- Email: [email protected]
P235 Quality of life and satisfaction of patients diagnosed and treated for breast cancer
Friday, 18 March 2011 change with ring enhancement that was consistent with red ring observed in the margin of ablated breast specimen at phase I study. Conclusion: MR mammography is useful for monitoring ablated breast lesion. RFA is a promising technique for local control of breast cancer. Disclosure of Interest: None Declared
P232
The role of preoperative MRI in influencing the surgical decision making, a retrospective look at the experience of a large academic hospital in the face of a rising mastectomy rates
H. Ali1 , S. Hensley Alford2 , J. Saltzgaber2 , M. Jankowski2 , S. Ruszkowski2 , A. Zarbo2 . 1 Oncology, 2 Henry Ford Hospital, Detroit, United States Goals: MRI scanning has become a common preoperative imaging modality in breast cancer management. We performed a retrospective analysis of the association of breast MRI with mastectomy at a large academic group practice. Methods: This analysis used data from the MIBOQi (the Michigan Breast Oncology Quality Initiative) project which includes women 50 years or older who underwent breast cancer (BC) surgery at our institution between October 2006-June 2010. We analyzed the influence of MRI prior to definitive surgery on the choice of surgical procedure. Among those who received an MRI and mastectomy, we reviewed the medical record to determine if the mastectomy was related to the MRI (lumpectomy was intended prior to MRI), surgically indicated (mastectomy intended prior to MRI or performed after a lumpectomy), or by patient choice. Data were available on patient demographics, surgical decisions, type and date of surgery, and bMRI procedures. Logistic regression was used to assess the associations of mastectomy with stage at diagnosis, age, race, and breast MRI as univariate and multivariate models. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: A total of 436 women were included in the analysis. Of these women, 28% (n = 124) received a preoperative breast MRI and 17% (n = 74) received a mastectomy. In univariate analysis, mastectomy was associated with stage (stage IIB or greater, OR = 3.85; 95% CI 1.76–8.46) and preoperative breast MRI (OR = 1.89; 95% CI 1.12–3.17). When controlling for stage, age, and race, preoperative breast MRI was still associated with mastectomy (adjusted OR = 1.93; 95% CI 1.12–3.31). Among the women who received an MRI and mastectomy (n = 30), the mastectomy decision was MRI related in 11 cases (37%), surgically indicated in 15 cases (50%), and the patient’s choice in 4 cases (13%). Conclusion: Women who received a preoperative breast MRI were almost twice as likely to have a mastectomy when compared to women who did not receive a preoperative breast MRI, even after controlling for age, race, and stage at diagnosis. Medical record review reveled that in half of cases the mastectomy was surgically indicated, however, a third of the time the MRI did influence the mastectomy decision. Disclosure of Interest: None Declared
P233
Descriptive results of surgical treatment for breast cancer: A 30-year experience in the northeast of China
S. Li1 , Z. Fan2 . 1 Department of breast surgery, 2 The first Hospital of Jilin University, Changchun, China
Poster Session II. Surgery/Sentinels/DCIS
422 (13.88%) were N.A. The most common pTNM classification still was Stage II, but the percentage of stage I patients gradually increased (30.1% in 2005–2009). The most common histological type was infiltrating ductal carcinoma (2233 patients, 73.43%). Modified radical mastectomy was the most common operation procedure performed (2250 patients, 73.99%), and was used increasingly while radical mastectomy was adopted decreasingly in recent decade. At the same time breast-conserving surgery (213 patients, 7.00%) seems to increase sharply in the recent decade. The sentinal lymphnode biopsy has become the first biopsy method of axillary lymphnode for the patients with early breast cancer in the past two years. Conclusion: The variation of operation procedures performed on patients with breast cancers reflected the advance of our understanding of the biology of breast cancer and the progression of new treatment principles. And modified radical mastectomy still was the major operation procedure in our hospital. Disclosure of Interest: None Declared
P234
