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P107. Can axillary lymph node clearance be avoided in select sentinel lymph node positive patients?
ABSTRACTS pressure on triple assessment clinics. http://dx.doi.org/10.1016/j.ejso.2015.03.144
S57 50% return rate in the post-operative group. The Breast Q will be introduced on iPads and patients will be asked to complete these during clinic appointments to improve data capture. http://dx.doi.org/10.1016/j.ejso.2015.03.146
P107. Can axillary lymph node clearance be avoided in select sentinel lymph node positive patients? Marian Oguntula, Anuradha Apte, Sankaran Chandrasekharan, Arunmoy Chakravorty Colchester Hospital University Foundation Trust, Colchester, Essex, UK Introduction: The Z0011 study demonstrated no significant difference in overall or disease free survival between patients with early stage (T1e2) breast cancer (BC) treated with axillary node clearance (ANC) and those treated with sentinel lymph node biopsy (SLNB) alone. ANC is associated with substantial surgical morbidity in comparison to SLNB. The aim of this study was to ascertain whether further axillary surgery could have been avoided in a select SLNB-positive patient group. Method: Radiological and pathological data of patients diagnosed with BC between 1/4/2011 and 31/3/2012 was collected retrospectively from the breast unit database. All patients underwent axillary ultrasound, FNA or core biopsy of axillary lymph-nodes and then SLNB and/or ANC as per NICE guidance. Tumour characteristics of the SLNB-positive and ANC-negative patient subgroup were then compared with ANC-positive patients using the Z0011 study as a guide. Results: The study included 199 BC patients identified during this period, of which 43 underwent ANC. 22 BC patients had positive lymph-nodes on USS and pathology and had ANC without SLNB whilst a further 21 had positive SLNB and then ANC. 16 patients (76.2%) of the SLNB-positive subgroup were not found to have any positive lymphnodes on ANC and had potentially avoidable further axillary surgery. Within this subgroup there were IDC(12), ILC(2), Mixed(2), ER-positive(16), HER2-positive(1), Grade 1 & 2(13) and grade 3(3). Conclusions: It is clearly evident that further axillary surgery could have been prevented in 81.25% of SLNB-positive patients with grade 1 & 2 tumours. A study with a larger patient group is currently under way. http://dx.doi.org/10.1016/j.ejso.2015.03.145
P108. Introducing PROMs to the Royal Devon & Exeter Hospital: A service development project Alexander George, Sandra Cookson, Sisse Olsen, Rachel Tillett Royal Devon & Exeter Hospital, Devon, UK Introduction: The current financial climate necessitates CCGs purchasing high quality care. Patient reported outcome measures (PROMs) are an important measure of quality. The aim of this project was to collect PROMs on patients undergoing breast reconstruction. The aim was to measure patient satisfaction and assess the effectiveness of paper data capture. Methods: The well-validated Breast Q PROM was selected. Patient pro formas were approved by the ethics committee and a licence to use breast Q was obtained. All breast reconstruction patients were invited to complete pre-operative PROMs by the breast reconstruction or preassessment nurse during 2014. Post-operative questionnaires were sent by post. Results: 94 patients underwent breast reconstruction during 2014. 30 patients completed a pre-operative Breast Q. The post-operative Breast Q return rate was 50%. 13/15 patients had immediate and 2/15 had bilateral reconstruction. 8 patients had free flaps, 2 had ALDs and 5 had implant-based reconstruction. There was no significant difference between the group’s pre- and post-operative Breast Q scores. Mean post-operative satisfaction scores were as follows: outcome 8020, breast 6723, information 8113, surgeon 9520. Physical well being (chest) scores remained at 76 in both groups. Physical well-being (abdomen) scores fell from 8226 to 5826 in patients undergoing free-flaps. Conclusion: Patient satisfaction scores have been high. However, paper Breast Q PROM completion rates have been poor (32%), with a
P109. Causes of failed sentinel lymph node biopsy in breast cancer patients Uma Sridharan, Mandana Pennick, Geraldine Mitchell Royal Liverpool Hospital, Merseyside, UK Introduction: Sentinel lymph node biopsy (SLNB) using a dual technique of radio labelled colloid injection and patent blue dye has been routinely performed in our Trust since 2004. We audited our practice to identify factors that might predict failure of the technique. Methods: Consecutive patients who had undergone breast isotope injection over 8 years (2005e2012) were identified. Where sentinel node biopsy had failed, data were collected to record demographics, past history and outcomes. All surgeons had undergone appropriate training. Results: Over eight years, 2070 SLNBs were performed