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Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit
626 HER2 results of breast carcinoma in Multidisciplinary Team (MDT) context and compare it against the NICE guideline ‘Early and locally advanced breast cancer. Diagnosis and treatment’. Methods: Data was collected prospectively during the study period at MDTs in St Richard’s Hospital, regarding number of patients, consideration for systemic treatment and availability of HER2 results. Results: 101 cases were discussed during audit period at the Breast MDT of whom 21 patients had treatment decisions made regarding adjuvant systemic treatment. In 20 cases, HER2 status was available. In the case where HER2 status was unknown, the core biopsy specimen had been too small to allow HER2 testing and this was later carried out on the operative specimen. We accept that sample size occasionally precludes early HER2 assessment, and was noted in 2010. In the initial audit in 2010, 3 cases were delayed because of batching and late receipt of histopathology information. In 2012 no cases were delayed by these factors, but 1 case was delayed by small sample size. Conclusions: The recommendations of avoiding delays in HER2 testing have had a positive impact on the availability of the results for the time of the MDT meeting. It is recommended to continue monitoring HER2 status in women with Breast Cancer, because it has been proven to be one of the most important markers of aggressive disease. http://dx.doi.org/10.1016/j.ejso.2014.02.056
P057. Symptomatic U3 lesions: An audit of 400 patients Anneliese Lawn, Zaki Akhtar, Nasir Husain, Sunita Shrotria, Tayo Johnson, Manish Kothari Ashford and St. Peter’s Hospital, Chertsey, UK Introduction: A U3 indeterminate lesion in the breast carries a 5-50% risk of malignancy. ABS Guidelines advise image needle biopsy to complete triple assessment and that core biopsy is preferred over FNAC particularly for solid lesions due to this method having a higher sensitivity and specificity. We reviewed our data in accordance with this. Method: Data on 400 consecutive patients with symptomatic U3 lesions was collated retrospectively from a single centre district general hospital from August 2010 until April 2012. Patient demographics, imaging, biopsy results by cytology or histopathology were reviewed. If surgery was undertaken the histology was reviewed for correlation with biopsy diagnosis. Notes were reviewed for follow up information until December 2013. Results: 400 patients were analysed; 8 male, 392 female (age ranged from 18 to 101 years). The majority of patients with U3 lesions were aged 40-73 however approximately a third of patients presenting were 39 years old or younger. 33 cancers were diagnosed. Of these 7 cases of were given a U3 grading but thought to be fibroadenomas on imaging. These patients were aged between 36-65 years old with mammograms coded as M2 or M3. 2 patients were diagnosed with phyllodes tumours on surgical excision. Both were benign but not diagnosed on needle biopsy. 50 patients did not undergo needle biopsy for reasons such as patient factors and further imaging. To our knowledge and review of the notes, no cancers were missed, however, delay to diagnosis was seen with FNAC giving inadequate results and when scans were performed by a ‘non-breast’ radiologist. Our breast imaging is now performed by breast radiologists and images discussed at benign or malignant MDT as appropriate. Conclusion: All indeterminate breast lesions require needle biopsy for diagnostic purposes and core biopsy remains preferential over FNAC. We highlight that breast imaging should be undertaken by specialist breast radiologists able to perform core biopsies to prevent delays in diagnosis and all patients with indeterminate radiology should be discussed at an MDT meeting. http://dx.doi.org/10.1016/j.ejso.2014.02.057
