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Analysing Sentinel Lymph Nodes with Intra-operative One Step Nucleic Acid Amplification (OSNA) - does it impact on operating times?
ABSTRACTS precisely define the location of the sentinel node in the axilla, to demonstrate that it is not randomly located and that the lymphatic flow of the breast follows a predetermined route. Methods: A consecutive series of 242 patients with DCIS or stage I breast cancer (T1N0/T2N0) who had SN localization were included in a prospective study, precisely mapping the location of the SN in the axilla. In order to do so we created a new anatomical classification of the lower part of the axilla based upon the intersection of two anatomical landmarks, the lateral thoracic vein (LTV) and the second intercostobrachial nerve (2nd ICBN). These two constant elements form the basis of 4 different axillary zones (A, B, C and D). Results: In 98.2% of patients the axillary SN is located medially, alongside the LTV, either below the 2nd ICBN (axillary Zone A; 86.6%) or above it (axillary Zone B; 11.6%). Only 4 patients (1.8%) had their SN located laterally in the axilla. Conclusion: Regardless of the site of the tumour in the breast, 98.2% of the SNs were found in the medial part of the axilla, alongside the LTV. This information should help avoid unnecessary lateral dissections. P20. Analysing Sentinel Lymph Nodes with Intra-operative One Step Nucleic Acid Amplification (OSNA) - does it impact on operating times? Vivien V. Ng, F. Charlton, G. Cunnick Wycombe General Hospital/Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, Buckinghamshire, HP11 2TT
Introduction: Sentinel lymph node biopsy (SLNB) for nodal staging of breast cancer is now routine practice. OSNA is a recent intra-operative tool using molecular analysis that allows for rapid accurate diagnosis of lymph node metastases. Our aim was to determine the time to analyse the sentinel nodes using OSNA and how this affected the overall time for the operation. Methods: The first 100 patients with breast cancer (mean age 59.5 years, range 30-85 years) who underwent SLNB with intra-operative OSNA analysis between May - November 2010 were all included. Patients underwent mastectomies and wide local excisions (+/- wire) after SLNB. Patients with sentinel nodes that were positive for metastases proceeded to an axillary node clearance. The duration of surgery to the breast and axilla and the time for the OSNA result after the node left theatre were recorded prospectively. Results: The median time for a SLNB to be performed was 12 minutes (range 2-57 minutes). The median time waited for the telephoned result was 44 minutes (range 28 -75 minutes). In 54%, the breast operation had finished prior to the results coming back, with a median waiting time of 3 minutes. Thus in 46% cases, the result was known before the breast operation had finished. 39 patients proceeded to an axillary node clearance based on a positive result (macro- and micrometastases). Conclusion: OSNA is a quick reliable system for analyzing sentinel nodes. It did not significantly delay operating times and eliminated the need for a second axillary operation. P21. Risk prediction of non-sentinel lymph node metastasis using the Stanford Online Calculator Carol Norman, C. Chianakwalam William Harvey Hospital, Ashford, Kent, TN24 0LZ
Background: 40-60% of patients with metastatic disease in the sentinel lymph node (SLN) will have no additional non-sentinel lymph node metastasis (NSLNM) following axillary lymph node dissection (ALND). Several models and normograms have been proposed to aid clinicians predict the risk of NSLNM. The aim of this study is to assess the performance of the Stanford Online Calculator (SOC). Methods: Database review of the first consecutive100 SLNB by a single surgeon between May 2009 and April 2010. Patients with positive
S9 SLN(s) - excluding isolated tumour cells - who underwent completion ALND were analysed. For each patient, the pathologic tumour size, size of SLN metastasis and the presence or absence of lymphovascular invasion were entered into the SOC to calculate the probability of NSLNM. Statistical analysis was done with the Student t test. Results: Of 22 patients with positive SLN(s), 19 underwent ALND. 9 (47%) had NSLNM. Only one additional NSLN was involved in 4 patients. The mean number of additional positive NSLN was 5 (1-28) and mean number of nodes resected was 12 (5-31). There was no statistical difference between the mean SOC predicted probabilities of patients with and without NSLNM (75% vs. 62%; P¼0.334). 1 patient with low SOC predicted score of 10% had no NSLNM (false negative rate 0%). Of 2 patients with predicted probability of 100%, 1 had no NSLNM (false positive rate 50%). Conclusion: At this early stage the SOC is not sufficiently discriminatory to change current practice. The audit continues. P22. In breast cancer, predicting which patients with macrometastasis in sentinel lymph nodes (SLN) have non SLN metastases is not possible Wail Sarakbi, S. Jones, P. Mills, A. Sever, J. Weeks, D. Fish, J. Withington, P. Jones Maidstone Hospital, MTW NHS Trust, Hermitage Lane, Barming, Maidstone, Kent, ME16 9QQ
