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P134 The IEO breast cancer data base: two decades of breast cancer treatment
14th St.Gallen International Breast Cancer Conference / The Breast 24S1 (2015) S26–S86
economic status, may be some of the probable primary cause for higher incidence of breast cancer in urban areas. Disclosure of Interest: No significant relationships. P134 The IEO breast cancer data base: two decades of breast cancer treatment B. Santillo *, N. Rotmensz. Data Quality Control Unit Division of Epidemiology and Biostatistics, European Institute og Oncology, Milan, Italy Goals: After its first 20 years of activity, the ‘young’ European Institute of Oncology (IEO), has become a pole of attraction for oncological cure in general and breast cancer in particular. Over 33% of the patients in our Institute are treated for breast cancer. This anniversary is the occasion to take stock of the situation. Methods: Since all data of patients operated are prospectively recorded in an institutional data base, and used for weekly multidisciplinary discussions, we decided to photograph the change of patient status at presentation, change in type of surgery performed and adjuvant treatment proposals. It has been chosen to present the results freezed at 1st year (mid 1994–1995), after 10 years (2004) and at the 20th year since beginning (2014). For homogeneity of analysis, only invasive disease has been considered. Results: If during the first years only a few hundreds of patients were operated yearly, in 2004, the peak of 2000 new cases was reached and remained relatively stable up to 2014. Geographic origin (increase number of far away living and foreign patients), age (elder), type of surgery (more mastectomy), histological type and subtypes, stage and obviously treatment proposal have changed over the years and will be discussed. Conclusion: Our long lasting data collection has offered the possibility of retrospectively analyse our population, detect change in characteristics, stage of disease and clinical practice, orient new strategy and last but not least has resulted in more than 150 articles published in peer reviewed journals. Disclosure of Interest: No significant relationships. P135 Regular image follow up of contralateral breast in metachronous bilateral breast cancer S.H. Kang *, H. Kim. General Surgery, Breast Division, Keimyung University School of Medicine, Daegu, Korea Goals: Regular mammographic follow up is recommended to patients with previous history of breast malignancy in many clinics to detect contralateral breast cancer development. We aimed to evaluate the effect of regular radiologic follow up on early detection of contralateral breast cancer and prognosis in patients with metachronous bilateral breast cancer. Methods: We reviewed medical record of all breast malignant patients in our institute from 1983 to June 2014 and we found 49 (1.7%) patients of metachronous bilateral breast cancer. Patients with bilateral breast cancer within 6-month interval, bilateral cancer through direct spread, non-compliance who had delayed surgery were excluded, so that 44 patients were included. We divided these 44 patients into two groups whether or not regular radiologic follow up and compared clinicopathologic factors including age, stage, time interval of 1st and 2nd cancer, operation method and breast cancer specific survival. We used SPSS for statistical analysis. The significance for difference between two groups was performed with chi-square test. The significance for survival was performed with Kaplan–Meier method, log rank test and Breslow test. Results: Mean age of 1st and 2nd breast cancer diagnosis in total patients was 43.8 years and 49.2 years. Mean time interval between 1st and 2nd cancer was 68.9 months. In situ carcinoma was found
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in 5 (11.4%) patients, stage 1 in 11 (25%), stage 2 in 21 (47.7%), stage 3 in 6 (13.6%) as stage at diagnosis of 1st breast malignancy. Median follow up period was 150 months. Recurrences in total cohort were found in 13 patients (29.5%), seven patients’ deaths were breast cancer specific. Regular radiologic follow up with annual mammography with or without ultrasonography was performed in 28 patients (63.6%, group 1), however, 12 patients (27.3%, group 2) did not have regular follow up. Another four patients (9.1%) had no medical information about follow up. With regard to second breast cancer, stage 0 and 1 malignancies were more in group 1 than in group 2 (82.1% vs 25.0%, p = 0.006) and patients with same or decreased stage were more in group 1 than group 2 (71.4% vs 33.3%, p = 0.042). However, time interval between 1st and 2nd cancer did not show statistical difference (68.7 and 74.1 months, p = 0.801) and breast cancer specific survival between two groups showed minimal superior to group 1 with borderline significance (p = 0.043). Conclusion: Regular radiologic follow up for contralateral breast of known breast cancer patients can absolutely lead to early detection for second cancer. However, time interval between 1st and 2nd cancer is no difference and the benefit of breast cancer specific survival is slightly better with borderline significance. Disclosure of Interest: No significant relationships.
