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Invisible DCIS; gaining an insight into the unknown
662
ABSTRACTS
P177. Re-excision of margins: Always a necessary procedure? Laura Sweeney, Maurice Stokes Mater Misericordiae University Hospital, Dublin, Ireland
P179. Use of oncoplastic techniques for breast conserving surgery Tamara Kiernan, Claudia Mackean Countess of Chester Hospital, Chester, UK
Introduction: Any breast procedure can prove to be a very stressful and worrisome ordeal for a patient: especially if it is a second or follow up procedure. One such procedure would be re-excision of margins (ReM) after a wide local excision (WLE), with suspicious histology at or near the original specimen margin. With the patient having undergone initial surgery for removal of a lesion, they then have the worry of having to undergo a second surgical procedure with the local risks and risks of general anaesthetic. Method: We retrospectively reviewed 326 cases of ReM over six years, between 2007 and 2013. We looked at each case, seeing what were the histological margins at the initial WLE specimen and whether or not the further ReM histology were clear, satisfactory or required further ReM. Results: 186 cases (n¼326) or ReM showed clear margins with no evidence of carcinoma in situ, invasive carcinoma or atypical hyperplasia at the new margin. 85 cases showed either carcinoma in situ, invasive carcinoma or atypical hyperplasia (or a combination) within an accepted margin of >2mm from edge of specimen. 55 cases had either carcinoma in situ, invasive carcinoma or atypical hyperplasia (or a combination) at or <1mm from resected margin. [Further breakdown margin size data available] Conclusion: Given that a large amount of our study (43%) had a suspicious lesion present in the ReM specimen, it does show the importance of going back to re-excise suspicious and close margins. However, almost 57% of all ReM cases had clear histology, leading to the question of possibly unnecessary prodedures and worry for the patient for an already cleared lesion at inital WLE.
Introduction: Statement 3 of NICE Quality Standards (QS12) states that: People with early breast cancer undergoing breast conserving surgery, which may include the use of oncoplastic techniques, have an operation that both minimises local recurrence and achieves a good aesthetic outcome. To assess compliance with this statement a four month audit of breast conservation, at the Countess of Chester Hospital, was conducted. Methods: Case-notes on all patients undergoing breast conserving surgery (BCS) for breast cancer were identified and type of operation performed and histological results were collected. An oncoplastic excision was defined as an operation with an incision placed off the breast mound in the circumareolar region, inframammary fold or using a breast reduction technique. Results: Of 39 cases, 20 (51%) patients underwent BCS using an oncoplastic technique. Of these 8 (40%) required re-excision to clear margins. This was a higher re-excision rate than the standard wide local excision (21%), but still in keeping with national standards. Excluding therapeutic mammoplasties (3), the average weight for the oncoplastic group was 47.71g which is lower than the standard group (59.46g). There was a positive association between the extent of DCIS in the specimen and the re-excision rate. Conclusions: The higher re-excision rate in oncoplastic incisions may be due to intra-operative difficulty with an incision remote to the lesion. Surgeons should ensure that oncological safety is not compromised when planning an oncoplastic excision.