by six surgeons. Failed SLNB occurred in 46/2070 (2.2%) of cases, mean patient age 61 years. When SLNB failed, axillary node sample (ANS) was performed in 33 patients, axillary node clearance (ANC) in 13. Further macro metastases were present in 6/46. Nine patients (20%) had a history of previous surgery on the ipsilateral breast. Probe failure occurred in 2 patients. We found a significant rise in SLNB failures in 2008. Departmental audit revealed new staff performing isotope injection. Once this had been identified and appropriate training undertaken the failure rate subsequently reduced. Conclusions: SLNB is successful in 97.8% of our patients. Previous ipsilateral breast surgery led to a SLNB failure rate of 20%. The importance of the audit loop is highlighted by investigating a sudden peak in failures, identifying and attending to the problem with subsequent improvement in results. http://dx.doi.org/10.1016/j.ejso.2015.03.147
P110. Role of the Memorial Sloan Kettering (MSK) nomogram in guiding the management of sentinel node positive breast cancer Sukitha Namal Rupasinghe, Raman Vinayagam, Maria Callaghan, Jonathan Michael Lund, Shabbir Poonawala Wirral Breast Unit, Wirral University Teaching Hospitals NHS Foundation Trust, Clatterbridge, Bebington, Merseyside, UK Aim: Sentinel node biopsy (SNB) is the standard approach for axillary staging in early breast cancer patients with a preoperatively negative axilla. National guidelines recommend further axillary treatment with either completion axillary node clearance (cANC) or axillary radiotherapy. We audited our management of positive sentinel nodes. Methods: All patients who underwent further axillary treatment for positive sentinel node biopsies between January 2013 and December 2014 were reviewed. Data collected included demographics, histology, pre-operative and post-operative staging and treatment. All nodes were analysed using serial haematoxylin-eosin. The Memorial Sloan Kettering (MSK) nomogram for predicting further nodal metastases was then applied retrospectively. Results: 179 patients had SNB of whom 21 (11.7%) [median age 58; range 30e77] underwent cANC for positive SNB. Only 5/21 (24%) [median MSK predicted risk 22%; range 17%e74%] had further metastatic nodes in the cANC. There was no direct correlation with any single variable for predicting further metastases in the cANC. However, using the MSK nomogram, patients who scored below 15% had no further nodal metastases (p ¼ 0.06 Fisher’s exact, AUC ¼ 0.791), and 8/21 (38%) patients would have avoided cANC if this threshold was used.
S57 50% return rate in the post-operative group. The Breast Q will be introduced on iPads and patients will be asked to complete these during clinic appointments to improve data capture. http://dx.doi.org/10.1016/j.ejso.2015.03.146
P107. Can axillary lymph node clearance be avoided in select sentinel lymph node positive patients? Marian Oguntula, Anuradha Apte, Sankaran Chandrasekharan, Arunmoy Chakravorty Colchester Hospital University Foundation Trust, Colchester, Essex, UK Introduction: The Z0011 study demonstrated no significant difference in overall or disease free survival between patients with early stage (T1e2) breast cancer (BC) treated with axillary node clearance (ANC) and those treated with sentinel lymph node biopsy (SLNB) alone. ANC is associated with substantial surgical morbidity in comparison to SLNB. The aim of this study was to ascertain whether further axillary surgery could have been avoided in a select SLNB-positive patient group. Method: Radiological and pathological data of patients diagnosed with BC between 1/4/2011 and 31/3/2012 was collected retrospectively from the breast unit database. All patients underwent axillary ultrasound, FNA or core biopsy of axillary lymph-nodes and then SLNB and/or ANC as per NICE guidance. Tumour characteristics of the SLNB-positive and ANC-negative patient subgroup were then compared with ANC-positive patients using the Z0011 study as a guide. Results: The study included 199 BC patients identified during this period, of which 43 underwent ANC. 22 BC patients had positive lymph-nodes on USS and pathology and had ANC without SLNB whilst a further 21 had positive SLNB and then ANC. 16 patients (76.2%) of the SLNB-positive subgroup were not found to have any positive lymphnodes on ANC and had potentially avoidable further axillary surgery. Within this subgroup there were IDC(12), ILC(2), Mixed(2), ER-positive(16), HER2-positive(1), Grade 1 & 2(13) and grade 3(3). Conclusions: It is clearly evident that further axillary surgery could have been prevented in 81.25% of SLNB-positive patients with grade 1 & 2 tumours. A study with a larger patient group is currently under way. http://dx.doi.org/10.1016/j.ejso.2015.03.145
