Ex vivo terahertz pulsed imaging to differentiate malignant from normal breast tissue

ABSTRACTS maintained database. Data collected included year and age at diagnosis as well as histological type. Data was analysed using Microsoft Excel 2003. Results: 7785 breast cancers were diagnosed. 652 women had ILC (8.4%) and 368 had IDLC (4.7%). Median age was 62 (range 29e94). Both ILC and IDLC were more common in postmenopausal women. There was no evidence of an increase in the incidence of ILC and IDLC, in fact there was a peak in the incidence between 1998 and 2000 after which it fell to levels similar to those in 1997. Conclusion: For our population based analysis the incidence of ILC and IDLC have fallen over the last 6 years in contrast to other published studies. Hormone replacement therapy has been implicated in the US but is this true for the UK? Do our results reflect the general pattern in the UK? And if so why is there a variation between populations? In order to address these issues further studies are need. P74. The role of touch imprint cytology in a District General Hospital: a pilot study Sarah L. Horna, E. Shahb a Kent and Sussex, Tunbridge Wells, Mount Ephraim, Tunbridge Wells, Kent, TN4 8AT b Conquest Hospital, St Leonards on Sea Introduction: Touch Imprint Cytology (TIC), a technique allowing intra-operative assessment of axillary lymph nodes, along with frozen section and molecular biological systems, such as Veridex and Osna. These allow progression to axillary lymph node dissection at the same operation. TIC requires specialist cytopathologists. We present our experience in a District General Hospital. Methods: A prospective study of consecutive series of patients undergoing level II or III axillary lymph node dissection (ALND), from October 2006 to September 2007, was undertaken. One surgeon and three cytopathologists were involved. TIC of a random level I lymph node was compared with the imprint node histology, for all cases. Sensitivity, specificity and Fischer’s exact T test were used for data analysis. Cytopathologists were blinded to the use of coated and uncoated slides, used for each case. Results: 38 of the 42 consecutive cases were analysed (4 exclusions as uninterpretable), with a mean axillary yield of 13.7. 12 TIC nodes were positive; in all these the imprint node histology was also positive. 26 TIC nodes were negative and all imprint nodes negative in these cases. Sensitivity ¼ 100%, specificity ¼ 100%, false negative rate of 0 and P < 0.0001 (Fischer’s exact T-Test). The pathologists observed no difference in the coated and uncoated slides. Conclusion: Our data suggests TIC of intra-operative lymph nodes is a useful tool in a District General setting for determining whether or not to proceed to full ALND at that operation. A dedicated surgical team and cytopathology department is required and coated or uncoated slides can be used. P75. The role of Aromatase Inhibitors in the treatment of Gynaecomastia Asmaa Al-Allak, S. Govindarajulu, M. Shere, A. Sahu, S. Cawthorn Frenchay Hospital, Park Rd, Bristol, BS16 1LE Introduction: Gynaecomastia is a benign condition of the male breast resulting from an imbalance in oestrogen/androgen ratio. Most of the circulating oestrogen is produced by the aromatisation of testosterone thus aromatase inhibitors (AIs) could be the mainstay of treatment. The aim of this study was to identify patients treated with the AI Arimidex, assess its effectiveness and identify any factors that may predict response to treatment. Methods: Men treated with Arimidex were identified from a prospectively maintained database. Response to treatment was categorised as: ‘complete’ if symptoms resolved, ‘partial’ and ‘failed’ with no improvement. Data was analysed using SPSS 14.0. Results: Between 1999 - 2007 a total of 51 men were identified, median age of 37 (range 15-88). The most common type was idiopathic (47). Duration of treatment ranged from 1 to 6 weeks (median 2 weeks). 2 failed

1225 to attend, 2 did not tolerate the AI, 29 had complete resolution of their symptoms (59%), 4 had a partial response (8%) and 16 failed to respond (33%). The table below compares the groups.

Age Range Average Bilateral Surgery

Responders, n ¼ 33 (%)

None responders, n ¼ 16 (%)

15e88 47 4 (12) 4 (12)

15e75 38 6 (37.5) 4 (25)