The role of pre-operative CT staging in predicting the sentinel lymph node status
S. Khawaja1 , A. Huws1 , R. Kannan1 , H. Sumrien1 , Y. Sharaiha1 , S. Holt1 . 1 Breast Unit, Prince Philip Hospital, Llanelli, United Kingdom Goals: In our institution, intraoperative analysis of the sentinel lymph node is performed with the help of the pCR veridex technique. This eliminates the need for a second delayed axillary clearance in the majority of patients. However, it prolongs the procedure by approximately 40 minutes because of the delay in reporting the results. To prevent patients from unnecessarily undergoing the latter procedure, the role of pre-operative CT staging in assessing the axilla was evaluated. Methods: Newly diagnosed breast cancer patients undergoing preoperative CT staging and sentinel lymph node biopsies were included in the study. The indications of the latter investigation were patients less than 40 years at the time of diagnosis and predicted grade III breast cancers on the core biopsies. Patients excluded were the ones who underwent CT staging for known axillary disease. At the onset of the study, patients were initially included retrospectively and later followed prospectively. Results: The study included patients undergoing pre-operative CT staging from January 2007 to the present date. 79 patients underwent preoperative CT staging. The indications were an age of less than 40 years in 10 patients and predicted grade III breast cancers in 25 patients. 70 patients had no axillary involvement on the CT scan. Out of these patients, 52 were confirmed histologically to have negative sentinel lymph nodes. 5 patients were veridex positive but H&E negative representing micrometastases. 2 further patients had micrometastases on H&E staining. However, 11 patients were found to have histologically proven axillary disease. This made a false negative rate of 15%. Out of the 9 patients with predicted axillary lymph node disease on the CT scan, 7 were confirmed histologically to have the latter findings. Conclusion: Our results show that pre-operative CT staging can relatively accurately assess the axilla in breast cancer patients. Since we have found the above findings, we have begun to omit patients from undergoing sentinel node biopsies in CT predicted axillary node disease. These patients undergo an immediate axillary clearance. Disclosure of Interest: None Declared
P235 Goals: To review the evolution of the current surgical treatment for breast cancer over the past thirty years in the First Hospital of Jilin University (the former Bethune University of Medical Sciences) in the northeast of China. Methods: 3041 patients with primary breast cancer diagnosed and surgically treated in the First Hospital from January 1980 to December 2009 were analyzed, retrospectively. Results: The patient’s number with breast cancer in our hospital increased year by year over the past 30 years. Characteristics of all patients population are as follow: three thousand and thirteen patients (99.1%) are female, twenty-eight (0.9%) are male. The incidence peak was 45−49 yr in the recent decade. Median age at diagnosis was earlier in the northeast than in the western countries or in Shanghai, although it increased from 44.9 yr in 1985–1989 to 50.1 yr in 2005–2009. Patients were clinically and pathologically staged in accordance with UICC, 24 (0.79%) were stage 0, 584 (19.20%) patients were stage I, 1510 (49.65%) were stage II, 457 (15.03%) cases were stage III, 44 (1.45%) were stage IV and
S55
Quality of life and satisfaction of patients diagnosed and treated for breast cancer
´ 1 , P. Manosalvas1 , M. Gallego1 , M. Sanz1 , M. Arroyo1 , S. Aragon 1 , N. Pinas ´ ˜ 3. M. Blanco1 , R. Noguero2 , B. Sancho1 , J. Hernandez 1 Ginecolog´ıa y obstetricia, Hospital 12 de Octubre, Madrid, 2 ginecolog´ıa ´ y obstetricia, Hospital Infanta Cristina, Parla, 3 Psicooncolog´ıa medica, Hospital 12 de Octubre Madrid, Spain Goals: EuroQoL, a quality of life related to health questionnaire, assesses the mood, the core activity, the social relationship and pain. Anxietydepression scale (VAS) is used to assess the quality of life (QoL) of breast cancer patients attended in our unit. We conducted interviews at the first review postsurgery. Methods: A prospective observational study in 617 patients from 2007 to 2010. EuroQoL, VAS and the clinical features were analysed. The Chisquare and Fisher test were applied using SPSS 17.