ABSTRACTS P058. Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit Anneliese Lawn, Tayo Johnson, Manish Kothari Ashford and St Peter’s Hospital, Chertsey, UK Introduction: Oncoplastic surgery has become a challenging, rewarding and dynamic part of breast surgery. Despite oncoplastic surgery becoming increasing popular and fellowships becoming available following CCT, variation exists in techniques of oncoplastic and reconstructive breast surgery amongst breast units and no formal training in oncoplastic reconstructive surgery exists during speciality training. Our aim was to improve training in oncoplastic surgery in our department. Methods: We devised and set up a dedicated Oncoplastic and Reconstructive Multidisciplinary Team Meeting in our breast unit which is based in a district general hospital. This forms part of our weekly Breast Academic Forum aimed to facilitate teaching and training of the breast surgery team juniors and to encourage discussion between consultant trainers. Other members of the MDT include breast care nurses and radiologists, Patients who are thought to pose an ‘interesting’ oncoplastic challenge on clinical review or are due to undergo reconstructive surgery are discussed at this MDT meeting. An MDT proforma was devised and a case presentation is prepared by the trainees with a review of the history, radiology and professional hospital photography. Discussion is centred on the challenges faced based on the patients’ native anatomy and an emphasis on the patient’s own wishes for surgery. Any postoperative complications are also discussed for learning points. Results: 55 patients requiring oncoplastic and reconstructive techniques have been discussed on our Oncoplastic MDT. This has greatly facilitated training particularly concerning planning and decision making in oncoplastic surgery and knowledge in the process of requesting and ordering prosthesis and acellular dermal matrix. Conclusion: We believe that all units involved in breast reconstruction and oncoplastic surgery should devise an Oncoplastic MDT as a forum to facilitate teaching and training in these techniques. http://dx.doi.org/10.1016/j.ejso.2014.02.058
P059. Imaging in the over 75s attending symptomatic breast clinics: Does everyone need a mammogram? D.A. Finch1, J. Smith2, R. Vijh3, P. McManus1, K. Grover1, T. Mahapatra1, A. Hubbard1, P.J. Kneeshaw1 1 Castle Hill Hospital, Hull, UK 2 Diana Princess of Wales Hospital, Grimsby, UK 3 Scunthorpe General Hospital, Scunthorpe, UK Introduction: Mammography is performed in all symptomatic female breast referrals aged 40 years and over. If there is no palpable abnormality (P1) imaging is still performed which is effectively screening. Unlike the screening programme, there is no upper age limit for imaging these patients. The aim of this audit is to establish whether putting an upper limit of 75 years of age for patients with no clinical abnormality could have a detrimental effect on their care. Methods: Patients aged 75 years and over attending the symptomatic breast clinic were indentified. Data was collected prospectively from three centres over a one year period (01/08/2012 to 31/07/13). Results: 217 patients were identified (all female, mean age 81 years). 61 patients were found to have no abnormality (P1). 56 of these underwent imaging, of which 3 patients were found to have invasive malignancy. All the 3 patients went on to have primary endocrine therapy. The remaining 5 patients were either too frail, or did not cooperate with imaging and underwent no further investigation or treatment. Overall, 73 patients were found to have invasive malignancy following clinical and/or radiological suspicion. 63 of these patients were evaluated as P4 or P5 clinically.
P057. Symptomatic U3 lesions: An audit of 400 patients Anneliese Lawn, Zaki Akhtar, Nasir Husain, Sunita Shrotria, Tayo Johnson, Manish Kothari Ashford and St. Peter’s Hospital, Chertsey, UK Introduction: A U3 indeterminate lesion in the breast carries a 5-50% risk of malignancy. ABS Guidelines advise image needle biopsy to complete triple assessment and that core biopsy is preferred over FNAC particularly for solid lesions due to this method having a higher sensitivity and specificity. We reviewed our data in accordance with this. Method: Data on 400 consecutive patients with symptomatic U3 lesions was collated retrospectively from a single centre district general hospital from August 2010 until April 2012. Patient demographics, imaging, biopsy results by cytology or histopathology were reviewed. If surgery was undertaken the histology was reviewed for correlation with biopsy diagnosis. Notes were reviewed for follow up information until December 2013. Results: 400 patients were analysed; 8 male, 392 female (age ranged from 18 to 101 years). The majority of patients with U3 lesions were aged 40-73 however approximately a third of patients presenting were 39 years old or younger. 33 cancers were diagnosed. Of these 7 cases of were given a U3 grading but thought to be fibroadenomas on imaging. These patients were aged between 36-65 years old with mammograms coded as M2 or M3. 2 patients were diagnosed with phyllodes tumours on surgical excision. Both were benign but not diagnosed on needle biopsy. 