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Breast Tumour Measurement: Ultrasound versus Mammography
1174
ABSTRACTS
Mammoglobin has been shown to be a better indicator of metastatic disease than conventional markers. An association between MGB expression and morbidity/mortality has been demonstrated. This suggests that although patient numbers are small MGB may have the potential to be used as a prognostic indicator for patients with early breast cancer.
Conclusions: Our study indicates that those with a previous history of childhood sexual abuse may respond differently to the need for mastectomy and are more likely to choose reconstruction. They are more depressed postoperatively and may require greater psychological support during the diagnostic and treatment process for breast cancer.
P33. Management of male breast cancer - comparison of general and dedicated breast surgeons Jamie McIntosh, A. Sammon, C. Fowler Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3 NN
P35. Early drain removal safely reduces post-operative stay after breast and axillary surgery Emma Keane, R. Watkins, C. Osborne Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH
Aim: Male breast cancer (MBC) is uncommon, and most surgeons have an infrequent exposure to this disease. We have compared the investigation and management of MBC by general surgeons with that of dedicated breast surgeons to see if they differ. Methods: All cases of MBC from 1992 to 2007 inclusive were identified from pathology department records. Data was obtained by retrospective note review. Results: Twenty cases of MBC were identified, of which one set of patient’s notes was unobtainable. Eleven cases of MBC were managed by two dedicated breast surgeons from June 2000, prior to this four general surgeons managed eight cases. Tissue confirmation of malignancy (FNA or core biopsy) was more commonly achieved by breast surgeons than general surgeons (8/11 and 4/8 respectively). All patients underwent mastectomy except one who underwent wide local excision and another who was treated conservatively, both by general surgeons. An axillary procedure was only omitted in one patient, managed by a general surgeon. Adjuvant treatment was more commonly given to patients managed by breast surgeons than general surgeons, including hormonal therapy (11/11 and 6/ 8 respectively) and radiotherapy (9/11 and 4/8 respectively). All patients managed by breast surgeons had complete follow up, however none could be identified for 3 of the 8 patients managed by general surgeons. Conclusions: MBC patients managed by breast surgeons had higher rates of pre-operative tissue diagnosis and adjuvant treatment when compared to patients managed by general surgeons, and had more complete follow-up. MBC should be managed by dedicated breast surgeons. P34. Does Depression And Childhood Sexual Abuse Influence Decision For Reconstruction Versus Mastectomy Alone? Joanna Sewarda, L. Clarkb, P. Salmonb, J. Hillb, C. Holcombea a Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP b Department of Psychology, University of Liverpool, Liverpool Introduction: Pre-morbid life experience influences a patient’s response to diagnosis and treatment of breast cancer. A history of depression prior to diagnosis is a strong predictor for depression in the following 12 months and childhood abuse is also a risk factor for emotional problems after breast cancer. Do these aspects of previous life experience influence the decision for reconstruction in patients requiring mastectomy? Methods: 29 patients who had breast reconstruction were matched by age to 31 patients from a control group of 104 patients who had mastectomy alone. Data was prospectively collected on pre-morbid history of depression using the Schizophrenia and Affective Disorder Schedule and incidence of childhood sexual, physical and emotional abuse by clinical interview and questionnaire. Degree of depression was measured using the Hospital Anxiety and Depression Scale (HADS) two weeks and 12 months post-operatively. Results: The reconstruction group had significantly higher depression scores post-operatively HADS mean score of 5.21 & 2.43 (F ¼ (1,40) ¼ 7.507, p ¼ .009). Both groups had similar scores 12 months post-operatively. The incidence of reported abuse is higher in the reconstruction group, with 16.6, 13.3 and 20% reporting sexual, emotional and physical abuse respectively, versus 8.3, 13.3 and 13.3% in the non-reconstruction group (x2 ¼ 16.334, p < 0.001).