http://dx.doi.org/10.1016/j.ejso.2014.02.176 http://dx.doi.org/10.1016/j.ejso.2014.02.178 P178. Breast reconstruction in the ‘elderly’ e A feasible reality Natalie Chand, Anthony Skene, Dexter Perry Royal Bournemouth Hospital, Bournemouth, UK Introduction: The national population continues to age, but advances have allowed safer surgical treatment for breast cancer in older women. Post-mastectomy reconstruction is an important part of holistic treatment but does involve lengthier surgery and carries added risks of potential complications. Evidence has shown that age itself is not a risk factor for poor surgical outcomes, but concern over this causes surgeons to be wary of offering elderly patients the opportunity of reconstruction. Methods: We examined our local reconstructive database between January 2009 and December 2012 (including breast reconstruction and/ or symmetrisation) with regards to demographics and post-operative complications. Demographic data was compared with national data gained via Hospital Episode Statistics. Results: 129 reconstructions and 85 other oncoplastic procedures were performed over this time period. The mean age at diagnosis of breast cancer was 60 years, compared with 56 years nationally. The local reconstructed population contained a higher-than-national proportion of patients over 65 years and 75 years. 17 surgical complications documented: 1 (0.4%) loss of implant to infection, 1 (0.4%) iatrogenic pneumothorax, 5 (2.2%) wound infections, 6 (2.7%) partial wound breakdowns, and 4 (1.8%) returns to theatre for bleeding. Conclusion: Population demographics vary nationally. The choice of reconstruction candidate should be based on objective measures of surgical fitness, taking into account type of reconstruction and patient choice. In line with national recommendations, our unit discusses reconstructive options with all appropriate candidates, irrespective of age. Breast reconstruction in the ‘elderly’ is a reality, and is feasible without an excess of complications. http://dx.doi.org/10.1016/j.ejso.2014.02.177
P180. Invisible DCIS; gaining an insight into the unknown Amy Light, Alice Leaver, Heather Humphreys, Mujahid Pervaz Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK Introduction: Re-operation rate following breast conserving surgery (BCS) is 20%. Where histological size is far greater than on pre-operative imaging, the term “invisible DCIS” may be applied. This is extremely problematic; the true extent of disease is unknown. There is a paucity of evidence into this topic. We investigated invisible DCIS cases in our centre, gaining insight into this group of patients whom little is known about. Methods: Data was collected from pathology and theatre records on all patients between Jan 2011-2013 who underwent BCS. Radiological and histological sizes were compared. Invisible DCIS cases were assessed for patient and tumour characteristics, regression analysis was used to identify any correlations. Results: A total of 508 BCS were undertaken. Re-operation rate was 15%. Of these cases, 58 were undertaken for residual disease. In the remaining 17 cases requiring re-operations, “invisible DCIS” was found. The rate of invisible DCIS following BCS was therefore estimated at 3.3%. The mean age was 58. In 11 cases there was an absence of calcification on core. Conclusion: Invisible DCIS is uncommon but does contribute to re-operations following BCS. This is distressing for patients and poses the additional anxiety surrounding future surveillance. As this is uncommon our data is too few to fully form conclusions as to how these cases can be better predicted. Given the low estimated occurrence of invisible DCIS following BCS, we would advocate a multi-centre study to gain a better insight into this troublesome condition. http://dx.doi.org/10.1016/j.ejso.2014.02.179
ABSTRACTS
P177. Re-excision of margins: Always a necessary procedure? Laura Sweeney, Maurice Stokes Mater Misericordiae University Hospital, Dublin, Ireland
P179. Use of oncoplastic techniques for breast conserving surgery Tamara Kiernan, Claudia Mackean Countess of Chester Hospital, Chester, UK
Introduction: Any breast procedure can prove to be a very stressful and worrisome ordeal for a patient: especially if it is a second or follow up procedure. One such procedure would be re-excision of margins (ReM) after a wide local excision (WLE), with suspicious histology at or near the original specimen margin. With the patient having undergone initial surgery for removal of a lesion, they then have the worry of having to undergo a second surgical procedure with the local risks and risks of general anaesthetic. Method: We retrospectively reviewed 326 cases of ReM over six years, between 2007 and 2013. We looked at each case, seeing what were the histological margins at the initial WLE specimen and whether or not the further ReM histology were clear, satisfactory or required further ReM. Results: 186 cases (n¼326) or ReM showed clear margins with no evidence of carcinoma in situ, invasive carcinoma or atypical hyperplasia at the new margin. 85 cases showed either carcinoma in situ, invasive carcinoma or atypical hyperplasia (or a combination) within an accepted margin of >2mm from edge of specimen. 55 cases had either carcinoma in situ, invasive carcinoma or atypical hyperplasia (or a combination) at or <1mm from resected margin. [Further breakdown margin size data available] Conclusion: Given that a large amount of our study (43%) had a suspicious lesion present in the ReM specimen, it does show the importance of going back to re-excise suspicious and close margins. However, almost 57% of all ReM cases had clear histology, leading to the question of possibly unnecessary prodedures and worry for the patient for an already cleared lesion at inital WLE.