S56
Poster Session II. Surgery/Sentinels/DCIS
Results: 38.9% patients suffered mastectomy vs 61.1% conservative surgery. Immediately reconstruction was performed on 8.4% patients. 35% underwent axillary dissection (AD), 55.6% suffered sentinel node dissection (SBLN). 50.5% received adjuvant chemotherapy, 74.6% radiotherapy, 77% tamoxifen or aromatase inhibitor. We conducted 398 interviews. SCORES EUROQol: low 9%, medium 48.8%, high 4.12%. 45% maintained their main activity, 37.6% were not anxious or depressed. VAS score was 5.5 for anxiety and 3.2 for depression. Four age groups were established to see differences in the total score of the EUROQol and in each item. Among age groups, those who underwent AD (292) only PAINscore EUROQol was significant different (p 0.034). SBLN (317) did not show significant differences in the items of EUROQol respect to those who did not perform axillary surgery. Radical vs conservative did not show significant differences of all items or Score EUROQol. Patients taking hormonotherapy had a lower EuroQOL on main Activity (p 0.026). Mood and impairment in social relationships significantly associated (p 0.027, p 0.030 respectively). QoL was found significant different in women taking Hormonetherapy regardless of the class (p 0.017). Conclusion: Most of the patients who participated in the interview had a high score on the EUROQol. Nearly half of them kept their core business after surgery. We found a significant difference in pain EUROQol item and AD regardless the age group. Performance SBLN enables to reach the similar EUROQol level than the patients suffered no axillary manipulation. Thus, side effects of endocrinotherapy must be considered because they impact negatively on our patients’ demeanours and their social relationships. Disclosure of Interest: None Declared
P236
3T-MRI can predict the metastasis of sentinel node detected by 3D-CT mammary lymphography
K. Yamashita1 , S. Haga1 , K. Shimizu1 . 1 Department of Surgery, Nippon Medical School, Tokyo, Japan Goals: 3D-CT lymphography (LG) can show the detailed lymphatic network of the breast and the axilla, and can contribute to more accurate sentinel node (SN) biopsy. We reported the effectiveness of SPECT-fused 3D-CT LG for surgery at the last meeting. Now, we applied 3-tesla-MRI to enhance SN and to match with the SN detected by 3D-CT LG. It shows the typical shape of the metastasized lymph node. We tried to predict the SN metastasis before surgery by the enhanced pattern of SN. Methods: 3D-CT LG was performed to mark SN on the skin before surgery. Above the tumor and near the areola, 2 ml of Iopamidol 300 was injected subcutaneously. Images of CT scan were taken at 1 and 3 min after injection to produce a 3D image of lymph ducts and nodes. The dynamic contrast-enhanced MRI of the breast was performed using 3T MRI by bolus injection of gadolinium. T1-weighted fat-suppressed images were reconstructed to 3D images to show the shape of SN. SN biopsy was performed by dye and RI method using the endoscopic technique. The skin incision was made 1 cm long in the axilla on the marked position. Results: We have performed 3D-CT LG on 200 patients and evaluated SN in 3D-MRI on 50 patients. The average age was 55.1 years old. The average tumor size was 2.4 cm. The average sampled number of SN was 2.3. SN metastasis was observed on 16 patients and not on 34 patients. Only sentinel node metastasis was on 10 patients (62.5%). There was no false negative study. We performed mastectomy on 8 patients, and the video-assisted breast conserving surgery on 42 patients. The comparison of 3D-CT LG and 3D-MRI shows the incompatible enhancement on 18 patients. 8 were metastasized among them. The enhanced shapes of SN were classified to 3 patterns. Whole enhanced pattern was observed on 34, partial enhanced pattern was on 10, and non-enhanced pattern was on 6. 3D-MRI was more sensitive to metastasis by the differentiation of the enhanced patterns of SN. 3D-MRI with 3D-CT LG will become to be more predictive for metastasis than only 3D-CT LG. Conclusion: 3D-MRI can show the sensitive enhancement of SN guided with 3D-CT LG. The precisely detected SN of 3D-CT LG will be predictable for metastasis by the incompatibility of the enhanced pattern of SN with 3D-MRI. They will help the accurate SN biopsy and will be the indication tools to decide the axillary surgery: SN biopsy or axillary preservation. Disclosure of Interest: None Declared
