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P224 Optimizing breast conserving surgery by ex vivo ultrasound and radiological examination of breast cancer tissue
Friday, 18 March 2011 autologous tissue (17.4%). There have been no local or distant failures at a mean follow-up of 17 months. The cosmetic results of the contralateral prophylactic NSM were rated as good to excellent, and patients were generally very pleased with the result. Conclusion: NSM should be considered for contralateral prophylactic mastectomy, no matter what type of mastectomy is utilized on the cancer side. Disclosure of Interest: None Declared
P223
Oncologic outcome of areola-sparing mastectomy with immediate reconstruction using free flap techniques compared with conventional skin-sparing mastectomy
N. Net1 , M. Hubalek2 , R. Achleitner2 , T. Bauer2 , M. Daniaux2 , C. Marth2 . 1 Gynecology and Obstretics, 2 Medical University Innsbruck, Innsbruck, Austria Goals: Reconstruction after breast cancer is becoming increasingly important. Immediate reconstruction is an alternative to primary mastectomy and subsequent reconstruction after adjuvant therapy of breast cancer. The originally described technique of Skin sparing mastectomy (SSME) included the removal of gland, nipple areola complex (NAC), and biopsy scar. The purpose of this study is to evaluate the oncological safety and technical outcomes of areola-sparing mastectomy (ASME) with immediate free flap reconstruction compared with conventional SSME and immediate reconstruction with free flap. Methods: This retrospective analysis includes 167 patients who underwent immediate breast reconstruction using either deep inferior epigastric perforator (DIEP) flap or free transverse musculocutaneous gracilis (TMG) flap between April 2002 and September 2008. 86 patients received a free DIEP flap and 81 patients free TMG flap for reconstruction, respectively. In 45/86 patients with TRAM flap reconstruction and in 36/81 with TMG flap reconstruction the nipple only was removed (48% ASME). We compared complication rate, local recurrence rate (LRR), disease-free survival (DFS), overall survival (OS) and cosmetic results between ASME and SSME with immediate TRAM reconstruction cases. Results: Median follow up of patients with ASME or SSME was 46 months. Local failure occurred in 6 (7.4%) of 81 patients who underwent ASME and in 4 (4.7%) of 86 patients who underwent SSME. There were no areola recurrences. Overall survival in the ASME was 99% and in SSME 98%. Disease free survival was in both groups 90%. No statistical differences of local failure rate, overall survival und disease free survival could be detected between the two surgical approaches. Cosmetic outcome of ASME was better than that of SSME in the majority of patients. Subsequent adjuvant therapies were not subject for delay due to immediate reconstruction with either free flap. Partial or complete loss of the flap was a very minor problem and occurred in less than 3% of all patients. Conclusion: Our study demonstrates that ASME with immediate free DIEP or TMG reconstruction is as safe as conventional SSME. Surgical removal of the areola is not associated with a lower number of local recurrences. Immediate DIEP or TMG reconstruction and provides a good cosmetic outcome and high patient satisfaction. Disclosure of Interest: None Declared
P224
Optimizing breast conserving surgery by ex vivo ultrasound and radiological examination of breast cancer tissue
A. Huschmand Nia1,2 , B. Dohmen3,4 , M. Hollaender5,6 , M. Hofmann7,8 , K. Scherer8,9 , R. Kubale10,11 . 1 Breast Cancer Center Pirmasens, Pirmasens, 2 German Society for Obstetrics and Gynecology, Berlin, 3 Institute for Pathology, Kaiserslautern, 4 German Society for Senology, Tuebingen, 5 Praxis for gynecology and medical tumortherapy, Pirmasens, 6 German Cancer Society, Berlin, 7 Radiology Department, Pirmasens, 8 German Roentgen Society, Berlin, 9 Breast cancer Screening Programm Pfalz, 10 Praxis for radiology and nuclear medicine, Pirmasens, Germany, 11 European Radiological Society, Vienna, Austria Goals: We studied the role of ex vivo high resolution ultrasound and radiological examination of breast cancer tissue for the reduction of reexcision rate in breast conserving surgery (BCS). Methods: We developed a tissue transfer and X-ray system in 2008 which reliably ensures precise localization of the tumor within the excised tissue by tissue-radiographs (horizontally and vertically) and tissueultrasound. The system is based on a non-opaque tray with radio-opaque