Introduction: With emphasis on improved cost-effectiveness, length of hospital stay has become an important marker of efficiency. Post-operative hospital stay following breast surgery has often depended on the presence of suction drains. Optimal timing of drain removal remains controversial and no clear consensus has been reached. Our aim was to facilitate discharge from hospital by early drain removal. Methods: A protocol was developed for mastectomy and wide local excision patients with or without nodal surgery in which all drains were removed by 48 hours at the latest, irrespective of the total volume or rate of fluid drainage, with a view to early discharge from hospital at that stage. Following implementation a prospective study was carried out from July to October 2007. A retrospective analysis for the same period in 2006 was performed. Results: 40 in-patients were studied in 2007 compared with 76 in 2006. Fewer numbers in the former group are explained by increased use of day case surgery for patients requiring intermediate surgery such as wide local excision with axillary node sampling. All patients adhered to the new protocol but 7 had their discharge delayed for other reasons, including warfarin stabilisation and blood glucose control. There was no significant difference between the ages of the patients in the two periods. Length of stay was reduced for the mastectomy patients who underwent any type of axillary surgery from 3.3 days in 2006 to 2.0 days in 2007 (Mann-Whitney U; 45.5; p ¼ 0.0007). For patients undergoing mastectomy with axillary node clearance length of stay was reduced from 3.7 days in 2006 to 2.0 days in 2007 (Mann-Whitney U; 15.5; p ¼ 0.0062). No increase in complication rates was noted over the later period. Conclusions: The new protocol for early drain removal appeared safe and effectively reduced the length of stay by almost 50%, representing a saving of approximately £6,000 over the three-month period.
P36. Breast Tumour Measurement: Ultrasound versus Mammography Myutan Kulendran, B. Krupowicz, C. Pogson, S. Joshi, S. Ebbs Mayday University Hospital, 530 London Road, Croydon, CR7 7YE Aim: Primary tumour size has prognostic significance and determines treatment for breast cancer. There has been contradictory results with regard to estimation of tumour size by mammography and ultrasonography in the literature. We undertook a retrospective study to compare tumour size as measured by mammography and ultrasonography to final histological assessment. Method: A total of 200 patients were selected at random from the British Association of Surgical Oncology (BASO) Breast Cancer database. The histological tumour size was recorded from the database. Corresponding radiological data was determined from formal reports. Results: Mammography overestimated tumour size by 2.7 8.8 mm(P < 0.05) in comparison to the histological size. Ultrasound underestimated tumour size by 0.98 4.2 mm (P < 0.05) in comparison to the histological size. Ultrasound accurately determined tumour size more frequently than mammography in 59% of cases. The correlation coefficient for mammographic determination of tumour dimension against histological size was 0.5(p < 0.0001) and for ultrasound was 0.3(P < 0.0001). By plotting data onto Bland-Altman graphs, the correlation between
ABSTRACTS ultrasound measurement and histological size was demonstrated to be significantly higher than between mammographic assessment and histology. Conclusion: Accurate pre-operative tumour assessment is essential for the surgical management of breast cancer. In particular patients receiving neoadjuvant therapy rely on accurate tumour measurements in order to assess treatment response. This study has demonstrated that ultrasound remains the more accurate modality in determining tumour size as compared to mammography.
P37. Pre operative factors do not predict axillary node status Adam Farquharson, R. George, W. Barber, I. Azmy, S. Holt, D. Chadwick Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire, S44 5BL Introduction: Histological axillary node status remains the single most important prognostic indicator in invasive breast cancer. The optimum surgical technique to assess the axilla remains controversial but increasingly sentinel node biopsy (SNB) is used. The aim of this study was to identify if clinical, radiological and tumour characteristics in patients undergoing axillary node sampling (ANS) and axillary node clearance (ANC) would predict node positivity prior to the introduction of SNB. Methods: From a prospective database, 213 women who underwent ANS or ANC were identified and characteristics of their cancer recorded. Univariate analysis (Mann-Whitney) was performed to examine the effect of these characteristics on the presence of lymph node metastases in each type of surgery and a multivariate model constructed to identify independent predictors of lymph node positivity. Results: Of the 213 patients identified 106 (50%) underwent ANS and 107 (50%) underwent ANC with one or more positive lymph node found in 25% and 33% respectively. Increased clinical size of lesion, size on mammogram and size on ultrasound scan were independent predictors of node positivity (p ¼ 0.07, 0.024 and 0.004 respectively). It was not possible to identify a group with absolute node negativity. Conclusions: This study confirms that it is impossible to predict node positivity prior to axillary node surgery. This would support the widespread adoption of SNB to provide accurate staging and avoid unnecessary morbidity of ANC for node negative cases. Accordingly there is an urgent need in the UK to invest in units accredited to provide training in this technique.