P108. Introducing PROMs to the Royal Devon & Exeter Hospital: A service development project Alexander George, Sandra Cookson, Sisse Olsen, Rachel Tillett Royal Devon & Exeter Hospital, Devon, UK Introduction: The current financial climate necessitates CCGs purchasing high quality care. Patient reported outcome measures (PROMs) are an important measure of quality. The aim of this project was to collect PROMs on patients undergoing breast reconstruction. The aim was to measure patient satisfaction and assess the effectiveness of paper data capture. Methods: The well-validated Breast Q PROM was selected. Patient pro formas were approved by the ethics committee and a licence to use breast Q was obtained. All breast reconstruction patients were invited to complete pre-operative PROMs by the breast reconstruction or preassessment nurse during 2014. Post-operative questionnaires were sent by post. Results: 94 patients underwent breast reconstruction during 2014. 30 patients completed a pre-operative Breast Q. The post-operative Breast Q return rate was 50%. 13/15 patients had immediate and 2/15 had bilateral reconstruction. 8 patients had free flaps, 2 had ALDs and 5 had implant-based reconstruction. There was no significant difference between the group’s pre- and post-operative Breast Q scores. Mean post-operative satisfaction scores were as follows: outcome 8020, breast 6723, information 8113, surgeon 9520. Physical well being (chest) scores remained at 76 in both groups. Physical well-being (abdomen) scores fell from 8226 to 5826 in patients undergoing free-flaps. Conclusion: Patient satisfaction scores have been high. However, paper Breast Q PROM completion rates have been poor (32%), with a
P109. Causes of failed sentinel lymph node biopsy in breast cancer patients Uma Sridharan, Mandana Pennick, Geraldine Mitchell Royal Liverpool Hospital, Merseyside, UK Introduction: Sentinel lymph node biopsy (SLNB) using a dual technique of radio labelled colloid injection and patent blue dye has been routinely performed in our Trust since 2004. We audited our practice to identify factors that might predict failure of the technique. Methods: Consecutive patients who had undergone breast isotope injection over 8 years (2005e2012) were identified. Where sentinel node biopsy had failed, data were collected to record demographics, past history and outcomes. All surgeons had undergone appropriate training. Results: Over eight years, 2070 SLNBs were performed by six surgeons. Failed SLNB occurred in 46/2070 (2.2%) of cases, mean patient age 61 years. When SLNB failed, axillary node sample (ANS) was performed in 33 patients, axillary node clearance (ANC) in 13. Further macro metastases were present in 6/46. Nine patients (20%) had a history of previous surgery on the ipsilateral breast. Probe failure occurred in 2 patients. We found a significant rise in SLNB failures in 2008. Departmental audit revealed new staff performing isotope injection. Once this had been identified and appropriate training undertaken the failure rate subsequently reduced. Conclusions: SLNB is successful in 97.8% of our patients. Previous ipsilateral breast surgery led to a SLNB failure rate of 20%. The importance of the audit loop is highlighted by investigating a sudden peak in failures, identifying and attending to the problem with subsequent improvement in results. http://dx.doi.org/10.1016/j.ejso.2015.03.147
P110. Role of the Memorial Sloan Kettering (MSK) nomogram in guiding the management of sentinel node positive breast cancer Sukitha Namal Rupasinghe, Raman Vinayagam, Maria Callaghan, Jonathan Michael Lund, Shabbir Poonawala Wirral Breast Unit, Wirral University Teaching Hospitals NHS Foundation Trust, Clatterbridge, Bebington, Merseyside, UK Aim: Sentinel node biopsy (SNB) is the standard approach for axillary staging in early breast cancer patients with a preoperatively negative axilla. National guidelines recommend further axillary treatment with either completion axillary node clearance (cANC) or axillary radiotherapy. We audited our management of positive sentinel nodes. Methods: All patients who underwent further axillary treatment for positive sentinel node biopsies between January 2013 and December 2014 were reviewed. Data collected included demographics, histology, pre-operative and post-operative staging and treatment. All nodes were analysed using serial haematoxylin-eosin. The Memorial Sloan Kettering (MSK) nomogram for predicting further nodal metastases was then applied retrospectively. Results: 179 patients had SNB of whom 21 (11.7%) [median age 58; range 30e77] underwent cANC for positive SNB. Only 5/21 (24%) [median MSK predicted risk 22%; range 17%e74%] had further metastatic nodes in the cANC. There was no direct correlation with any single variable for predicting further metastases in the cANC. However, using the MSK nomogram, patients who scored below 15% had no further nodal metastases (p ¼ 0.06 Fisher’s exact, AUC ¼ 0.791), and 8/21 (38%) patients would have avoided cANC if this threshold was used.