P124. Can increasing Body Mass Index (BMI) affect the accuracy of pre-operative axillary ultrasound scan in breast cancer patients?

ABSTRACTS P121. The importance of a chaperone e Ways to improve underuse Katy Rose1, Sarah Eshelby2, Paul Thiruchelvam3, A. Khoo4, Katy Hogben2 1 West Middlesex University Hospital NHS Trust, London, UK 2 Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK 3 The Royal Marsden NHS Foundation Trust, London, UK 4 Norfolk and Norwich University Hospital, Norfolk, UK Introduction: The importance of chaperones during intimate examination is well recognised. In addition to providing reassurance and support for the patient, chaperones offer protection to the doctor as well. As a result of this, documentation of chaperones in notes is essential. Methods: This 3 stage cross sectional study was completed in a tertiary breast service unit acting as the main referral service for North West London. An initial retrospective analysis was performed and results from this found 0% documentation about chaperone use. Interventions were made: -

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Stage 1: The findings from the initial cycle and chaperone guidelines were presented to the department along with the introduction of a “chaperone stamp” to clinical notes and a “memo pamphlet”. Stage 2: “Chaperone stamp” alone e data collected 1 year after initial data collection.

Results: Stage 1: 69.9%; (p < 0.001; CI 59.04% to 80.76%) and Stage 2: 76.6% (p < 0.001; CI 66.7% to 87.13%) both demonstrated increase in documentation of chaperone use compared to initial practice. A 6.7% difference in documentation of chaperone preference was observed between the two post intervention data sets, this was not a significant difference; (p ¼ 0.226, CI 15.71% to 2.31%). Conclusions: In modern healthcare environments where patient choice and autonomy are paramount it is essential that clinicians who regularly perform intimate examinations fully comply with chaperone guidance. The authors would suggest that a pro forma approach, such as our chaperone stamp, is an efficacious way to comply and facilitate early identification of any issues with compliance, thus ensuring safeguarding of patients and staff involved in intimate examinations.

S61 Conclusion: Careful selection of patients needs to be carried out to ensure possible prevention of failure of reconstruction accounting for factors affecting wound healing. Advantages include remote scar mastectomy, good inframammary fold definition and ptosis, cost reduction, acceptability in patients who prefer not to have animal products. Results seem promising, however, larger sample size and longer follow up is required. http://dx.doi.org/10.1016/j.ejso.2015.03.160

P123. What is the diagnostic value of red blood cells seen in nipple discharge cytology? Sonal Halai, Steven Goh Peterborough City Hospital, Peterborough, UK Introduction: Nipple cytology (NC) is routinely used to assess patients presenting with spontaneous nipple discharge (SND). The presence of red blood cells (RBC) in NC has routinely prompted further intervention. We evaluated the diagnostic value of RBC found in NC. Methods: A retrospective review of all patients who presented with SND between 2009 and 2014 was conducted. Clinical and radiological findings, NC and excised histology were cross-referenced for analysis. Results: A total of 482 NC were included (mean age 45 years, range 15e99). 223 samples were reported normal, 38 insufficient and 221 NC were positive for the following: RBC (164), epithelial cells (25), papillary cells (17) and atypia (15). 173 patients proceeded to have surgery. The following histology were found: 16 carcinoma, 11 DCIS, 3 atypical ductal hyperplasia, 66 papilloma, 1 tubular adenoma, 1 fibroadenoma, 59 duct ectasia and 16 benign breast changes. Defining all malignant pathologies and papilloma in the excised histology as true positive: the presence of RBC in NC has a sensitivity of 67.7%, specificity of 39.0%, positive predictive value (PPV) of 58.0%, and negative predictive value of 49.2%. RBC was present in NC for 18 of the 27 malignancies. Conclusions: 27 out of 482 (5.6%) of our patients with SND were found to have a malignant pathology. Although RBC in NC has a poor PPV in our study, it was the sole abnormality in 6 patients with malignancies. We therefore conclude that the presence of RBC in NC increases the index of suspicion, and should prompt further intervention.