Friday, 18 March 2011
P237
Patterns of nodal enhancement on MR imaging with SPIO in patients with breast cancer demonstrating positive sentinel nodes
K. Motomura1 , S. Nakahara1 , M. Ishitobi1 , Y. Komoike1 , H. Koyama1 , H. Inaji1 , T. Horinouchi2 , K. Nakanishi2 . 1 Surgery, 2 Radiology, Osaka Medical Center for Cancer and Cardiovascular, Osaka, Japan Goals: Superparamagnetic iron oxide (SPIO)-enhanced MR imaging has been reported to be promising for the detection of metastases in sentinel nodes localized by CT lymphography in patients with breast cancer (Motomura SABCS 2009). This study investigated the patterns of nodal enhancement on SPIO-enhanced MR imaging in patients with breast cancer and pathologically positive sentinel nodes. Methods: This study included 120 patients with breast cancer. Sentinel nodes were identified by CT lymphography, and SPIO-enhanced MR imaging of the axilla was performed to detect metastases in the sentinel nodes. Sentinel node biopsy was performed using a combination of dye and radiocolloid. Imaging results were correlated with histopathologic findings. Results: Twenty-seven nodes from 24 patients with positive sentinel nodes were evaluated. Four false negative patients were excluded. Three patterns of SPIO uptake were demonstrated for positive sentinel nodes. Four nodes (14.8%) showed uniform high signal intensity, 16 nodes (59.3%) showed partial high signal intensity involving more than 50% of the node, and 7 nodes (25.9%) showed partial high signal intensity in less than 50% of the node. High-signal-intensity patterns that were uniform or involved more than 50% of the node were observed in lymph nodes that contained macro-metastases, while high-signal-intensity patterns involving less than 50% of the node were observed in lymph nodes that contained micro-metastases. When the area of signal intensity was compared with the pathological size of the metastases, there was no difference for nodes with metastases 5 mm, but there was a significant difference for nodes with metastases <5 mm (p > 0.05 and p < 0.001, respectively, paired t test). Conclusion: High-signal-intensity patterns that are uniform or involve more than 50% of the node are features of nodes with macro-metastases. The area of high signal intensity correlated with the pathological size of metastases for nodes with metastases 5 mm in this series. Disclosure of Interest: None Declared
P238
Breast sentinel lymph node analysis intraoperative with OSNA (One step Nucleic Acid Amplification) to avoid second surgery for axillary lymph node dissection
F. Godey1 , C. Athias Bendavid2 , G. gandon1 , P. Tas3 , S. Rouquette2 , J. Blanchot4 , F. Foucher5 , J. Leveque5 . 1 Biology, 2 Surgery, Centre Eugene Marquis Cancer institute, 3 Pathology, Richier Laboratory, 4 Gynecology, Sagesse Private Hospital, 5 Gynecology, Pontchaillou University Hospital, Rennes, France Goals: Conventional methods for intraoperative assessment of sentinel lymph node (SLN) biopsy in breast cancer have a low sensitivity and lead to a second surgery when metastasis’ SLN were detected in postoperative histology. The OSNA method was developed to accurately detect intraoperative metastases (0.2 mm) by amplification of CK19 mRNA. OSNA assay for 367 patients is presented. Methods: SLN was analysed with OSNA intraoperative according to the manufacturer’s recommendations. CK19 mRNA copy number per ml of lysate determine the node status (no metastasis, micro metastasis, or macro metastasis). 367 patients underwent an axillary SLN procedure. OSNA was considered for patient management and an axillary lymph nodes dissection (ALND) was performed during the same surgery as SLN biopsy when OSNA positive. OSNA assay (N = 259 patients, infiltrant carcinoma <2 cm) was compared to standard histology using a match referent population (N = 355) who have underwent SLN biopsy procedure one year before with standard histology. Statistics were performed using SAS (Statistical analysis system). Results: OSNA positivity was found in 26.43% (N = 97/367) of patients, 27.7% (N = 90/324) considering only invasive carcinoma, 27.8% (N = 69/248) of patients with ductal carcinoma, 30% (N = 18/60) of patients with lobular carcinoma: these results are not significantly different. SLN OSNA metastasis’ size is significantly correlated to metastasis in ALND. SLN positivity rate was 24.32% in OSNA population (N = 259) compared to 24.79% in the reference population (N = 355) including isolated tumour
