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P069. Is scintigram necessary prior to sentinel node biopsy?
S46 P068. Therapeutic mammoplasty e A patient perspective Abhilash Paily, Caroline J. Mortimer, Neeraj Kumar Garg Ipswich Hospital NHS Trust, Ipswich, UK Introduction: Therapeutic mammoplasty offers the advantage of removing cancer as well as preserving the aesthetic appearance of the breast. We report patient experience following therapeutic mammoplasty in a DGH looking at length of stay, satisfaction, complications and any delay in adjuvant treatment. Methods: Data on patients who underwent therapeutic mammoplasty over 18 month period were compared with an equivalent number of patients who had standard breast conserving surgery. Patients in the study group were sent validated Breast QÔ questionnaire. Questions were based on eight domains including patient awareness of body image after surgery and patient views on medical team involved. Results: Twenty seven out of 50 patients responded (54%). 81% of patients felt their involvement in preoperative information and planning was excellent. 56% agreed that outcome of surgery was exactly how they had envisaged. 67% of patients felt confident in a social setting and in party clothes. 63 % felt self-assured. The majority (65%) felt sexually confident at all times and 80% were pleased with the outcome. However, 20% were dissatisfied, who developed breast asymmetry and required symmetrisation procedure. 74% patients, who had therapeutic mammoplasty were discharged on the same day as compared to 100% who had standard WLE were discharged within 23 hours. 12 patients in the therapeutic mammoplasty group stayed overnight because of social circumstances. One patient had a haematoma. No delay in adjuvant treatment noted between two groups. Conclusion: Therapeutic mammoplasty helps in avoiding mastectomy with reasonably high (80%) patient satisfaction scores. http://dx.doi.org/10.1016/j.ejso.2015.03.106
P069. Is scintigram necessary prior to sentinel node biopsy? Asma Akthar, Soni Soumian, Robert Kirby, Sankaran Narayanan University Hospital North Midlands, Stoke on Trent, UK Background: A peer reviewed study found in 228 patients only 92% of scintigrams identified sentinel node adding very little to patient management and concluded its use was unnecessary. Aim: The aim of our audit was to ascertain the role of scintigrams prior to sentinel lymph node biopsy by identifying any difference in the yield of sentinel nodes and axillary clearances if scintigram is performed or not. Method: Patients who had dual method sentinel lymph node biopsy in 2010 and 2013 at UHNS under a single consultant were included. In 2010 there was no scintigram performed and in 2013 scintigrams were done on all patients. 99 patients from 2010 and 87 patients from 2013 were compared. The number of failed localisations, number of nodes harvested and subsequent axillary clearance were collected. Results: There were two failed localisation in 2010 and one in 2013 group. Numbers of nodes harvested were similar with no significant difference in the yield of number nodes removed. There were 27% single and 73% multiple nodes identified in post scintigram group vs 32% single and 68% multiple nodes in the no scintigram group. Axillary clearance rate was 19% vs 22% in scintigram vs no scintigram group with no difference in subsequent axillary clearances. Conclusion: Scintigram did not improve the sentinel node detection, number of nodes yielded and further axillary clearance. It is time consuming, expensive and result inconvenient to the patients with no added benefit to the procedure. Routine use of scintigrams needs to be reviewed. http://dx.doi.org/10.1016/j.ejso.2015.03.107
ABSTRACTS P070. A chart for rapid comprehensive assessment and planning for oncoplastic and reconstructive breast surgery Amit Agrawal Cambridge University Hospitals, Addenbrookes Hospital, Cambridge, UK Introduction: Assessment for oncoplastic and reconstructive surgery can be time consuming and subjective with a steep learning curve. An organised approach to assessment may help minimise these limitations of current routine practice. Methods: A useful author-used chart incorporating essential variables of the two components of clinic consultation (history and examination), provides parameters that contribute to planning and charting goals of possible oncoplastic options. Results: History[ S-Surgery from the past including donor sites (e.g., abdominal) S-Sicknesses including diabetes, family history (unilateral/bilateral, conserving/mastectomy) S-Smoking, medications S-pSychological status (patient decision-making ability) S-Social including work, pleasure activities (e.g., cancer on dominant side) S-Size e Bra cup S-(s)Expectations of patient (physical, body image) Examination[ S-Shoulder limitation or Spine deformity (pseudo-asymmetry) S-Scars (and size/volume of past tissue removed) S-Skin Stretch(-ibility) and (Sun Burn) from Radiotherapy for recurrence (elasticity, dermal thickness) S-Size (of tumour, breast and patient/BMI)(replacement or displacement or mastectomy) S-Site of tumour S-Sagging (ptosis) S-Symmetry (charting existing a/symmetry) Post patient-decision preparation and Goals of surgery S-Size (base Stand/vertical and base Side-ways measurement) (e.g. implant reconstruction) S-Sticking in front (projection) S-Shape including NAC S-Sensitivity/Shade (colour) of nipple-areola complex (in reduction, nipple-sparing mastectomy) S-Suckling function (ductal damage/loss e.g., reduction in childbearing age) S-Symmetry S-Scar minimisation (e.g., vertical scar mammaplasty) Conclusions: This chart may allow rapid yet comprehensive oncoplastic assessment minimising inadvertent exclusion of any common variable. In future, when prospectively validated, it may enable junior trainees/ breast care nurses establish baseline facts which may allow an experienced surgeon balance risks and differentiate between options helping arrive at a shared-decision with the patient. http://dx.doi.org/10.1016/j.ejso.2015.03.108
P071. Axillary lymph node surgery in breast cancer patients: Yield of lymph node metastases at initial axillary surgery and subsequent axillary clearance Preet Hamilton, Alice Townend, Kevin Clark, Alice Leaver Queen Elizabeth Hospital, Gateshead, UK Introduction: In our Trust, all breast cancers undergo pre-operative axillary staging with ultrasound and, where appropriate, needle biopsy. This triages patients to sentinel lymph node biopsy (SLNB) or more invasive axillary node clearance (ANC). Where SLNB demonstrates node metastasis, patients may require a second surgical procedure (ANC) or axillary radiotherapy, both associated with additional patient morbidity. We present an audit of our practice, particularly the yield of positive nodes at SLNB, ANC, and subsequent ANC, performed after a positive SLNB.