Poster Session II. Surgery/Sentinels/DCIS
S53
topographic markers. We evaluated the role of ex vivo high resolution ultrasound and tissue-radiographs for the reduction of re-excision rate in 200 cases of primary breast cancer undergoing BCS. Additional excisions were performed during the primary surgery when tissue radiographs and tissue ultrasound indicated a low margin. The margins defined by tissue radiographs were than compared to the histological findings. Results: Our re-excision rates due to low margins for non palpable invasive carcinomas (smaller than 15 mm) was 2.2% and 10% for DCIS. Conclusion: Ex vivo high resolution ultrasound and radiological examination of breast cancer tissue can help to reduce the re-excision rate for low or positive margins significantly. Tissue-radiographs can furthermore improve communication between radiologists, breast surgeon and pathologists especially for multifocal disease and lesions smaller than 15 mm, provided that a standard tissue transfer and x-ray system is used. Disclosure of Interest: None Declared
P225
Results of combined treatment of breast oncoplastic operations
V. Ostapenko1 , A. Mudenas1 , S. Bruzas1 , J. Sabonis1 , A. Jackevicius1 , A. Ostapenko2 . 1 Institute Oncology Vilnius University, 2 Vilnius University Medical Faculty, Vilnius, Lithuania Goals: The goal of this work to evaluate the results of combined treatment of breast oncoplastic operations. Methods: During 1999–2009m. 5908 patient with breast cancer underwent treatment at Lithuanian Oncology center. The data on vital status of all patients was summarized by Jan 1, 2009. Non-systematic random sampling (each next or third patient file) was used to evaluate the treatment results of operated patients. The surgery treatment − oncoplastic operation was used as primarily selection criteria. The 429 patient (7.3%) were selected for the study. Patient at stage I−III were selected for further analysis. The median follow-up time was 79.4 month. 79.8% of patients were found alive by end of follow-up. All pts underwent breast oncoplastic conserving surgery, irradiation and chemo/hormonotherapy. Evaluating the size of the tumor, volume of removed tissues, breast and tumour proportions, 3 techniques of oncoplastic operations were introduced: Breast oncoplastic operation with local tissues mammoplasty (Crescent Lift, Benelli lift), II Breast oncoplastic operation with reduction mammoplasty (superior/inferior pedicle, lateral mammoplasty), III Breast oncoplastic operation with m. Latissimus dorsi flap or with “Mentor” (190–375 cm3 ) implants. Distribution of pts according pathological tumor size − “pT” was, pT1 − 192, pT2 − 213, pT3 − 24. Distribution of pts according to nodal status “pN” − PN0 − 276, pN1 − 124, pN2 − 29. Distribution of pts according differentiation degree “G” − “G1” − 126, “G2” − 212, “G3” − 91. Estrogen and progesterone receptors were evaluated in 118 pts. Results: The five year overall survival for stage I was 94.87% (95% Conf. Interval: 90.01–97.40%). For stage II five year overall survival was 76.5%. (95% Conf. Interval: 69.66–82.00%). For stage III five year overall survival was 69.23%. Stage I five year disease free survival was 88.66% (95% Conf. Interval: 82.38%–92.79%), Stage II five year disease free survival − 86.49% (95% Conf. Interval 80.15–90.92), Stage III five year disease free survival − 69.23% (95% Conf. Interval 47.80−83.26). Conclusion: The combined treatment of breast cancer stage I patients after oncoplastic operations showed 5 years overall survival results 94.87% with good aesthetic results. Disclosure of Interest: None Declared
P226
High resolution ultrasound guided location of non palpable breast lesions is safe and can significantly reduce hook-wire guided surgery
A. Huschmand Nia1,2 , B. Dohmen3,4 , K. Scherer5,6 , M. Hollaender2,7 , M. Hofmann6,8 , R. Kubale9,10 . 1 Clinic for Obstetrics and Gynecology, Breast Cancer Center, Pirmasens, 2 German Society for Obstetrics and Gynecology, Berlin, 3 Westpfalz Klinikum, Institute for Pathology, Kaiserslautern, 4 German Society for Senology, Tuebingen, 5 Mammography Screening Programm Pfalz, Pirmasens, 6 German Roentgen Society, Berlin, 7 Praxis for Gynecology and Medical Tumortherapie, 8 Radiology, City Hospital Pirmasens, 9 Praxis for Radiology and Nuclearmedicine, Pirmasens, Germany, 10 European Radiological Society, Wien, Austria Goals: Hook-wire guided surgery was introduced in 1980 by Kopans and DeLuca to help locate occult lesions of the breast. The procedure is