P232
The role of preoperative MRI in influencing the surgical decision making, a retrospective look at the experience of a large academic hospital in the face of a rising mastectomy rates
H. Ali1 , S. Hensley Alford2 , J. Saltzgaber2 , M. Jankowski2 , S. Ruszkowski2 , A. Zarbo2 . 1 Oncology, 2 Henry Ford Hospital, Detroit, United States Goals: MRI scanning has become a common preoperative imaging modality in breast cancer management. We performed a retrospective analysis of the association of breast MRI with mastectomy at a large academic group practice. Methods: This analysis used data from the MIBOQi (the Michigan Breast Oncology Quality Initiative) project which includes women 50 years or older who underwent breast cancer (BC) surgery at our institution between October 2006-June 2010. We analyzed the influence of MRI prior to definitive surgery on the choice of surgical procedure. Among those who received an MRI and mastectomy, we reviewed the medical record to determine if the mastectomy was related to the MRI (lumpectomy was intended prior to MRI), surgically indicated (mastectomy intended prior to MRI or performed after a lumpectomy), or by patient choice. Data were available on patient demographics, surgical decisions, type and date of surgery, and bMRI procedures. Logistic regression was used to assess the associations of mastectomy with stage at diagnosis, age, race, and breast MRI as univariate and multivariate models. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: A total of 436 women were included in the analysis. Of these women, 28% (n = 124) received a preoperative breast MRI and 17% (n = 74) received a mastectomy. In univariate analysis, mastectomy was associated with stage (stage IIB or greater, OR = 3.85; 95% CI 1.76–8.46) and preoperative breast MRI (OR = 1.89; 95% CI 1.12–3.17). When controlling for stage, age, and race, preoperative breast MRI was still associated with mastectomy (adjusted OR = 1.93; 95% CI 1.12–3.31). Among the women who received an MRI and mastectomy (n = 30), the mastectomy decision was MRI related in 11 cases (37%), surgically indicated in 15 cases (50%), and the patient’s choice in 4 cases (13%). Conclusion: Women who received a preoperative breast MRI were almost twice as likely to have a mastectomy when compared to women who did not receive a preoperative breast MRI, even after controlling for age, race, and stage at diagnosis. Medical record review reveled that in half of cases the mastectomy was surgically indicated, however, a third of the time the MRI did influence the mastectomy decision. Disclosure of Interest: None Declared
P233
Descriptive results of surgical treatment for breast cancer: A 30-year experience in the northeast of China
S. Li1 , Z. Fan2 . 1 Department of breast surgery, 2 The first Hospital of Jilin University, Changchun, China
Poster Session II. Surgery/Sentinels/DCIS
422 (13.88%) were N.A. The most common pTNM classification still was Stage II, but the percentage of stage I patients gradually increased (30.1% in 2005–2009). The most common histological type was infiltrating ductal carcinoma (2233 patients, 73.43%). Modified radical mastectomy was the most common operation procedure performed (2250 patients, 73.99%), and was used increasingly while radical mastectomy was adopted decreasingly in recent decade. At the same time breast-conserving surgery (213 patients, 7.00%) seems to increase sharply in the recent decade. The sentinal lymphnode biopsy has become the first biopsy method of axillary lymphnode for the patients with early breast cancer in the past two years. Conclusion: The variation of operation procedures performed on patients with breast cancers reflected the advance of our understanding of the biology of breast cancer and the progression of new treatment principles. And modified radical mastectomy still was the major operation procedure in our hospital. Disclosure of Interest: None Declared
P234
The role of pre-operative CT staging in predicting the sentinel lymph node status