Introduction: SLN biopsy (SLNB) is the standard axillary staging procedure for breast cancer patients. Tumour characteristics cannot exclude the presence of metastasis in non sentinel lymph nodes. This study assesses whether the number of positive sentinel lymph nodes predicts the incidence of non sentinel lymph node involvement, or the number of lymph nodes involved. Methods: Most patients with nodal involvement were detected by routine axillary ultrasound . The remainder underwent SLNB. Those with a positive SLNB between October 2006 and June 2009 were reviewed to show the incidence and number of positive SLNs found after completion ANC. Results: Total number of patients having SLNB ¼ 482 Patients with positive SLNB ¼ 103 TOTAL positive who underwent ANC¼ 101 34% ANC positive Median number of nodes¼2 Range 1-7 SINGLE positive SLN¼ 51 26% ANC positive Range 1-5 2 or more positive SLN¼ 22 62% ANC positive Range 2-7 Micromets at ANC¼ 22 23% ANC positive Range 1-5 ITCs at ANC ¼2, no positive nodes at ANC Conclusions: 34% of patients with a positive SLN were found to have non SLN metastasis. The number of non SLNs involved was between 1 and 7 and was the same whether 1, 2 or more SLNs were involved. Leaving up to 7 involved non SLNs surgically untreated cannot be recommended. Completion ANC should be advised for patients with a positive SLN. P23. Which patients benefit from intra-operative assessment of sentinel nodes? Louis Savagea, M. Dania, S. Pinderb, A. Purushothamb, M. Douekb a Guys and St Thomas’ Hospitals, London, SE1 9RT b King’s College London
Introduction: Sentinel lymph node biopsy (SLNB) for nodal staging of breast cancer is now routine practice. OSNA is a recent intra-operative tool using molecular analysis that allows for rapid accurate diagnosis of lymph node metastases. Our aim was to determine the time to analyse the sentinel nodes using OSNA and how this affected the overall time for the operation. Methods: The first 100 patients with breast cancer (mean age 59.5 years, range 30-85 years) who underwent SLNB with intra-operative OSNA analysis between May - November 2010 were all included. Patients underwent mastectomies and wide local excisions (+/- wire) after SLNB. Patients with sentinel nodes that were positive for metastases proceeded to an axillary node clearance. The duration of surgery to the breast and axilla and the time for the OSNA result after the node left theatre were recorded prospectively. Results: The median time for a SLNB to be performed was 12 minutes (range 2-57 minutes). The median time waited for the telephoned result was 44 minutes (range 28 -75 minutes). In 54%, the breast operation had finished prior to the results coming back, with a median waiting time of 3 minutes. Thus in 46% cases, the result was known before the breast operation had finished. 39 patients proceeded to an axillary node clearance based on a positive result (macro- and micrometastases). Conclusion: OSNA is a quick reliable system for analyzing sentinel nodes. It did not significantly delay operating times and eliminated the need for a second axillary operation. P21. Risk prediction of non-sentinel lymph node metastasis using the Stanford Online Calculator Carol Norman, C. Chianakwalam William Harvey Hospital, Ashford, Kent, TN24 0LZ
Background: 40-60% of patients with metastatic disease in the sentinel lymph node (SLN) will have no additional non-sentinel lymph node metastasis (NSLNM) following axillary lymph node dissection (ALND). Several models and normograms have been proposed to aid clinicians predict the risk of NSLNM. The aim of this study is to assess the performance of the Stanford Online Calculator (SOC). Methods: Database review of the first consecutive100 SLNB by a single surgeon between May 2009 and April 2010. Patients with positive
S9 SLN(s) - excluding isolated tumour cells - who underwent completion ALND were analysed. For each patient, the pathologic tumour size, size of SLN metastasis and the presence or absence of lymphovascular invasion were entered into the SOC to calculate the probability of NSLNM. Statistical analysis was done with the Student t test. Results: Of 22 patients with positive SLN(s), 19 underwent ALND. 9 (47%) had NSLNM. Only one additional NSLN was involved in 4 patients. The mean number of additional positive NSLN was 5 (1-28) and mean number of nodes resected was 12 (5-31). There was no statistical difference between the mean SOC predicted probabilities of patients with and without NSLNM (75% vs. 62%; P¼0.334). 1 patient with low SOC predicted score of 10% had no NSLNM (false negative rate 0%). Of 2 patients with predicted probability of 100%, 1 had no NSLNM (false positive rate 50%). Conclusion: At this early stage the SOC is not sufficiently discriminatory to change current practice. The audit continues. P22. In breast cancer, predicting which patients with macrometastasis in sentinel lymph nodes (SLN) have non SLN metastases is not possible Wail Sarakbi, S. Jones, P. Mills, A. Sever, J. Weeks, D. Fish, J. Withington, P. Jones Maidstone Hospital, MTW NHS Trust, Hermitage Lane, Barming, Maidstone, Kent, ME16 9QQ
Introduction: SLN biopsy (SLNB) is the standard axillary staging procedure for breast cancer patients. Tumour characteristics cannot exclude the presence of metastasis in non sentinel lymph nodes. This study assesses whether the number of positive sentinel lymph nodes predicts the incidence of non sentinel lymph node involvement, or the number of lymph nodes involved. Methods: Most patients with nodal involvement were detected by routine axillary ultrasound . The remainder underwent SLNB. Those with a positive SLNB between October 2006 and June 2009 were reviewed to show the incidence and number of positive SLNs found after completion ANC. Results: Total number of patients having SLNB ¼ 482 Patients with positive SLNB ¼ 103 TOTAL positive who underwent ANC¼ 101 34% ANC positive Median number of nodes¼2 Range 1-7 SINGLE positive SLN¼ 51 26% ANC positive Range 1-5 2 or more positive SLN¼ 22 62% ANC positive Range 2-7 Micromets at ANC¼ 22 23% ANC positive Range 1-5 ITCs at ANC ¼2, no positive nodes at ANC Conclusions: 34% of patients with a positive SLN were found to have non SLN metastasis. The number of non SLNs involved was between 1 and 7 and was the same whether 1, 2 or more SLNs were involved. Leaving up to 7 involved non SLNs surgically untreated cannot be recommended. Completion ANC should be advised for patients with a positive SLN. P23. Which patients benefit from intra-operative assessment of sentinel nodes? Louis Savagea, M. Dania, S. Pinderb, A. Purushothamb, M. Douekb a Guys and St Thomas’ Hospitals, London, SE1 9RT b King’s College London