P38. Breast Cancer in the very young & very old - a 10-year comparative study Solomon John, P. Truran, M. Kabir, P. Surtees, A. Rich, O. Iwuchukwu Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP Introduction: Young patients diagnosed with breast cancer are often considered to have more biologically aggressive disease. We carried out a comparative study over a 10-year period to examine this hypothesis. Methods: Breast cancer patients in age groups (40 years and 80 years) over a 10-year period (1997-2006) were used for a retrospective comparative study of prospectively collected data. Specifically the tumour biology was assessed with appropriate statistical tests, where applicable. Results: 53.4% (n-167) patients were 80 years & 90 patients 40 years. 52% of patients 80 years, had core biopsy and neoadjuvant hormone treatment. There was no statistical difference in the nearest margin and tumour size between the two groups. However Grade 3 tumours predominated in the younger age group (52% vs. 25%) p 0.027. Excluding those who have not had axillary surgery, there was no difference in nodal positivity in both groups (43% vs. 53%; p - 0.575). 27.8% of patients below 40 years had LVI vs.28.6% in the >80 age group. ER/PR status was similar in both age groups (71.4% vs.78.1%; p - 0.608). Mean NPI in 40 year group was 4.56 vs.4.27 in the 80 age group (p - 0.383).
1175 Conclusion: Although there was a significant difference in tumour grades, the overall NPI in both groups was statistically insignificant.
P39. Are NICE guidelines useful in clinical practice? Mohamad Ali Kazem, V. Pope, S. Selvschandran, A. Samee Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ Aim: GPs are encouraged to refer breast patients using priority criteria as per NICE Guidelines. This study assessed whether the guidelines were being followed, and whether they helped to distinguish cancer from benign disease. Method: the study was a prospective audit of GP referrals to breast clinics in a District General Hospital against the NICE guidelines over two months (January- February 2008). The GPs’ referral letters were reviewed in clinic and compared with the guidelines, and the clinical and radiological findings. Family history patients were excluded. Results: 258 GP referrals were received over the 60 day period. 251 patients (97.3%) were female. 148 (57.4%) of the referrals were sent as urgent, or via the ‘‘two week wait’’ cancer fax-line. 110 (42.6%) were referred routinely. 57 of the referrals did not meet the guidelines, with 29 (11.2%) patients who met urgent criteria being sent routinely. 28 (10.9%) patients were sent urgently without meeting the urgent criteria, including 13 complaining of breast pain, 8 breast lumps, and 3 breast abscesses. Appropriate urgent referrals had a 15% cancer detection rate (18 cancers/ 120 referrals), whereas inappropriate urgent referrals had a 0% cancer rate (0 / 28). One patient with an increase in size of an existing breast lump was sent routinely but found to have cancer. Conclusion: Guidelines helped to identify the high risk patients; however GPs did not follow them in 22.1 % of the cases. P40. Does the diagnostic core biopsy represent the operative histopathology in invasive breast cancer? Rebecca Hughes, R. Foulkes, C. Jones, P. Holland, C. Gateley Royal Gwent Hospital, Newport, NP20 2UB Management depends on the type and grade of the invasive breast cancer. We assessed concordance between preoperative core biopsy and operative histopathology. Between February 2006 and January 2007, 100 invasive breast cancers were diagnosed by core biopsy. Results of the diagnostic cores were compared to the operative histopathology reports. Core biopsy diagnosed 93 patients with invasive ductal carcinoma and 7 invasive lobular carcinoma. Tumour type was confirmed by the operative report in all cases. Core biopsy reported Grade 1 malignancy in 12, Grade 2 in 60 and Grade 3 in 28 patients. When compared to the operative histopathology, Grade 1 core biopsy was upgraded to Grade 2 in 3 cases (25%); Grade 2 was downgraded in 5 (9%) and upgrade to Grade 3 in 15 (25%) of cases; and Grade 3 was downgraded to Grade 2 in 4 (14%) of cases. Only 25 of the core and operative histopathologies were reported by the same histopathologist. Where the same histopathologist reported both specimens, concordance for grade was 88% compared to 71% where reported by different histopathologists. These results indicate an excellent concordance between core and operative histopathology for tumour type. Where there is discordance in tumour grade, the core biopsy tends to underestimates that of the breast cancer. There is better concordance for grade when the same histopathologist reports both core and operative histopathology. Continuity in the histopathologist, reporting the core and operative specimens should be recommended. P41. Evaluation of the role of mammography in young women Rhodri Codd, B. Ceri, C. Gateley, N. Evans Royal Gwent Hospital, Newport, NP20 2UB Increasing use and ability of ultrasound, in conjunction with needle biopsy to make a definitive diagnosis, suggests that routine mammography may not be warranted in young women.