P069. Is scintigram necessary prior to sentinel node biopsy? Asma Akthar, Soni Soumian, Robert Kirby, Sankaran Narayanan University Hospital North Midlands, Stoke on Trent, UK Background: A peer reviewed study found in 228 patients only 92% of scintigrams identified sentinel node adding very little to patient management and concluded its use was unnecessary. Aim: The aim of our audit was to ascertain the role of scintigrams prior to sentinel lymph node biopsy by identifying any difference in the yield of sentinel nodes and axillary clearances if scintigram is performed or not. Method: Patients who had dual method sentinel lymph node biopsy in 2010 and 2013 at UHNS under a single consultant were included. In 2010 there was no scintigram performed and in 2013 scintigrams were done on all patients. 99 patients from 2010 and 87 patients from 2013 were compared. The number of failed localisations, number of nodes harvested and subsequent axillary clearance were collected. Results: There were two failed localisation in 2010 and one in 2013 group. Numbers of nodes harvested were similar with no significant difference in the yield of number nodes removed. There were 27% single and 73% multiple nodes identified in post scintigram group vs 32% single and 68% multiple nodes in the no scintigram group. Axillary clearance rate was 19% vs 22% in scintigram vs no scintigram group with no difference in subsequent axillary clearances. Conclusion: Scintigram did not improve the sentinel node detection, number of nodes yielded and further axillary clearance. It is time consuming, expensive and result inconvenient to the patients with no added benefit to the procedure. Routine use of scintigrams needs to be reviewed. http://dx.doi.org/10.1016/j.ejso.2015.03.107
ABSTRACTS P070. A chart for rapid comprehensive assessment and planning for oncoplastic and reconstructive breast surgery Amit Agrawal Cambridge University Hospitals, Addenbrookes Hospital, Cambridge, UK Introduction: Assessment for oncoplastic and reconstructive surgery can be time consuming and subjective with a steep learning curve. An organised approach to assessment may help minimise these limitations of current routine practice. Methods: A useful author-used chart incorporating essential variables of the two components of clinic consultation (history and examination), provides parameters that contribute to planning and charting goals of possible oncoplastic options. Results: History[ S-Surgery from the past including donor sites (e.g., abdominal) S-Sicknesses including diabetes, family history (unilateral/bilateral, conserving/mastectomy) S-Smoking, medications S-pSychological status (patient decision-making ability) S-Social including work, pleasure activities (e.g., cancer on dominant side) S-Size e Bra cup S-(s)Expectations of patient (physical, body image) Examination[ S-Shoulder limitation or Spine deformity (pseudo-asymmetry) S-Scars (and size/volume of past tissue removed) S-Skin Stretch(-ibility) and (Sun Burn) from Radiotherapy for recurrence (elasticity, dermal thickness) S-Size (of tumour, breast and patient/BMI)(replacement or displacement or mastectomy) S-Site of tumour S-Sagging (ptosis) S-Symmetry (charting existing a/symmetry) Post patient-decision preparation and Goals of surgery S-Size (base Stand/vertical and base Side-ways measurement) (e.g. implant reconstruction) S-Sticking in front (projection) S-Shape including NAC S-Sensitivity/Shade (colour) of nipple-areola complex (in reduction, nipple-sparing mastectomy) S-Suckling function (ductal damage/loss e.g., reduction in childbearing age) S-Symmetry S-Scar minimisation (e.g., vertical scar mammaplasty) Conclusions: This chart may allow rapid yet comprehensive oncoplastic assessment minimising inadvertent exclusion of any common variable. In future, when prospectively validated, it may enable junior trainees/ breast care nurses establish baseline facts which may allow an experienced surgeon balance risks and differentiate between options helping arrive at a shared-decision with the patient. http://dx.doi.org/10.1016/j.ejso.2015.03.108
P071. Axillary lymph node surgery in breast cancer patients: Yield of lymph node metastases at initial axillary surgery and subsequent axillary clearance Preet Hamilton, Alice Townend, Kevin Clark, Alice Leaver Queen Elizabeth Hospital, Gateshead, UK Introduction: In our Trust, all breast cancers undergo pre-operative axillary staging with ultrasound and, where appropriate, needle biopsy. This triages patients to sentinel lymph node biopsy (SLNB) or more invasive axillary node clearance (ANC). Where SLNB demonstrates node metastasis, patients may require a second surgical procedure (ANC) or axillary radiotherapy, both associated with additional patient morbidity. We present an audit of our practice, particularly the yield of positive nodes at SLNB, ANC, and subsequent ANC, performed after a positive SLNB.