P value

<0.05 >0.05

Conclusion: Two thirds of patients responded and was well tolerated. Predictors of response could be age, where older patients are more likely to benefit, and laterality with the likelihood of treatment succeeding in those with unilateral gynaecomastia. It is worthwhile considering AI for the treatment of gynaecomastia. P76. Improving the accuracy of clinical estimation of lesion size using simple measuring adjuncts Martha Nixona, T. Underwooda, N. Coombsb a Royal United Hospital, Combe Park, Bath, BA1 3NG b Swindon Hospital Aims: The management of many diseases, including breast cancer, is often influenced by the pre-operative stage or dimension of the tumour. Breast cancer patients treated with primary endocrine therapy are reviewed regularly to assess tumour response, but often by different clinicians. Accurate assessment of lesion size is therefore essential. The aim of this study was to assess the accuracy of clinical sizing of lesions and investigate the impact of two measuring adjuncts on size estimation. Methods: Fifty staff estimated the size of five ‘‘artificial lesions’’ embedded within a simulated breast using clinical assessment. This was repeated using a card prompt of concentric circles of specific diameters, and a pair of callipers (Draper tools). Reported estimations were compared with the true dimensions of the lesions and a value was considered accurate if within 5 mm of the true lesion size. Results: Of 250 clinical measurement made, 50.4% were accurate. This improved to 70.4% (p < 0.0001) and 83.6% (p < 0.0001) respectively, when the card prompt or callipers were used. Inter-observer variability of lesion size estimation decreased with use of the adjuncts (clinical: +8.3 mm; card: +7.1 mm; callipers: +3.0 mm). Conclusion: We recommend the use of simple adjuncts including callipers in the routine assessment of lesion size. These tools are cheap, reliable and may permit more consistent clinical reporting of lesion size within a breast clinic. P77. Ex vivo terahertz pulsed imaging to differentiate malignant from normal breast tissue Uttam Sonia, M. Kontosa, P. Ashworthb, A. Olorunsolaa, S. Pindera, A. Purushothama a King’s College London, Guy’s & St Thomas, Section of Research Oncology, 3rd Floor Bermondsey Wing, Guy’s Hospital, Great Maze Pond, London, SE1 9RT b Teraview Ltd, Cambridge Introduction: About 60-70% of patients with early breast cancer undergo breast-conserving surgery. Of these, approximately 25-30% are found to have close or involved margins at final histology and require further surgery to ensure clear margins. Current methods of intra-operative margin assessment are unreliable. The terahertz (THz) region of electromagnetic spectrum (10111013 Hz) has shown good potential in a ex vivo study using a flatbed scanner to distinguish between healthy fibrous breast tissue, adipose tissue, and

1226 malignant breast tissue. The aim of this study was to extend this observation in a prospective cohort of patients’ tissue samples by testing a prototype terahertz pulsed imaging (TPI) probe which if successful could potentially be applied in an in vivo clinical trial to determine margin of excision intra-operatively in patients undergoing breast-conserving surgery. Methods: Following written informed consent, 106 tissue samples from 71 breast cancer patients were scanned individually with a prototype TPI probe and the results of scanning analysed and correlated with the histopathological result of each specimen. Results: Statistical analysis showed that 90% (27/30) of cancers and 81% (142/176) of normal tissue (adipose & fibrous) were distinguished correctly and the overall proportion correctly classified was 82%. This differentiation between fat/fibrous tissue compared with malignant tissue was most prominent at lower THz frequencies (0.1-0.2 THz). Conclusion: TPI scanning can differentiate between fat/fibrous tissue compared with malignant breast tissue. This observation is most striking at lower THz frequencies (0.1 - 0.2 THz). Further work is being undertaken prior to commencing in vivo patient studies. P78. Preoperative staging of node positive primary breast cancer with Positron Emission Tomography/Computed Tomography Zita Galvin, M. Barry, F. Flannigan, M. Kell Mater Misericordiae University Dublin, Eccles St, Dublin 7, Ireland Introduction: Preoperative radiological axillary staging identifies lymph node positive patients at risk of systemic disease. Positron emission tomography/computed tomography (PETCT) appears to be an accurate imaging modality for breast cancer patients. The purpose of this study was to evaluate the impact of PETCT on patients with a preoperative diagnosis of axillary metastasis. Patients and methods: Over an 8 month period all patients diagnosed with breast cancer underwent axillary ultrasound and suspicious nodes were biopsied using fine needle aspiration cytology. Newly diagnosed breast cancer patients with positive axillary cytology went on to have whole body PETCT prior to definitive treatment planning. Indeterminate PETCT result patients went on to have additional imaging to clarify disease status. Results: Thirty-two patients were identified as node positive preoperatively that underwent PETCT. Lymph node metastases were identified in 20 patients on PETCT, sensitivity 62.5%. Definite metastatic disease was identified in 31.2% of patients (10/32) and indeterminate disease requiring further evaluation in 15.6 % of patients (5/32). 11 patients had a change in treatment planning due to PETCT. Conclusion: PET/CT underestimates loco-regional lymph node staging in breast cancer patients. PET/CT is a useful in detecting distant metastases in high-risk breast cancer. P79. Choosing mastectomy to avoid adjuvant radiotherapy. Is this accurate from previous practice or misguided patient perception? Sunil Amonkar, P. Sinha, A. Anand, S. Lari, P. Truran, J. Hardman, R. Brookstein Darlington Memorial Hospital, Hollyhurst Road, Darlington, DL3 6HX Introduction: Breast cancer surgery continues to evolve, aiming to conserve breast tissue and minimise axillary dissection. There is a general impression however that mastectomy avoids the need for subsequent radiotherapy particularly in elderly patients. Adjuvant radiotherapy following mastectomy (ARFM) may still be required for close resection margins or nodal disease. We reviewed ARFM for patients in our symptomatic breast unit. Methods: Case notes for patients who underwent mastectomy for invasive breast cancer between 1999 & 2004 were retrospectively reviewed. Radiotherapy as initial post-operative adjuvant treatment was solely considered. Those who had subsequent radiotherapy for recurrent disease were excluded, as were locally advanced tumours involving the skin and male patients.