ABSTRACTS
Mammoglobin has been shown to be a better indicator of metastatic disease than conventional markers. An association between MGB expression and morbidity/mortality has been demonstrated. This suggests that although patient numbers are small MGB may have the potential to be used as a prognostic indicator for patients with early breast cancer.
Conclusions: Our study indicates that those with a previous history of childhood sexual abuse may respond differently to the need for mastectomy and are more likely to choose reconstruction. They are more depressed postoperatively and may require greater psychological support during the diagnostic and treatment process for breast cancer.
P33. Management of male breast cancer - comparison of general and dedicated breast surgeons Jamie McIntosh, A. Sammon, C. Fowler Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3 NN
P35. Early drain removal safely reduces post-operative stay after breast and axillary surgery Emma Keane, R. Watkins, C. Osborne Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH
Aim: Male breast cancer (MBC) is uncommon, and most surgeons have an infrequent exposure to this disease. We have compared the investigation and management of MBC by general surgeons with that of dedicated breast surgeons to see if they differ. Methods: All cases of MBC from 1992 to 2007 inclusive were identified from pathology department records. Data was obtained by retrospective note review. Results: Twenty cases of MBC were identified, of which one set of patient’s notes was unobtainable. Eleven cases of MBC were managed by two dedicated breast surgeons from June 2000, prior to this four general surgeons managed eight cases. Tissue confirmation of malignancy (FNA or core biopsy) was more commonly achieved by breast surgeons than general surgeons (8/11 and 4/8 respectively). All patients underwent mastectomy except one who underwent wide local excision and another who was treated conservatively, both by general surgeons. An axillary procedure was only omitted in one patient, managed by a general surgeon. Adjuvant treatment was more commonly given to patients managed by breast surgeons than general surgeons, including hormonal therapy (11/11 and 6/ 8 respectively) and radiotherapy (9/11 and 4/8 respectively). All patients managed by breast surgeons had complete follow up, however none could be identified for 3 of the 8 patients managed by general surgeons. Conclusions: MBC patients managed by breast surgeons had higher rates of pre-operative tissue diagnosis and adjuvant treatment when compared to patients managed by general surgeons, and had more complete follow-up. MBC should be managed by dedicated breast surgeons. P34. Does Depression And Childhood Sexual Abuse Influence Decision For Reconstruction Versus Mastectomy Alone? Joanna Sewarda, L. Clarkb, P. Salmonb, J. Hillb, C. Holcombea a Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP b Department of Psychology, University of Liverpool, Liverpool Introduction: Pre-morbid life experience influences a patient’s response to diagnosis and treatment of breast cancer. A history of depression prior to diagnosis is a strong predictor for depression in the following 12 months and childhood abuse is also a risk factor for emotional problems after breast cancer. Do these aspects of previous life experience influence the decision for reconstruction in patients requiring mastectomy? Methods: 29 patients who had breast reconstruction were matched by age to 31 patients from a control group of 104 patients who had mastectomy alone. Data was prospectively collected on pre-morbid history of depression using the Schizophrenia and Affective Disorder Schedule and incidence of childhood sexual, physical and emotional abuse by clinical interview and questionnaire. Degree of depression was measured using the Hospital Anxiety and Depression Scale (HADS) two weeks and 12 months post-operatively. Results: The reconstruction group had significantly higher depression scores post-operatively HADS mean score of 5.21 & 2.43 (F ¼ (1,40) ¼ 7.507, p ¼ .009). Both groups had similar scores 12 months post-operatively. The incidence of reported abuse is higher in the reconstruction group, with 16.6, 13.3 and 20% reporting sexual, emotional and physical abuse respectively, versus 8.3, 13.3 and 13.3% in the non-reconstruction group (x2 ¼ 16.334, p < 0.001).
