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Assessment of neoadjuvant chemotherapy responses for locally advanced breast cancer patients: DCE-MRI vs resection histology
ABSTRACTS
493
Methods: Prospective data was collected from all patients who underwent OSNA testing from June 2010 to December 2012. A subset of 48 patients (110 nodes) who had SLNs with macrometastases on OSNA was included. The MSK nomogram score, the maximum OSNA copy number and the nodal status following ALNC were recorded for each patient. Results: 31% (15/48) of patients with macrometastases on SLNB had at least one positive lymph node at ALNC and 69% (33/40) had no further metastases. The differences in the MSK nomogram score and the log OSNA copy number were significant between these two groups although the ROC was better with the OSNA copy number.
Non SLN Status at ALNC
MSK Nomogram Score
Log (OSNA Copy Number)
At least one positive (n¼15) Negative (n¼33)
171(SEM ¼ 10.98)
5.2(SEM¼0.21)
139(SEM ¼ 5.29) p¼0.005, ROC¼0.73
4.5(SEM ¼0.1) p¼0.001, ROC¼0.78
Conclusions: These results support the use of OSNA copy numbers to predict the risk of further positive non-SLN. In the future this may help predict those patients who could be spared an axillary clearance even if they had positive nodes at SLNB. http://dx.doi.org/10.1016/j.ejso.2013.01.148
P113. Assessment of neoadjuvant chemotherapy responses for locally advanced breast cancer patients: DCE-MRI vs resection histology Tasadooq Hussaina, Vijay Agarwala, Vera Garimellaa, Peter J. Kneeshawa, Mike J. Linda, Lynn Cawkwellb a Castle Hill Hospital, Hull, UK b University of Hull - HYMS, Hull, UK
Background: Neoadjuvant chemotherapy is used to downstage locally advance breast cancer and allows increased rates of breast conserving surgery. Studies have shown Dynamic contrast enhanced- MRI (DCE-MRI) to provide a more accurate prediction of residual disease. However, therapy induced changes and presence of discontinuous foci from tumour fragmentation following chemotherapy can make prediction of response on DCEMRI challenging. Aim: We aimed to compare therapy responses assessed on DCE-MRI with final resection histology following administration of anthracyline (FEC) neoadjuvant chemotherapy for locally advanced breast cancer patients. Methods: Imaging and radiological data was available for 24 patients who received FEC chemotherapy. All patients undergoing chemotherapy were staged with the DCE-MRI of the breast before and after treatment. Therapy responses were determined based on RECIST criteria. Patients who had complete or partial response were considered responders and patients with stable and progressive disease were considered non responders. Results: Assessing Modality
Responders
Non-responders
Pre-treatment MRI to post treatment MRI Pre-treatment MRI to final resection histology
15
8
12
11
A 75% concordance was seen in responses determined by DCE-MRI and the final resection histology. 25% patients showed differences in therapy responses determined by DCE-MRI compared to final resection size.