P136 Diagnostic impact of magnetic resonance imaging in ultrasound occult breast calcification W. Wang *. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Goals: X-ray mammography (XRM) is important for breast calcification detection, especially for some ultrasound occult calcification. However, false-positive findings occur and lead to unnecessary biopsy. The purpose of this investigation was to identify the values of magnetic resonance imaging (MRI) in this part of patients. Methods: The study involved 226 calcified lesions in 207 asymptomatic patients admitted between January 2011 and March 2014. Eligible for investigation were ultrasound occult breast calcification classified as BI-RADS 4–5 in the initial mammography that all had MRI test and histopathologic verification. Accordingly, 207 patients with 42 malignant and 184 benign lesions were enrolled. Two blinded observers reviewed the MRI images of the calcification and categorized lesions into mass or nonmass and used BI-RADS to classify the lesions. Results: In the diagnosis of breast cancer in ultrasound occult calcification, sensitivity for mammography and MRI were 69% vs. 85.7% (p = 0.068), and specificity were 64.7% vs. 88% (p < 0.001). The diagnostic sensitivity was significantly higher for combined MRI+XRM (100%, c2 = 11.08, P < 0.005) than for XRM alone, and the negative predictive value was increased from 90.2% to 100%. In the malignant calcification, 11.9% (5/42) had no abnormality in MRI and 78.6% (33/42) were nonmass-like enhancement, while 78.3% benign calcification had no abnormality in MRI (p < 0.001). 78.5% malignant calcifications were carcinoma in situ (CIS) or had CIS part, and 81% were hormone-receptor positive. Conclusion: Additional breast MRI can improve the diagnostic sensitivity of mammography in ultrasound occult calcification. According to the high negative predictive value, some patients may avoid biopsy or operation. Nonmass-like enhancement in MRI is more common in malignant calcification. Most of ultrasound occult malignant calcification had carcinoma in situ and were hormonereceptor positive. Disclosure of Interest: No significant relationships.
economic status, may be some of the probable primary cause for higher incidence of breast cancer in urban areas. Disclosure of Interest: No significant relationships. P134 The IEO breast cancer data base: two decades of breast cancer treatment B. Santillo *, N. Rotmensz. Data Quality Control Unit Division of Epidemiology and Biostatistics, European Institute og Oncology, Milan, Italy Goals: After its first 20 years of activity, the ‘young’ European Institute of Oncology (IEO), has become a pole of attraction for oncological cure in general and breast cancer in particular. Over 33% of the patients in our Institute are treated for breast cancer. This anniversary is the occasion to take stock of the situation. Methods: Since all data of patients operated are prospectively recorded in an institutional data base, and used for weekly multidisciplinary discussions, we decided to photograph the change of patient status at presentation, change in type of surgery performed and adjuvant treatment proposals. It has been chosen to present the results freezed at 1st year (mid 1994–1995), after 10 years (2004) and at the 20th year since beginning (2014). For homogeneity of analysis, only invasive disease has been considered. Results: If during the first years only a few hundreds of patients were operated yearly, in 2004, the peak of 2000 new cases was reached and remained relatively stable up to 2014. Geographic origin (increase number of far away living and foreign patients), age (elder), type of surgery (more mastectomy), histological type and subtypes, stage and obviously treatment proposal have changed over the years and will be discussed. Conclusion: Our long lasting data collection has offered the possibility of retrospectively analyse our population, detect change in characteristics, stage of disease and clinical practice, orient new strategy and last but not least has resulted in more than 150 articles published in peer reviewed journals. Disclosure of Interest: No significant relationships. P135 Regular image follow up of contralateral breast in metachronous bilateral breast cancer S.H. Kang *, H. Kim. General Surgery, Breast Division, Keimyung University School of Medicine, Daegu, Korea Goals: Regular mammographic follow up is recommended to patients with previous history of breast malignancy in many clinics to detect contralateral breast cancer development. We aimed to evaluate the effect of regular radiologic follow up on early detection of contralateral breast cancer and prognosis