http://dx.doi.org/10.1016/j.ejso.2015.03.159 http://dx.doi.org/10.1016/j.ejso.2015.03.161 P122. An initial experience using a titanium-coated polypropylene mesh (TiLoopÒ Bra) for implant based breast reconstruction Anne Shrestha, Ravi Acharya, Sumohan Chatterjee Hope Hospital, Manchester, UK Introduction: Titanium-coated polypropylene mesh (TCPM) is considered as an alternative to acellular dermal matrix (ADM) in implant based breast reconstruction (IBBR). TCPM is used as a hammock to envelop the lower pole of the implant or expander, as with the ADM. The aim of this study is to examine the limitations and complications of TCPM for IBBR and associated risk factors. Methods: A retrospective analysis of 23 patients who underwent immediate or delayed IBBR using TCPM was carried out. Primary endpoint considered the incidence of removal of implant or expander with or without mesh. Results: 26 procedures IBBR with TCPM was carried out in 23 patients, 3 had bilateral procedures. Time from procedure was a median of 413 days (range 47- 764). 4 reconstructions failed and implants were removed. 2 patients were smokers, 1 had radiotherapy prior to reconstruction and 1 had recurrent seroma and removal was after 12 months. 3 other patients developed seroma and 2 developed skin necrosis. 16 out of 23 patients had immediate breast reconstruction after have skin sparing mastectomy, only 1 requiring contralateral reduction. 3 underwent delayed reconstruction using expander with TCPM.

P124. Can increasing Body Mass Index (BMI) affect the accuracy of pre-operative axillary ultrasound scan in breast cancer patients? Habib Tafazal, Veena Vishwanath Queen Elizabeth Hospital, Birmingham, UK Introduction: Accurate pre-operative diagnosis of axillary nodal metastases may avoid further surgery. Obesity may obscure the visualisation of these nodes and can therefore reduce diagnostic accuracy of potential nodal spread. The aim of this study was to assess the relationship between patient body mass index (BMI) and subsequent accuracy of pre-operative axillary ultrasound scan in patients with breast cancer. Methods: Between January 2014 and June 2014, all patients who were diagnosed with breast cancer were retrospectively identified using an electronic patient database. Demographics, BMI, pre-operative imaging and histopathological results were analysed. Logistic regression was performed to explore if patient age, BMI and size of primary tumour may affect correct identification of axillary spread. Results: Of 159 patients identified, mean age (S.D.) was 61.0 (13.1) and median (i.q.r) BMI was 27.6 (24.6e31.6). More patients had a correct US diagnosis than those with an incorrect US diagnosis (98 vs 43 P < 0.001). BMI was similar between these two groups (Correct 27.7 (25.4e32.1) vs incorrect 27.2 (24.2e31.5) P ¼ 0.360). When controlling

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for BMI, age, histology and primary tumour size, neither independent variables were statistically significant. Conclusion: BMI does not appear to influence the pre-operative diagnostic accuracy of axillary US. Therefore, regardless of BMI, axillary node ultrasound plays an essential role in determining further management in patients with breast cancer.

Conclusion: A substantial minority of NACT patients respond sufficiently to NACT to safely benefit from breast conservation but the current lack of knowledge on how to safely assess post NACT calcification prevents that patient quality benefit. More detailed investigation on methods to assess micro calcification-associated malignant response to chemotherapy is required.

http://dx.doi.org/10.1016/j.ejso.2015.03.162

http://dx.doi.org/10.1016/j.ejso.2015.03.164

P125. Presentation of breast diseases in Ghana e A trainee’s experience Natasha Jiwa1, Paul Ofori-Atta3, Steven Goh2 1 Homerton University Hospital, London, UK 2 Peterborough City Hospital, Cambridgeshire, UK 3 Watford General Hospital, Hertfordshire, UK

P127. Procedure-specific electronic consent forms (OpInform.com) reduces errors in consenting practice for breast surgery Edward St John1, Alasdair Scott2, Edward Collins2, Henry Peake2, Sinead Barrowman2, Loretta Lau3, Tracey Irvine3, Farrokh Pakzad3, Ara Darzi1, Daniel Leff2 1 Imperial College, London, UK 2 Charing Cross Hospital, Imperial College NHS Trusts, London, UK 3 Royal Surrey County Hospital, Guildford, UK