Introduction: With emphasis on improved cost-effectiveness, length of hospital stay has become an important marker of efficiency. Post-operative hospital stay following breast surgery has often depended on the presence of suction drains. Optimal timing of drain removal remains controversial and no clear consensus has been reached. Our aim was to facilitate discharge from hospital by early drain removal. Methods: A protocol was developed for mastectomy and wide local excision patients with or without nodal surgery in which all drains were removed by 48 hours at the latest, irrespective of the total volume or rate of fluid drainage, with a view to early discharge from hospital at that stage. Following implementation a prospective study was carried out from July to October 2007. A retrospective analysis for the same period in 2006 was performed. Results: 40 in-patients were studied in 2007 compared with 76 in 2006. Fewer numbers in the former group are explained by increased use of day case surgery for patients requiring intermediate surgery such as wide local excision with axillary node sampling. All patients adhered to the new protocol but 7 had their discharge delayed for other reasons, including warfarin stabilisation and blood glucose control. There was no significant difference between the ages of the patients in the two periods. Length of stay was reduced for the mastectomy patients who underwent any type of axillary surgery from 3.3 days in 2006 to 2.0 days in 2007 (Mann-Whitney U; 45.5; p ¼ 0.0007). For patients undergoing mastectomy with axillary node clearance length of stay was reduced from 3.7 days in 2006 to 2.0 days in 2007 (Mann-Whitney U; 15.5; p ¼ 0.0062). No increase in complication rates was noted over the later period. Conclusions: The new protocol for early drain removal appeared safe and effectively reduced the length of stay by almost 50%, representing a saving of approximately £6,000 over the three-month period.
P36. Breast Tumour Measurement: Ultrasound versus Mammography Myutan Kulendran, B. Krupowicz, C. Pogson, S. Joshi, S. Ebbs Mayday University Hospital, 530 London Road, Croydon, CR7 7YE Aim: Primary tumour size has prognostic significance and determines treatment for breast cancer. There has been contradictory results with regard to estimation of tumour size by mammography and ultrasonography in the literature. We undertook a retrospective study to compare tumour size as measured by mammography and ultrasonography to final histological assessment. Method: A total of 200 patients were selected at random from the British Association of Surgical Oncology (BASO) Breast Cancer database. The histological tumour size was recorded from the database. Corresponding radiological data was determined from formal reports. Results: Mammography overestimated tumour size by 2.7 8.8 mm(P < 0.05) in comparison to the histological size. Ultrasound underestimated tumour size by 0.98 4.2 mm (P < 0.05) in comparison to the histological size. Ultrasound accurately determined tumour size more frequently than mammography in 59% of cases. The correlation coefficient for mammographic determination of tumour dimension against histological size was 0.5(p < 0.0001) and for ultrasound was 0.3(P < 0.0001). By plotting data onto Bland-Altman graphs, the correlation between
ABSTRACTS ultrasound measurement and histological size was demonstrated to be significantly higher than between mammographic assessment and histology. Conclusion: Accurate pre-operative tumour assessment is essential for the surgical management of breast cancer. In particular patients receiving neoadjuvant therapy rely on accurate tumour measurements in order to assess treatment response. This study has demonstrated that ultrasound remains the more accurate modality in determining tumour size as compared to mammography.
P37. Pre operative factors do not predict axillary node status Adam Farquharson, R. George, W. Barber, I. Azmy, S. Holt, D. Chadwick Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire, S44 5BL Introduction: Histological axillary node status remains the single most important prognostic indicator in invasive breast cancer. The optimum surgical technique to assess the axilla remains controversial but increasingly sentinel node biopsy (SNB) is used. The aim of this study was to identify if clinical, radiological and tumour characteristics in patients undergoing axillary node sampling (ANS) and axillary node clearance (ANC) would predict node positivity prior to the introduction of SNB. Methods: From a prospective database, 213 women who underwent ANS or ANC were identified and characteristics of their cancer recorded. Univariate analysis (Mann-Whitney) was performed to examine the effect of these characteristics on the presence of lymph node metastases in each type of surgery and a multivariate model constructed to identify independent predictors of lymph node positivity. Results: Of the 213 patients identified 106 (50%) underwent ANS and 107 (50%) underwent ANC with one or more positive lymph node found in 25% and 33% respectively. Increased clinical size of lesion, size on mammogram and size on ultrasound scan were independent predictors of node positivity (p ¼ 0.07, 0.024 and 0.004 respectively). It was not possible to identify a group with absolute node negativity. Conclusions: This study confirms that it is impossible to predict node positivity prior to axillary node surgery. This would support the widespread adoption of SNB to provide accurate staging and avoid unnecessary morbidity of ANC for node negative cases. Accordingly there is an urgent need in the UK to invest in units accredited to provide training in this technique.