in patients with metachronous bilateral breast cancer. Methods: We reviewed medical record of all breast malignant patients in our institute from 1983 to June 2014 and we found 49 (1.7%) patients of metachronous bilateral breast cancer. Patients with bilateral breast cancer within 6-month interval, bilateral cancer through direct spread, non-compliance who had delayed surgery were excluded, so that 44 patients were included. We divided these 44 patients into two groups whether or not regular radiologic follow up and compared clinicopathologic factors including age, stage, time interval of 1st and 2nd cancer, operation method and breast cancer specific survival. We used SPSS for statistical analysis. The significance for difference between two groups was performed with chi-square test. The significance for survival was performed with Kaplan–Meier method, log rank test and Breslow test. Results: Mean age of 1st and 2nd breast cancer diagnosis in total patients was 43.8 years and 49.2 years. Mean time interval between 1st and 2nd cancer was 68.9 months. In situ carcinoma was found
S71
in 5 (11.4%) patients, stage 1 in 11 (25%), stage 2 in 21 (47.7%), stage 3 in 6 (13.6%) as stage at diagnosis of 1st breast malignancy. Median follow up period was 150 months. Recurrences in total cohort were found in 13 patients (29.5%), seven patients’ deaths were breast cancer specific. Regular radiologic follow up with annual mammography with or without ultrasonography was performed in 28 patients (63.6%, group 1), however, 12 patients (27.3%, group 2) did not have regular follow up. Another four patients (9.1%) had no medical information about follow up. With regard to second breast cancer, stage 0 and 1 malignancies were more in group 1 than in group 2 (82.1% vs 25.0%, p = 0.006) and patients with same or decreased stage were more in group 1 than group 2 (71.4% vs 33.3%, p = 0.042). However, time interval between 1st and 2nd cancer did not show statistical difference (68.7 and 74.1 months, p = 0.801) and breast cancer specific survival between two groups showed minimal superior to group 1 with borderline significance (p = 0.043). Conclusion: Regular radiologic follow up for contralateral breast of known breast cancer patients can absolutely lead to early detection for second cancer. However, time interval between 1st and 2nd cancer is no difference and the benefit of breast cancer specific survival is slightly better with borderline significance. Disclosure of Interest: No significant relationships.
P136 Diagnostic impact of magnetic resonance imaging in ultrasound occult breast calcification W. Wang *. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Goals: X-ray mammography (XRM) is important for breast calcification detection, especially for some ultrasound occult calcification. However, false-positive findings occur and lead to unnecessary biopsy. The purpose of this investigation was to identify the values of magnetic resonance imaging (MRI) in this part of patients. Methods: The study involved 226 calcified lesions in 207 asymptomatic patients admitted between January 2011 and March 2014. Eligible for investigation were ultrasound occult breast calcification classified as BI-RADS 4–5 in the initial mammography that all had MRI test and histopathologic verification. Accordingly, 207 patients with 42 malignant and 184 benign lesions were enrolled. Two blinded observers reviewed the MRI images of the calcification and categorized lesions into mass or nonmass and used BI-RADS to classify the lesions. Results: In the diagnosis of breast cancer in ultrasound occult calcification, sensitivity for mammography and MRI were 69% vs. 85.7% (p = 0.068), and specificity were 64.7% vs. 88% (p < 0.001). The diagnostic sensitivity was significantly higher for combined MRI+XRM (100%, c2 = 11.08, P < 0.005) than for XRM alone, and the negative predictive value was increased from 90.2% to 100%. In the malignant calcification, 11.9% (5/42) had no abnormality in MRI and 78.6% (33/42) were nonmass-like enhancement, while 78.3% benign calcification had no abnormality in MRI (p < 0.001). 78.5% malignant calcifications were carcinoma in situ (CIS) or had CIS part, and 81% were hormone-receptor positive. Conclusion: Additional breast MRI can improve the diagnostic sensitivity of mammography in ultrasound occult calcification. According to the high negative predictive value, some patients may avoid biopsy or operation. Nonmass-like enhancement in MRI is more common in malignant calcification. Most of ultrasound occult malignant calcification had carcinoma in situ and were hormonereceptor positive. Disclosure of Interest: No significant relationships.