S. Khawaja1 , A. Huws1 , R. Kannan1 , H. Sumrien1 , Y. Sharaiha1 , S. Holt1 . 1 Breast Unit, Prince Philip Hospital, Llanelli, United Kingdom Goals: In our institution, intraoperative analysis of the sentinel lymph node is performed with the help of the pCR veridex technique. This eliminates the need for a second delayed axillary clearance in the majority of patients. However, it prolongs the procedure by approximately 40 minutes because of the delay in reporting the results. To prevent patients from unnecessarily undergoing the latter procedure, the role of pre-operative CT staging in assessing the axilla was evaluated. Methods: Newly diagnosed breast cancer patients undergoing preoperative CT staging and sentinel lymph node biopsies were included in the study. The indications of the latter investigation were patients less than 40 years at the time of diagnosis and predicted grade III breast cancers on the core biopsies. Patients excluded were the ones who underwent CT staging for known axillary disease. At the onset of the study, patients were initially included retrospectively and later followed prospectively. Results: The study included patients undergoing pre-operative CT staging from January 2007 to the present date. 79 patients underwent preoperative CT staging. The indications were an age of less than 40 years in 10 patients and predicted grade III breast cancers in 25 patients. 70 patients had no axillary involvement on the CT scan. Out of these patients, 52 were confirmed histologically to have negative sentinel lymph nodes. 5 patients were veridex positive but H&E negative representing micrometastases. 2 further patients had micrometastases on H&E staining. However, 11 patients were found to have histologically proven axillary disease. This made a false negative rate of 15%. Out of the 9 patients with predicted axillary lymph node disease on the CT scan, 7 were confirmed histologically to have the latter findings. Conclusion: Our results show that pre-operative CT staging can relatively accurately assess the axilla in breast cancer patients. Since we have found the above findings, we have begun to omit patients from undergoing sentinel node biopsies in CT predicted axillary node disease. These patients undergo an immediate axillary clearance. Disclosure of Interest: None Declared
P235 Goals: To review the evolution of the current surgical treatment for breast cancer over the past thirty years in the First Hospital of Jilin University (the former Bethune University of Medical Sciences) in the northeast of China. Methods: 3041 patients with primary breast cancer diagnosed and surgically treated in the First Hospital from January 1980 to December 2009 were analyzed, retrospectively. Results: The patient’s number with breast cancer in our hospital increased year by year over the past 30 years. Characteristics of all patients population are as follow: three thousand and thirteen patients (99.1%) are female, twenty-eight (0.9%) are male. The incidence peak was 45−49 yr in the recent decade. Median age at diagnosis was earlier in the northeast than in the western countries or in Shanghai, although it increased from 44.9 yr in 1985–1989 to 50.1 yr in 2005–2009. Patients were clinically and pathologically staged in accordance with UICC, 24 (0.79%) were stage 0, 584 (19.20%) patients were stage I, 1510 (49.65%) were stage II, 457 (15.03%) cases were stage III, 44 (1.45%) were stage IV and
S55
Quality of life and satisfaction of patients diagnosed and treated for breast cancer
´ 1 , P. Manosalvas1 , M. Gallego1 , M. Sanz1 , M. Arroyo1 , S. Aragon 1 , N. Pinas ´ ˜ 3. M. Blanco1 , R. Noguero2 , B. Sancho1 , J. Hernandez 1 Ginecolog´ıa y obstetricia, Hospital 12 de Octubre, Madrid, 2 ginecolog´ıa ´ y obstetricia, Hospital Infanta Cristina, Parla, 3 Psicooncolog´ıa medica, Hospital 12 de Octubre Madrid, Spain Goals: EuroQoL, a quality of life related to health questionnaire, assesses the mood, the core activity, the social relationship and pain. Anxietydepression scale (VAS) is used to assess the quality of life (QoL) of breast cancer patients attended in our unit. We conducted interviews at the first review postsurgery. Methods: A prospective observational study in 617 patients from 2007 to 2010. EuroQoL, VAS and the clinical features were analysed. The Chisquare and Fisher test were applied using SPSS 17.