Introduction: Statement 3 of NICE Quality Standards (QS12) states that: People with early breast cancer undergoing breast conserving surgery, which may include the use of oncoplastic techniques, have an operation that both minimises local recurrence and achieves a good aesthetic outcome. To assess compliance with this statement a four month audit of breast conservation, at the Countess of Chester Hospital, was conducted. Methods: Case-notes on all patients undergoing breast conserving surgery (BCS) for breast cancer were identified and type of operation performed and histological results were collected. An oncoplastic excision was defined as an operation with an incision placed off the breast mound in the circumareolar region, inframammary fold or using a breast reduction technique. Results: Of 39 cases, 20 (51%) patients underwent BCS using an oncoplastic technique. Of these 8 (40%) required re-excision to clear margins. This was a higher re-excision rate than the standard wide local excision (21%), but still in keeping with national standards. Excluding therapeutic mammoplasties (3), the average weight for the oncoplastic group was 47.71g which is lower than the standard group (59.46g). There was a positive association between the extent of DCIS in the specimen and the re-excision rate. Conclusions: The higher re-excision rate in oncoplastic incisions may be due to intra-operative difficulty with an incision remote to the lesion. Surgeons should ensure that oncological safety is not compromised when planning an oncoplastic excision.
http://dx.doi.org/10.1016/j.ejso.2014.02.176 http://dx.doi.org/10.1016/j.ejso.2014.02.178 P178. Breast reconstruction in the ‘elderly’ e A feasible reality Natalie Chand, Anthony Skene, Dexter Perry Royal Bournemouth Hospital, Bournemouth, UK Introduction: The national population continues to age, but advances have allowed safer surgical treatment for breast cancer in older women. Post-mastectomy reconstruction is an important part of holistic treatment but does involve lengthier surgery and carries added risks of potential complications. Evidence has shown that age itself is not a risk factor for poor surgical outcomes, but concern over this causes surgeons to be wary of offering elderly patients the opportunity of reconstruction. Methods: We examined our local reconstructive database between January 2009 and December 2012 (including breast reconstruction and/ or symmetrisation) with regards to demographics and post-operative complications. Demographic data was compared with national data gained via Hospital Episode Statistics. Results: 129 reconstructions and 85 other oncoplastic procedures were performed over this time period. The mean age at diagnosis of breast cancer was 60 years, compared with 56 years nationally. The local reconstructed population contained a higher-than-national proportion of patients over 65 years and 75 years. 17 surgical complications documented: 1 (0.4%) loss of implant to infection, 1 (0.4%) iatrogenic pneumothorax, 5 (2.2%) wound infections, 6 (2.7%) partial wound breakdowns, and 4 (1.8%) returns to theatre for bleeding. Conclusion: Population demographics vary nationally. The choice of reconstruction candidate should be based on objective measures of surgical fitness, taking into account type of reconstruction and patient choice. In line with national recommendations, our unit discusses reconstructive options with all appropriate candidates, irrespective of age. Breast reconstruction in the ‘elderly’ is a reality, and is feasible without an excess of complications. http://dx.doi.org/10.1016/j.ejso.2014.02.177
P180. Invisible DCIS; gaining an insight into the unknown Amy Light, Alice Leaver, Heather Humphreys, Mujahid Pervaz Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK Introduction: Re-operation rate following breast conserving surgery (BCS) is 20%. Where histological size is far greater than on pre-operative imaging, the term “invisible DCIS” may be applied. This is extremely problematic; the true extent of disease is unknown. There is a paucity of evidence into this topic. We investigated invisible DCIS cases in our centre, gaining insight into this group of patients whom little is known about. Methods: Data was collected from pathology and theatre records on all patients between Jan 2011-2013 who underwent BCS. Radiological and histological sizes were compared. Invisible DCIS cases were assessed for patient and tumour characteristics, regression analysis was used to identify any correlations. Results: A total of 508 BCS were undertaken. Re-operation rate was 15%. Of these cases, 58 were undertaken for residual disease. In the remaining 17 cases requiring re-operations, “invisible DCIS” was found. The rate of invisible DCIS following BCS was therefore estimated at 3.3%. The mean age was 58. In 11 cases there was an absence of calcification on core. Conclusion: Invisible DCIS is uncommon but does contribute to re-operations following BCS. This is distressing for patients and poses the additional anxiety surrounding future surveillance. As this is uncommon our data is too few to fully form conclusions as to how these cases can be better predicted. Given the low estimated occurrence of invisible DCIS following BCS, we would advocate a multi-centre study to gain a better insight into this troublesome condition. http://dx.doi.org/10.1016/j.ejso.2014.02.179