P223
Oncologic outcome of areola-sparing mastectomy with immediate reconstruction using free flap techniques compared with conventional skin-sparing mastectomy
N. Net1 , M. Hubalek2 , R. Achleitner2 , T. Bauer2 , M. Daniaux2 , C. Marth2 . 1 Gynecology and Obstretics, 2 Medical University Innsbruck, Innsbruck, Austria Goals: Reconstruction after breast cancer is becoming increasingly important. Immediate reconstruction is an alternative to primary mastectomy and subsequent reconstruction after adjuvant therapy of breast cancer. The originally described technique of Skin sparing mastectomy (SSME) included the removal of gland, nipple areola complex (NAC), and biopsy scar. The purpose of this study is to evaluate the oncological safety and technical outcomes of areola-sparing mastectomy (ASME) with immediate free flap reconstruction compared with conventional SSME and immediate reconstruction with free flap. Methods: This retrospective analysis includes 167 patients who underwent immediate breast reconstruction using either deep inferior epigastric perforator (DIEP) flap or free transverse musculocutaneous gracilis (TMG) flap between April 2002 and September 2008. 86 patients received a free DIEP flap and 81 patients free TMG flap for reconstruction, respectively. In 45/86 patients with TRAM flap reconstruction and in 36/81 with TMG flap reconstruction the nipple only was removed (48% ASME). We compared complication rate, local recurrence rate (LRR), disease-free survival (DFS), overall survival (OS) and cosmetic results between ASME and SSME with immediate TRAM reconstruction cases. Results: Median follow up of patients with ASME or SSME was 46 months. Local failure occurred in 6 (7.4%) of 81 patients who underwent ASME and in 4 (4.7%) of 86 patients who underwent SSME. There were no areola recurrences. Overall survival in the ASME was 99% and in SSME 98%. Disease free survival was in both groups 90%. No statistical differences of local failure rate, overall survival und disease free survival could be detected between the two surgical approaches. Cosmetic outcome of ASME was better than that of SSME in the majority of patients. Subsequent adjuvant therapies were not subject for delay due to immediate reconstruction with either free flap. Partial or complete loss of the flap was a very minor problem and occurred in less than 3% of all patients. Conclusion: Our study demonstrates that ASME with immediate free DIEP or TMG reconstruction is as safe as conventional SSME. Surgical removal of the areola is not associated with a lower number of local recurrences. Immediate DIEP or TMG reconstruction and provides a good cosmetic outcome and high patient satisfaction. Disclosure of Interest: None Declared
P224
Optimizing breast conserving surgery by ex vivo ultrasound and radiological examination of breast cancer tissue
A. Huschmand Nia1,2 , B. Dohmen3,4 , M. Hollaender5,6 , M. Hofmann7,8 , K. Scherer8,9 , R. Kubale10,11 . 1 Breast Cancer Center Pirmasens, Pirmasens, 2 German Society for Obstetrics and Gynecology, Berlin, 3 Institute for Pathology, Kaiserslautern, 4 German Society for Senology, Tuebingen, 5 Praxis for gynecology and medical tumortherapy, Pirmasens, 6 German Cancer Society, Berlin, 7 Radiology Department, Pirmasens, 8 German Roentgen Society, Berlin, 9 Breast cancer Screening Programm Pfalz, 10 Praxis for radiology and nuclear medicine, Pirmasens, Germany, 11 European Radiological Society, Vienna, Austria Goals: We studied the role of ex vivo high resolution ultrasound and radiological examination of breast cancer tissue for the reduction of reexcision rate in breast conserving surgery (BCS). Methods: We developed a tissue transfer and X-ray system in 2008 which reliably ensures precise localization of the tumor within the excised tissue by tissue-radiographs (horizontally and vertically) and tissueultrasound. The system is based on a non-opaque tray with radio-opaque
Poster Session II. Surgery/Sentinels/DCIS
S53