S56
Poster Session II. Surgery/Sentinels/DCIS
Results: 38.9% patients suffered mastectomy vs 61.1% conservative surgery. Immediately reconstruction was performed on 8.4% patients. 35% underwent axillary dissection (AD), 55.6% suffered sentinel node dissection (SBLN). 50.5% received adjuvant chemotherapy, 74.6% radiotherapy, 77% tamoxifen or aromatase inhibitor. We conducted 398 interviews. SCORES EUROQol: low 9%, medium 48.8%, high 4.12%. 45% maintained their main activity, 37.6% were not anxious or depressed. VAS score was 5.5 for anxiety and 3.2 for depression. Four age groups were established to see differences in the total score of the EUROQol and in each item. Among age groups, those who underwent AD (292) only PAINscore EUROQol was significant different (p 0.034). SBLN (317) did not show significant differences in the items of EUROQol respect to those who did not perform axillary surgery. Radical vs conservative did not show significant differences of all items or Score EUROQol. Patients taking hormonotherapy had a lower EuroQOL on main Activity (p 0.026). Mood and impairment in social relationships significantly associated (p 0.027, p 0.030 respectively). QoL was found significant different in women taking Hormonetherapy regardless of the class (p 0.017). Conclusion: Most of the patients who participated in the interview had a high score on the EUROQol. Nearly half of them kept their core business after surgery. We found a significant difference in pain EUROQol item and AD regardless the age group. Performance SBLN enables to reach the similar EUROQol level than the patients suffered no axillary manipulation. Thus, side effects of endocrinotherapy must be considered because they impact negatively on our patients’ demeanours and their social relationships. Disclosure of Interest: None Declared
P236
3T-MRI can predict the metastasis of sentinel node detected by 3D-CT mammary lymphography
K. Yamashita1 , S. Haga1 , K. Shimizu1 . 1 Department of Surgery, Nippon Medical School, Tokyo, Japan Goals: 3D-CT lymphography (LG) can show the detailed lymphatic network of the breast and the axilla, and can contribute to more accurate sentinel node (SN) biopsy. We reported the effectiveness of SPECT-fused 3D-CT LG for surgery at the last meeting. Now, we applied 3-tesla-MRI to enhance SN and to match with the SN detected by 3D-CT LG. It shows the typical shape of the metastasized lymph node. We tried to predict the SN metastasis before surgery by the enhanced pattern of SN. Methods: 3D-CT LG was performed to mark SN on the skin before surgery. Above the tumor and near the areola, 2 ml of Iopamidol 300 was injected subcutaneously. Images of CT scan were taken at 1 and 3 min after injection to produce a 3D image of lymph ducts and nodes. The dynamic contrast-enhanced MRI of the breast was performed using 3T MRI by bolus injection of gadolinium. T1-weighted fat-suppressed images were reconstructed to 3D images to show the shape of SN. SN biopsy was performed by dye and RI method using the endoscopic technique. The skin incision was made 1 cm long in the axilla on the marked position. Results: We have performed 3D-CT LG on 200 patients and evaluated SN in 3D-MRI on 50 patients. The average age was 55.1 years old. The average tumor size was 2.4 cm. The average sampled number of SN was 2.3. SN metastasis was observed on 16 patients and not on 34 patients. Only sentinel node metastasis was on 10 patients (62.5%). There was no false negative study. We performed mastectomy on 8 patients, and the video-assisted breast conserving surgery on 42 patients. The comparison of 3D-CT LG and 3D-MRI shows the incompatible enhancement on 18 patients. 8 were metastasized among them. The enhanced shapes of SN were classified to 3 patterns. Whole enhanced pattern was observed on 34, partial enhanced pattern was on 10, and non-enhanced pattern was on 6. 3D-MRI was more sensitive to metastasis by the differentiation of the enhanced patterns of SN. 3D-MRI with 3D-CT LG will become to be more predictive for metastasis than only 3D-CT LG. Conclusion: 3D-MRI can show the sensitive enhancement of SN guided with 3D-CT LG. The precisely detected SN of 3D-CT LG will be predictable for metastasis by the incompatibility of the enhanced pattern of SN with 3D-MRI. They will help the accurate SN biopsy and will be the indication tools to decide the axillary surgery: SN biopsy or axillary preservation. Disclosure of Interest: None Declared
Friday, 18 March 2011