50 patients did not undergo needle biopsy for reasons such as patient factors and further imaging. To our knowledge and review of the notes, no cancers were missed, however, delay to diagnosis was seen with FNAC giving inadequate results and when scans were performed by a ‘non-breast’ radiologist. Our breast imaging is now performed by breast radiologists and images discussed at benign or malignant MDT as appropriate. Conclusion: All indeterminate breast lesions require needle biopsy for diagnostic purposes and core biopsy remains preferential over FNAC. We highlight that breast imaging should be undertaken by specialist breast radiologists able to perform core biopsies to prevent delays in diagnosis and all patients with indeterminate radiology should be discussed at an MDT meeting. http://dx.doi.org/10.1016/j.ejso.2014.02.057
ABSTRACTS P058. Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit Anneliese Lawn, Tayo Johnson, Manish Kothari Ashford and St Peter’s Hospital, Chertsey, UK Introduction: Oncoplastic surgery has become a challenging, rewarding and dynamic part of breast surgery. Despite oncoplastic surgery becoming increasing popular and fellowships becoming available following CCT, variation exists in techniques of oncoplastic and reconstructive breast surgery amongst breast units and no formal training in oncoplastic reconstructive surgery exists during speciality training. Our aim was to improve training in oncoplastic surgery in our department. Methods: We devised and set up a dedicated Oncoplastic and Reconstructive Multidisciplinary Team Meeting in our breast unit which is based in a district general hospital. This forms part of our weekly Breast Academic Forum aimed to facilitate teaching and training of the breast surgery team juniors and to encourage discussion between consultant trainers. Other members of the MDT include breast care nurses and radiologists, Patients who are thought to pose an ‘interesting’ oncoplastic challenge on clinical review or are due to undergo reconstructive surgery are discussed at this MDT meeting. An MDT proforma was devised and a case presentation is prepared by the trainees with a review of the history, radiology and professional hospital photography. Discussion is centred on the challenges faced based on the patients’ native anatomy and an emphasis on the patient’s own wishes for surgery. Any postoperative complications are also discussed for learning points. Results: 55 patients requiring oncoplastic and reconstructive techniques have been discussed on our Oncoplastic MDT. This has greatly facilitated training particularly concerning planning and decision making in oncoplastic surgery and knowledge in the process of requesting and ordering prosthesis and acellular dermal matrix. Conclusion: We believe that all units involved in breast reconstruction and oncoplastic surgery should devise an Oncoplastic MDT as a forum to facilitate teaching and training in these techniques. http://dx.doi.org/10.1016/j.ejso.2014.02.058
P059. Imaging in the over 75s attending symptomatic breast clinics: Does everyone need a mammogram? D.A. Finch1, J. Smith2, R. Vijh3, P. McManus1, K. Grover1, T. Mahapatra1, A. Hubbard1, P.J. Kneeshaw1 1 Castle Hill Hospital, Hull, UK 2 Diana Princess of Wales Hospital, Grimsby, UK 3 Scunthorpe General Hospital, Scunthorpe, UK Introduction: Mammography is performed in all symptomatic female breast referrals aged 40 years and over. If there is no palpable abnormality (P1) imaging is still performed which is effectively screening. Unlike the screening programme, there is no upper age limit for imaging these patients. The aim of this audit is to establish whether putting an upper limit of 75 years of age for patients with no clinical abnormality could have a detrimental effect on their care. Methods: Patients aged 75 years and over attending the symptomatic breast clinic were indentified. Data was collected prospectively from three centres over a one year period (01/08/2012 to 31/07/13). Results: 217 patients were identified (all female, mean age 81 years). 61 patients were found to have no abnormality (P1). 56 of these underwent imaging, of which 3 patients were found to have invasive malignancy. All the 3 patients went on to have primary endocrine therapy. The remaining 5 patients were either too frail, or did not cooperate with imaging and underwent no further investigation or treatment. Overall, 73 patients were found to have invasive malignancy following clinical and/or radiological suspicion. 63 of these patients were evaluated as P4 or P5 clinically.