topographic markers. We evaluated the role of ex vivo high resolution ultrasound and tissue-radiographs for the reduction of re-excision rate in 200 cases of primary breast cancer undergoing BCS. Additional excisions were performed during the primary surgery when tissue radiographs and tissue ultrasound indicated a low margin. The margins defined by tissue radiographs were than compared to the histological findings. Results: Our re-excision rates due to low margins for non palpable invasive carcinomas (smaller than 15 mm) was 2.2% and 10% for DCIS. Conclusion: Ex vivo high resolution ultrasound and radiological examination of breast cancer tissue can help to reduce the re-excision rate for low or positive margins significantly. Tissue-radiographs can furthermore improve communication between radiologists, breast surgeon and pathologists especially for multifocal disease and lesions smaller than 15 mm, provided that a standard tissue transfer and x-ray system is used. Disclosure of Interest: None Declared
P225
Results of combined treatment of breast oncoplastic operations
V. Ostapenko1 , A. Mudenas1 , S. Bruzas1 , J. Sabonis1 , A. Jackevicius1 , A. Ostapenko2 . 1 Institute Oncology Vilnius University, 2 Vilnius University Medical Faculty, Vilnius, Lithuania Goals: The goal of this work to evaluate the results of combined treatment of breast oncoplastic operations. Methods: During 1999–2009m. 5908 patient with breast cancer underwent treatment at Lithuanian Oncology center. The data on vital status of all patients was summarized by Jan 1, 2009. Non-systematic random sampling (each next or third patient file) was used to evaluate the treatment results of operated patients. The surgery treatment − oncoplastic operation was used as primarily selection criteria. The 429 patient (7.3%) were selected for the study. Patient at stage I−III were selected for further analysis. The median follow-up time was 79.4 month. 79.8% of patients were found alive by end of follow-up. All pts underwent breast oncoplastic conserving surgery, irradiation and chemo/hormonotherapy. Evaluating the size of the tumor, volume of removed tissues, breast and tumour proportions, 3 techniques of oncoplastic operations were introduced: Breast oncoplastic operation with local tissues mammoplasty (Crescent Lift, Benelli lift), II Breast oncoplastic operation with reduction mammoplasty (superior/inferior pedicle, lateral mammoplasty), III Breast oncoplastic operation with m. Latissimus dorsi flap or with “Mentor” (190–375 cm3 ) implants. Distribution of pts according pathological tumor size − “pT” was, pT1 − 192, pT2 − 213, pT3 − 24. Distribution of pts according to nodal status “pN” − PN0 − 276, pN1 − 124, pN2 − 29. Distribution of pts according differentiation degree “G” − “G1” − 126, “G2” − 212, “G3” − 91. Estrogen and progesterone receptors were evaluated in 118 pts. Results: The five year overall survival for stage I was 94.87% (95% Conf. Interval: 90.01–97.40%). For stage II five year overall survival was 76.5%. (95% Conf. Interval: 69.66–82.00%). For stage III five year overall survival was 69.23%. Stage I five year disease free survival was 88.66% (95% Conf. Interval: 82.38%–92.79%), Stage II five year disease free survival − 86.49% (95% Conf. Interval 80.15–90.92), Stage III five year disease free survival − 69.23% (95% Conf. Interval 47.80−83.26). Conclusion: The combined treatment of breast cancer stage I patients after oncoplastic operations showed 5 years overall survival results 94.87% with good aesthetic results. Disclosure of Interest: None Declared
P226
High resolution ultrasound guided location of non palpable breast lesions is safe and can significantly reduce hook-wire guided surgery
A. Huschmand Nia1,2 , B. Dohmen3,4 , K. Scherer5,6 , M. Hollaender2,7 , M. Hofmann6,8 , R. Kubale9,10 . 1 Clinic for Obstetrics and Gynecology, Breast Cancer Center, Pirmasens, 2 German Society for Obstetrics and Gynecology, Berlin, 3 Westpfalz Klinikum, Institute for Pathology, Kaiserslautern, 4 German Society for Senology, Tuebingen, 5 Mammography Screening Programm Pfalz, Pirmasens, 6 German Roentgen Society, Berlin, 7 Praxis for Gynecology and Medical Tumortherapie, 8 Radiology, City Hospital Pirmasens, 9 Praxis for Radiology and Nuclearmedicine, Pirmasens, Germany, 10 European Radiological Society, Wien, Austria Goals: Hook-wire guided surgery was introduced in 1980 by Kopans and DeLuca to help locate occult lesions of the breast. The procedure is