P237
Patterns of nodal enhancement on MR imaging with SPIO in patients with breast cancer demonstrating positive sentinel nodes
K. Motomura1 , S. Nakahara1 , M. Ishitobi1 , Y. Komoike1 , H. Koyama1 , H. Inaji1 , T. Horinouchi2 , K. Nakanishi2 . 1 Surgery, 2 Radiology, Osaka Medical Center for Cancer and Cardiovascular, Osaka, Japan Goals: Superparamagnetic iron oxide (SPIO)-enhanced MR imaging has been reported to be promising for the detection of metastases in sentinel nodes localized by CT lymphography in patients with breast cancer (Motomura SABCS 2009). This study investigated the patterns of nodal enhancement on SPIO-enhanced MR imaging in patients with breast cancer and pathologically positive sentinel nodes. Methods: This study included 120 patients with breast cancer. Sentinel nodes were identified by CT lymphography, and SPIO-enhanced MR imaging of the axilla was performed to detect metastases in the sentinel nodes. Sentinel node biopsy was performed using a combination of dye and radiocolloid. Imaging results were correlated with histopathologic findings. Results: Twenty-seven nodes from 24 patients with positive sentinel nodes were evaluated. Four false negative patients were excluded. Three patterns of SPIO uptake were demonstrated for positive sentinel nodes. Four nodes (14.8%) showed uniform high signal intensity, 16 nodes (59.3%) showed partial high signal intensity involving more than 50% of the node, and 7 nodes (25.9%) showed partial high signal intensity in less than 50% of the node. High-signal-intensity patterns that were uniform or involved more than 50% of the node were observed in lymph nodes that contained macro-metastases, while high-signal-intensity patterns involving less than 50% of the node were observed in lymph nodes that contained micro-metastases. When the area of signal intensity was compared with the pathological size of the metastases, there was no difference for nodes with metastases 5 mm, but there was a significant difference for nodes with metastases <5 mm (p > 0.05 and p < 0.001, respectively, paired t test). Conclusion: High-signal-intensity patterns that are uniform or involve more than 50% of the node are features of nodes with macro-metastases. The area of high signal intensity correlated with the pathological size of metastases for nodes with metastases 5 mm in this series. Disclosure of Interest: None Declared
P238
Breast sentinel lymph node analysis intraoperative with OSNA (One step Nucleic Acid Amplification) to avoid second surgery for axillary lymph node dissection
F. Godey1 , C. Athias Bendavid2 , G. gandon1 , P. Tas3 , S. Rouquette2 , J. Blanchot4 , F. Foucher5 , J. Leveque5 . 1 Biology, 2 Surgery, Centre Eugene Marquis Cancer institute, 3 Pathology, Richier Laboratory, 4 Gynecology, Sagesse Private Hospital, 5 Gynecology, Pontchaillou University Hospital, Rennes, France Goals: Conventional methods for intraoperative assessment of sentinel lymph node (SLN) biopsy in breast cancer have a low sensitivity and lead to a second surgery when metastasis’ SLN were detected in postoperative histology. The OSNA method was developed to accurately detect intraoperative metastases (0.2 mm) by amplification of CK19 mRNA. OSNA assay for 367 patients is presented. Methods: SLN was analysed with OSNA intraoperative according to the manufacturer’s recommendations. CK19 mRNA copy number per ml of lysate determine the node status (no metastasis, micro metastasis, or macro metastasis). 367 patients underwent an axillary SLN procedure. OSNA was considered for patient management and an axillary lymph nodes dissection (ALND) was performed during the same surgery as SLN biopsy when OSNA positive. OSNA assay (N = 259 patients, infiltrant carcinoma <2 cm) was compared to standard histology using a match referent population (N = 355) who have underwent SLN biopsy procedure one year before with standard histology. Statistics were performed using SAS (Statistical analysis system). Results: OSNA positivity was found in 26.43% (N = 97/367) of patients, 27.7% (N = 90/324) considering only invasive carcinoma, 27.8% (N = 69/248) of patients with ductal carcinoma, 30% (N = 18/60) of patients with lobular carcinoma: these results are not significantly different. SLN OSNA metastasis’ size is significantly correlated to metastasis in ALND. SLN positivity rate was 24.32% in OSNA population (N = 259) compared to 24.79% in the reference population (N = 355) including isolated tumour