Introduction: Breast cancer is still perceived as a taboo amongst many Ghanaian women, commonly resulting in a delayed and advanced presentation. Breast screening and access to specialist care are not widely available. We described our experience of conducting one-stop self-referral breast clinics in rural Ghana. Methods: Three separate voluntary working visits were carried out between October 2013 and October 2014. A total of 25 clinics were conducted. Clinical findings, imaging and therapeutic intervention (when performed) on all patients seen were included. Results: 210 patients (mean age 40) were included (206 female, 4 male). 86 patients were clinically screened and 124 patients presented symptomatically. Median duration of symptoms before attending clinic was 6 months (range 0.25 to 384 months). Clinical presentation included: pain in 67%, a lump in 52%, skin changes in 11% and nipple symptoms in 9%. Symptoms were unilateral in 79% of patients. Likely clinical diagnoses included: mastalgia 41%, benign breast lump 12% and cancer in 12%. The median size of palpable lumps was 35mm (range 5mm to 300mm). 27 patients were referred to regional centres for further assessment and 9 patients underwent an excision biopsy locally. Of those clinically screened, 83% had a normal examination and 17% benign changes. Conclusions: Presentation of breast disease in West Africa is delayed and severe. Diagnostic adjuncts such as imaging, simple biopsies and pathology services, as well as possibility of performing therapeutic interventions are limited. There is a striking difference in culture and beliefs in the perception of breast health. http://dx.doi.org/10.1016/j.ejso.2015.03.163

P126. Should more large breast cancers with calcifications receive conservation after NACT? Fiona Langlands, Kieran Horgan, David Dodwell, Rebecca Millican-Slater, Nisha Sharma Leeds Teaching Hospitals NHS Trust, Leeds, UK Neoadjuvant chemotherapy (NACT) is increasingly offered to patients with operable breast cancers for a number of indications, including early access to systemic treatment and potential downsizing. The presence of calcifications adds complexity to the estimation of tumour size before and after NACT. Methods: All NACT patients from 2007e2013 were analysed for tumour mammographic, MRI appearances, surgical and postoperative histology all details recorded. Results: There were 307 NACT patients. 121 had malignancy associated mammographic calcification; 49 had a mastectomy where the area of micro calcification was >40mm. 17 of these 49 theoretically, on review of the mastectomy histology, had a sufficient response to NACT which would have allowed breast conservation. 10 of these 17 had no residual invasive or in situ carcinoma.

Introduction: Consent forms, mandated by the Department of Health, structure the discussion of a procedure’s risks and benefits and provide medico-legal evidence of the consent process. We performed a prospective, closed-loop audit to assess the consent forms of patients undergoing breast surgery before and after the introduction of a web-based platform to generate procedure-specific forms. Methods: Hand-written consent forms for breast surgery were prospectively audited in a blinded fashion at two NHS Trusts (12/2013e01/2015). Assessments comprised the completion of individual form fields that were recorded as correct, incorrect, illegible or blank. Free-text entries for procedure risks were also evaluated. Responses were grouped into four domains (patient details, procedure details, surgeon sign-off and patient sign-off) and were considered “failed” if they were not correctly documented. The audit was repeated at one Trust where surgeons had switched to using a web-based tool generating procedure-specific consent forms (OpInform.com). Results: 176 consent forms were audited e 147 hand-written and 29 electronically-generated. 56% of all hand-written consent forms were missing important risks as assessed by two blinded consultant breast surgeons. The domain failure-rates for hand-written forms were: patient details, 37%; procedure details, 33%; doctor sign-off, 8%; and patient sign-off, 8%. Illegible handwriting accounted for 47% of failures. In contrast, there were no domain failures for electronically-generated consent forms, 0%. Conclusions: Hand-written consent forms suffer from inconsistencies in terms of completeness, clarity and legibility. Implementation of electronically-generated, procedure-specific forms minimise domain failures and may improve the quality of consent practice. http://dx.doi.org/10.1016/j.ejso.2015.03.165

P128. Sentinel Lymph Node Biopsy for ductal carcinoma in-situ: Should we be doing it? Masooma Zaidi, Max E. Marsden, Lucy Mansfield, Constantinos Yiangou, Avi Agrawal Queen Alexandra Hospital, Portsmouth, Hampshire, UK Introduction: Despite national guidelines, the indication for Sentinel Lymph Node Biopsy (SLNB) for ductal carcinoma in situ (DCIS) remains controversial. Recent literature supports changes to current practice in management of the axilla in the setting of invasive breast cancer and questions remain regarding the need to perform SLNB in DCIS. The aim of this study was to measure the incidence of sentinel node positivity for breast cancer patients with pure DCIS. Methods: A retrospective audit of a prospectively collected database and case notes of patients who had undergone breast surgery with SLNB, from 2004 to 2013 at our unit, that had pure DCIS on final