P38. Breast Cancer in the very young & very old - a 10-year comparative study Solomon John, P. Truran, M. Kabir, P. Surtees, A. Rich, O. Iwuchukwu Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP Introduction: Young patients diagnosed with breast cancer are often considered to have more biologically aggressive disease. We carried out a comparative study over a 10-year period to examine this hypothesis. Methods: Breast cancer patients in age groups (40 years and 80 years) over a 10-year period (1997-2006) were used for a retrospective comparative study of prospectively collected data. Specifically the tumour biology was assessed with appropriate statistical tests, where applicable. Results: 53.4% (n-167) patients were 80 years & 90 patients 40 years. 52% of patients 80 years, had core biopsy and neoadjuvant hormone treatment. There was no statistical difference in the nearest margin and tumour size between the two groups. However Grade 3 tumours predominated in the younger age group (52% vs. 25%) p 0.027. Excluding those who have not had axillary surgery, there was no difference in nodal positivity in both groups (43% vs. 53%; p - 0.575). 27.8% of patients below 40 years had LVI vs.28.6% in the >80 age group. ER/PR status was similar in both age groups (71.4% vs.78.1%; p - 0.608). Mean NPI in 40 year group was 4.56 vs.4.27 in the 80 age group (p - 0.383).
1175 Conclusion: Although there was a significant difference in tumour grades, the overall NPI in both groups was statistically insignificant.
P39. Are NICE guidelines useful in clinical practice? Mohamad Ali Kazem, V. Pope, S. Selvschandran, A. Samee Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ Aim: GPs are encouraged to refer breast patients using priority criteria as per NICE Guidelines. This study assessed whether the guidelines were being followed, and whether they helped to distinguish cancer from benign disease. Method: the study was a prospective audit of GP referrals to breast clinics in a District General Hospital against the NICE guidelines over two months (January- February 2008). The GPs’ referral letters were reviewed in clinic and compared with the guidelines, and the clinical and radiological findings. Family history patients were excluded. Results: 258 GP referrals were received over the 60 day period. 251 patients (97.3%) were female. 148 (57.4%) of the referrals were sent as urgent, or via the ‘‘two week wait’’ cancer fax-line. 110 (42.6%) were referred routinely. 57 of the referrals did not meet the guidelines, with 29 (11.2%) patients who met urgent criteria being sent routinely. 28 (10.9%) patients were sent urgently without meeting the urgent criteria, including 13 complaining of breast pain, 8 breast lumps, and 3 breast abscesses. Appropriate urgent referrals had a 15% cancer detection rate (18 cancers/ 120 referrals), whereas inappropriate urgent referrals had a 0% cancer rate (0 / 28). One patient with an increase in size of an existing breast lump was sent routinely but found to have cancer. Conclusion: Guidelines helped to identify the high risk patients; however GPs did not follow them in 22.1 % of the cases. P40. Does the diagnostic core biopsy represent the operative histopathology in invasive breast cancer? Rebecca Hughes, R. Foulkes, C. Jones, P. Holland, C. Gateley Royal Gwent Hospital, Newport, NP20 2UB Management depends on the type and grade of the invasive breast cancer. We assessed concordance between preoperative core biopsy and operative histopathology. Between February 2006 and January 2007, 100 invasive breast cancers were diagnosed by core biopsy. Results of the diagnostic cores were compared to the operative histopathology reports. Core biopsy diagnosed 93 patients with invasive ductal carcinoma and 7 invasive lobular carcinoma. Tumour type was confirmed by the operative report in all cases. Core biopsy reported Grade 1 malignancy in 12, Grade 2 in 60 and Grade 3 in 28 patients. When compared to the operative histopathology, Grade 1 core biopsy was upgraded to Grade 2 in 3 cases (25%); Grade 2 was downgraded in 5 (9%) and upgrade to Grade 3 in 15 (25%) of cases; and Grade 3 was downgraded to Grade 2 in 4 (14%) of cases. Only 25 of the core and operative histopathologies were reported by the same histopathologist. Where the same histopathologist reported both specimens, concordance for grade was 88% compared to 71% where reported by different histopathologists. These results indicate an excellent concordance between core and operative histopathology for tumour type. Where there is discordance in tumour grade, the core biopsy tends to underestimates that of the breast cancer. There is better concordance for grade when the same histopathologist reports both core and operative histopathology. Continuity in the histopathologist, reporting the core and operative specimens should be recommended. P41. Evaluation of the role of mammography in young women Rhodri Codd, B. Ceri, C. Gateley, N. Evans Royal Gwent Hospital, Newport, NP20 2UB Increasing use and ability of ultrasound, in conjunction with needle biopsy to make a definitive diagnosis, suggests that routine mammography may not be warranted in young women.