Conclusion: Neo-adjuvant therapy responses determined on DCE-MRI provides an acceptable level of concordance with final histology for anthracyline based chemotherapy. However, in 25% of patients DCE-MRI may not accurately predict response to anthracyline based neoadjuvant based chemotherapy for locally advanced breast cancer. http://dx.doi.org/10.1016/j.ejso.2013.01.149
P114. Bilateral simultaneous mastectomies Natasha Jiwa, Steven Goh Peterborough City Hospital, Peterborough, UK
Introduction: Bilateral same-time mastectomy has traditionally been thought of as the treatment for bilateral simultaneous breast cancer unsuitable for breast conserving surgery. However, we have noticed an increasing trend of women who are choosing to have simultaneous bilateral mastectomies for small, unilateral tumour or for risk-reducing purposes. We conducted an audit on this selected cohort of our patient population. Methods: A retrospective review of all patients undergoing simultaneous bilateral mastectomies between June 2002 and June 2012 was carried out. Cancer registry, case-notes, radiological and histopathological reports were used for data collection. Results: 53 out of 69 patients (mean age 51) with completed data were included. 8 patients underwent subcutaneous mastectomies for gynaecomastia and were excluded from subsequent analyses. 15 patients were operated on between 2002-2007 whereas there were 30 patients between 2007-2012. 47% underwent simultaneous mastectomies for bilateral simultaneous breast cancer. 28% of cases involved a mastectomy for ‘risk-reducing’ purposes and one case was bilateral risk reducing surgery. 59% of histology tumour size was less than 40mm and 33% of patients underwent reconstructive surgery. Mean hospital stay was 5.9 days (1-22), and 33% of patients underwent further revisional surgeries. Only 7% of our patients have a documented genetic mutation. Conclusions: We have noticed an increase in requests for simultaneous bilateral mastectomies even when it is not clinically indicated. This trend has obvious resource implications and further studies are needed to assess the long-term effects of these operations on physical as well as psychosocial well-being of this patient cohort. http://dx.doi.org/10.1016/j.ejso.2013.01.150
P115. Revision of symmetrisation surgery; a novel workup using CT angiography to identify the primary reduction mastopexy pedicle Ilyas Khattak, Joanna Seward, Susan Hignett, Richard McWilliams, Geraldine Mitchell Royal Liverpool University Hospital, Liverpool, UK
Introduction: Oncoplastic techniques are increasingly incorporated in the treatment of breast cancer, and with them their long-term follow-up implications. We present a case of revision mastopexy in a patient who previously underwent symmetrisation mastopexy following primary breast cancer treatment. The old case notes were not available and although clinical examination elucidated a wise pattern scar, the primary pedicle utilised for the procedure was uncertain. While neovascularisation occurs in the postoperative period, the primary pedicle should be respected during subsequent surgery. Prior to free flap surgery, abdominal vasculature is regularly investigated using computerised tomography angiography (CTA) and, as such, we attempted to extend this investigation to the nipple areola complex (NAC).
493
Methods: Prospective data was collected from all patients who underwent OSNA testing from June 2010 to December 2012. A subset of 48 patients (110 nodes) who had SLNs with macrometastases on OSNA was included. The MSK nomogram score, the maximum OSNA copy number and the nodal status following ALNC were recorded for each patient. Results: 31% (15/48) of patients with macrometastases on SLNB had at least one positive lymph node at ALNC and 69% (33/40) had no further metastases. The differences in the MSK nomogram score and the log OSNA copy number were significant between these two groups although the ROC was better with the OSNA copy number.
Non SLN Status at ALNC
MSK Nomogram Score
Log (OSNA Copy Number)
At least one positive (n¼15) Negative (n¼33)
171(SEM ¼ 10.98)
5.2(SEM¼0.21)
139(SEM ¼ 5.29) p¼0.005, ROC¼0.73
4.5(SEM ¼0.1) p¼0.001, ROC¼0.78
Conclusions: These results support the use of OSNA copy numbers to predict the risk of further positive non-SLN. In the future this may help predict those patients who could be spared an axillary clearance even if they had positive nodes at SLNB. http://dx.doi.org/10.1016/j.ejso.2013.01.148
P113. Assessment of neoadjuvant chemotherapy responses for locally advanced breast cancer patients: DCE-MRI vs resection histology Tasadooq Hussaina, Vijay Agarwala, Vera Garimellaa, Peter J. Kneeshawa, Mike J. Linda, Lynn Cawkwellb a Castle Hill Hospital, Hull, UK b University of Hull - HYMS, Hull, UK
Background: Neoadjuvant chemotherapy is used to downstage locally advance breast cancer and allows increased rates of breast conserving surgery. Studies have shown Dynamic contrast enhanced- MRI (DCE-MRI) to provide a more accurate prediction of residual disease. However, therapy induced changes and presence of discontinuous foci from tumour fragmentation following chemotherapy can make prediction of response on DCEMRI challenging. Aim: We aimed to compare therapy responses assessed on DCE-MRI with final resection histology following administration of anthracyline (FEC) neoadjuvant chemotherapy for locally advanced breast cancer patients. Methods: Imaging and radiological data was available for 24 patients who received FEC chemotherapy. All patients undergoing chemotherapy were staged with the DCE-MRI of the breast before and after treatment. Therapy responses were determined based on RECIST criteria. Patients who had complete or partial response were considered responders and patients with stable and progressive disease were considered non responders. Results: Assessing Modality
Responders
Non-responders
Pre-treatment MRI to post treatment MRI Pre-treatment MRI to final resection histology
15
8
12
11
A 75% concordance was seen in responses determined by DCE-MRI and the final resection histology. 25% patients showed differences in therapy responses determined by DCE-MRI compared to final resection size.
