do not always identify them and their precise significance remains under discussion in the literature. P85. Breast cancer outcomes following a national initiative in Ireland to restructure delivery of services for symptomatic disease Catherine de Blacam, J. Gray, T. Boyle, J. Kennedy, D. Hollywood, J. Reynolds St James’s Hospital, James’s Street, Dublin 8, Ireland Introduction: A national initiative in Ireland in 2000 defined 13 designated units to provide care for symptomatic breast cancer. Resources, including audit infrastructure, were provided. In the absence of a national audit of breast cancer outcomes, the aim of this study is to provide a detailed report of one unit’s subsequent experience, in particular comparing process and outcome data with international norms and benchmarks (SEER and EUROCARE), and to infer on the likely impact of the national initiative. Methods: A 5-year prospective audit of patients presenting to the Symptomatic Breast Clinic from 2001 to 2005 was conducted. All cancer diagnoses were discussed at the Breast Multidisciplinary Conference, and all clinicopathological data, treatment details and follow-up information were entered by a full-time data manager. Overall survival was calculated using the Kaplan-Meier method. Results: 839 patients were diagnosed through the clinic - 18 (2%) Stage 0, 169 (20%) Stage I, 380 (45%) Stage II, 142 (17%) Stage III and 123 (15%) Stage IV. At 35 months median follow-up, the overall 5year survival was 71%, with 100%, 91%, 83%, 72% and 11% for Stages 0-IV respectively. Disease-specific survival was 82%. Conclusions: Process and outcome data are consistent with international benchmarks. These data from one designated centre support the national initiatives in Ireland to restructure breast services. P86. A Computerised Decision Support System for Breast Multidisciplinary Meeting: a baseline prospective audit to validate the system Vivek Patkara, D. Acostab, J. Foxc, A. Jonesa, M. Keshtgara a Royal Free Hospital NHS Trust, Pond Street, London, NW3 2QG b UCL London c Dept of Engineering Science, Oxford.

1187 Introduction: Over last few years MDMs have become standard of care. However the empirical evidence in the UK highlights wide variation in clinical practices among MDMs. The computerised decision support (CDS) systems can play a potential role in improving MDM functioning. We have built a decision-support system to assist evidence-based decision making in breast MDM and are prospectively auditing MDM at our institution to validate this system. Methods: All benign and cancers presented in Breast MDM are included. All data presented in MDM including recommendations are entered in the CDS system. CDS uses 15 high quality on breast screening, diagnosis and management guidelines including NICE and NHSBSP guidelines. CDS also identifies patients suitable for clinical trials running in the unit. MDM recommendations, CDS recommendations and documentation are analysed. Results: 130 patients were audited. The MDM recommendations were congruent with that of evidence-based guidelines in 94% of cases. However only 60% of potentially suitable patients for clinical trials were identified in the MDM. The necessary data were not available for 6% of the cases listed in MDM forcing the team to bring those cases more than once for discussion. Conclusions: There is a potential for CDS system to improve certain aspects of MDM by helping overburdened clinicians. It can improve guideline-compliance and can also help refining the guidelines by feeding back MDM decisions into the loop. It will also improve recruitment of patients in clinical trials. Our ongoing audit will provide further data on efficacy and usability of such systems. P87. Accuracy of predicting axillary nodal status in patients with breast cancer Ennio Agabiti, A. Krishnan, C. Hubbard, P. Rajan, S. Lishman, L. Mogotalane, R. Moore Hinchingbrooke Hospital NHS Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, PE29 6NT Introduction: In literature the accuracy of preoperative ultrasound of the axilla in patients with breast cancer is variable. We assessed the sensitivity and specificity of the procedure in a recent series. Methods: It is routine practise at our hospital to examine the axilla with ultrasound at the time of diagnosis of breast cancer. We reviewed 100 consecutive breast cancer patients undergoing preoperative ultrasound of the axilla - with or without ultrasound-guided biopsy of lymph nodes prior to breast and axillary surgery: Sentinel Lymph Node Biopsy (SLNB), lymph node sampling or Axillary Lymph Node Dissection (ALND) - between November 2005 and May 2007. Two experienced Consultant Radiologists performed the preoperative ultrasound. Results: In 39 cases the axillary nodes showed features in keeping with possible metastasis and either a Fine Needle Aspiration Cytology (FNAC) and/or a Core Biopsy (CB) performed. 19 patients were excluded for insufficient data. In 42 cases the axillary nodes showed benign features and no biopsy was carried out. When compared with the results of the FNAC/CB and the final histology of the surgical specimen, there were 28 true positive, 11 false positive, 34 true negative and 8 false negative. Sensitivity was 77.8%, specificity 75.5%. Conclusions: The preoperative ultrasound of the axilla reinforces the therapeutic choices for the surgical treatment of the axilla. In selected cases, particularly in patients with small cancers, the preoperative finding of a metastatic axillary lymph node enables the surgeon to proceed with definitive axillary surgery, thus sparing the patient a second operation. P88. Should MRI be a routine pre-operative investigation for all patients undergoing breast conservation for invasive lobular cancer? Sheikh Ahmada, K. Gower-Thomasa, C. Champa, L. Satherleyb, R. Williamsa, E. Vaughan-Williamsa a Royal Glamorgan Hospital, Ynymaerdy, Llantrisant, South Wales, CF72 8XR b University Hospital of Wales