ABSTRACTS Results: 236 patients were studied; median age was 66 (range 31-89) yrs. 111 patients (47%) had positive axillary nodes. 90 patients (38%) received ARFM. Radiotherapy was to the chest wall, axilla or supraclavicular fossa in isolation or combination. Of those receiving radiotherapy, 41 patients (46%) had combined adjuvant chemoradiotherapy. Patients who received radiotherapy had significantly greater nodal involvement (68% vs. 32%, Chi sq. p < 0.01). They were younger (median age 59 yrs vs. 67 yrs) with fewer elderly patients (>70 yrs) receiving ARFM though this was not statistically significant (p ¼ 0.078). Conclusion: There is a perception that mastectomy reduces the likelihood or avoids the need for adjuvant radiotherapy. From our results more than a third of patients required radiotherapy following mastectomy, this finding also applied to elderly patients. Patients should be aware that despite mastectomy, there may be still be a requirement for adjuvant radiotherapy. P80. Intra-operative sentinel lymph node biopsy (SNB) using an RTPCR based assay allows savings in theatre utilisation and hospital stay Ramsey Cutressa, A. Agrawalb, A. McDowellc, F. Gabrielc, M. Jeffreyc, J. Gillb, M. Wiseb, I. Creec, C. Yiangoub a Southampton Breast Unit, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA b Portsmouth Breast Unit, Portsmouth Hospitals NHS Trust c Department of Pathology, Portsmouth Hospitals NHS Trust Introduction: Theatre times are slightly increased with intra-operative sentinel node analysis (ioaSNB), however node positive patients avoid a second hospital admission and a second operation. It is uncertain if overall this leads to changes in theatre and hospital bed utilisation. Methods: A qRT-PCR assay (GeneSearchTM BLN) was used for ioaSNB. The Portsmouth breast unit database was used to identify 4 groups of 30 consecutive patients who underwent: wide local excision (WLE) and SNB, WLE and axillary dissection (ALND), stand alone delayed completion axillary dissection (dALND), WLE and ioaSNB and 22 who underwent WLE and ioaSNB and immediate completion axillary dissection (iALND) (Total 142 patients). Comparisons were made between groups for average theatre times and hospital bed utilisation. Projected impact on theatre utilisation and hospital bed stay over 100 cases was calculated. Results: Intra-operative analysis adds 8 minutes to WLE and SNB and in node positive patients who undergo iALND the ioaSNB adds 14 minutes to WLE and AxCl. Bed days (overnight stay ¼ 2 bed days) were similar for WLE and SNB with or without intra-operative analysis and were similar for axillary clearance regardless of context. Introduction of ioaSNB was projected to lead to a saving of 9.5 hours theatre time and 62 hospital bed days over 100 cases.

Total theatre time (hr:min) Bed days

WLE ALND

WLE SNB

dALND oaSNB

WLE iALND

WLE ioSNB

1:39

1:14

1:20

1:22

1:53

3.13

2.10

3.03

2.17

2.74

Conclusion: Intra-operative SNB assessment can lead to savings in theatre time and hospital bed utilisation. P81. A menopause service for women with breast cancer or at high risk from breast cancer Jane Woykaa, N. Tannaa, K. Abernethya, R. Reichartb, J. Pitkina a The Northwick Park Menopause Clinical & Research Unit, Northwick Park N W London Hospitals NHS Trust, Watford Road, Harrow, HA1 3UJ b The Northwick Park and St Mark’s Breast Unit Objective: Women with breast cancer or at high risk have special needs not addressed by breast cancer or menopause clinics. Specialist