Conclusion: Neo-adjuvant therapy responses determined on DCE-MRI provides an acceptable level of concordance with final histology for anthracyline based chemotherapy. However, in 25% of patients DCE-MRI may not accurately predict response to anthracyline based neoadjuvant based chemotherapy for locally advanced breast cancer. http://dx.doi.org/10.1016/j.ejso.2013.01.149
P114. Bilateral simultaneous mastectomies Natasha Jiwa, Steven Goh Peterborough City Hospital, Peterborough, UK
Introduction: Bilateral same-time mastectomy has traditionally been thought of as the treatment for bilateral simultaneous breast cancer unsuitable for breast conserving surgery. However, we have noticed an increasing trend of women who are choosing to have simultaneous bilateral mastectomies for small, unilateral tumour or for risk-reducing purposes. We conducted an audit on this selected cohort of our patient population. Methods: A retrospective review of all patients undergoing simultaneous bilateral mastectomies between June 2002 and June 2012 was carried out. Cancer registry, case-notes, radiological and histopathological reports were used for data collection. Results: 53 out of 69 patients (mean age 51) with completed data were included. 8 patients underwent subcutaneous mastectomies for gynaecomastia and were excluded from subsequent analyses. 15 patients were operated on between 2002-2007 whereas there were 30 patients between 2007-2012. 47% underwent simultaneous mastectomies for bilateral simultaneous breast cancer. 28% of cases involved a mastectomy for ‘risk-reducing’ purposes and one case was bilateral risk reducing surgery. 59% of histology tumour size was less than 40mm and 33% of patients underwent reconstructive surgery. Mean hospital stay was 5.9 days (1-22), and 33% of patients underwent further revisional surgeries. Only 7% of our patients have a documented genetic mutation. Conclusions: We have noticed an increase in requests for simultaneous bilateral mastectomies even when it is not clinically indicated. This trend has obvious resource implications and further studies are needed to assess the long-term effects of these operations on physical as well as psychosocial well-being of this patient cohort. http://dx.doi.org/10.1016/j.ejso.2013.01.150
P115. Revision of symmetrisation surgery; a novel workup using CT angiography to identify the primary reduction mastopexy pedicle Ilyas Khattak, Joanna Seward, Susan Hignett, Richard McWilliams, Geraldine Mitchell Royal Liverpool University Hospital, Liverpool, UK
Introduction: Oncoplastic techniques are increasingly incorporated in the treatment of breast cancer, and with them their long-term follow-up implications. We present a case of revision mastopexy in a patient who previously underwent symmetrisation mastopexy following primary breast cancer treatment. The old case notes were not available and although clinical examination elucidated a wise pattern scar, the primary pedicle utilised for the procedure was uncertain. While neovascularisation occurs in the postoperative period, the primary pedicle should be respected during subsequent surgery. Prior to free flap surgery, abdominal vasculature is regularly investigated using computerised tomography angiography (CTA) and, as such, we attempted to extend this investigation to the nipple areola complex (NAC).