- Email: [email protected]
P238 Breast sentinel lymph node analysis intraoperative with OSNA (One step Nucleic Acid Amplification) to avoid second surgery for axillary lymph node dissection
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
Friday, 18 March 2011 cells (ITC) in SLN positivity and 22.82% if excluding ITC. These results are not significantly different and suggest that OSNA could detect ITC. Conclusion: For infiltrant breast cancer surgery, SLN positivity rate using OSNA or standard final histology is the same, but thanks to OSNA 24.32% of patients avoided a second surgery for ALND. Disclosure of Interest: None Declared
P239
Examination about the adaptation of sentinel lymph node biopsy after neoadjuvant chemotherapy using 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in breast cancer
T. Shigekawa1 , I. Sugitani1 , H. Takeuchi1 , M. Misumi1 , N. Nakamiya1 , M. Sugiyama1 , N. Fujiuchi1 , A. Osaki1 , T. Saeki1 . 1 Breast Oncology, Saitama Medical University, Hidaka, Japan Goals: An accurate evaluation of axillary lymph node (ALN) involvement is essential for the therapeutic indication of sentinel lymph node (SLN) biopsy (SLNB). Although SLNB after primary systemic chemotherapy (PSC) has been examined in many studies, the reliability of it remains controversial. The aim of this study was to examine the utility of 18F-FDG PET/CT for selecting optimal patients who were suitable for SLNB after PSC in advanced breast cancer. Methods: Between June 2007 and April 2010, 79 patients with AJCC Stage II or III breast cancer, treated with anthracycline and/or taxane-based PSC and who underwent SLNB followed by complete ALN dissection, were enrolled for this study and 61 patients underwent 18F-FDG PET/CT before and after PSC for axillary staging. Visual assessment of 18F-FDG uptake for the axilla was performed by two experienced nuclear medicine radiologists and any abnormal axillary uptake greater than background activity was defined as metastasis positive lymph node. Results: An SLN was successfully identified in 60 patients (76%). The sensitivity of SLNB was 79.5% (31 of 39 patients) and the falsenegative rate was 20.5% (8 of 39 patients). Using 18F-FDG PET/CT criteria, patients with metastasis negative lymph node both before and after PSC (16 patients) had a better identification rate (87.5%; 14 of 16 patients), sensitivity (100%; 6 of 6 patients) and false-negative rate (0%; 0 of 6 patients) compared with those with metastasis positive lymph node before and/or after PSC (75.6%, 79.2%, and 20.8%, respectively). Conclusion: In patients who were metastasis negative both before and after PSC using 18F-FDG PET/CT criteria. The false-negative rate was very good (0%). So it was thought that these patients were suitable for SLNB after PSC. Disclosure of Interest: None Declared
P240
Poster Session II. Surgery/Sentinels/DCIS
7 ipsilateral breast recurrence and 7 distant metastases. Disease-Free survival was 96.6%, and overall survival was 97.7%. Conclusion: The incidence of axillary recurrence for the areolar injection method was relatively low and consistent with previous reports in other observational studies using other injection methods. Disclosure of Interest: None Declared
P241
S.H. Cho1 , M.R. Lee1 , D.C. Kim2 , K.C. Lee3 , J.H. Lee4 , H.C. Kwon5 , H.S. Lee6 , S. Lee5 . 1 Department of Surgery, 2 Department of Pathology, 3 Department of Plastic and Reconstructive Surgery, 4 Department of Radiology, 5 Department of Internal Medicine, 6 Department of Radiation Oncology, Dong-A Medical Center, Busan, Korea, Republic of Goals: Injection for sentinel lymph node biopsy (SLNB) in breast cancer surgery has been adopted by many institutions. However, there are a few studies that have reported the follow-up results for patients whose SLNB was performed with this injection method alone. Methods: Five hundred twenty nine patients with breast cancer underwent SLNB with periareolar injection of only radiotracer between March 2002 and March 2010. The follow-up examinations consisted of a physical examination, laboratory examination, mammography and ultrasonography every 6 months. Results: Of 529 patients with SLNB, 483 were found to have negative sentinel lymph nodes so that no axillary lymph node dissection (ALND) was performed. There were 22 macrometastases, 4 micrometastases and 20 isolated tumor cells in postoperative pathologic examination. So these were excluded from this study. Identification rate of SLN using periareolar injection with radiotracer was 100%. Median follow-up periods were 35.7 months (range 7–96.3). 2 of the 483 patients developed ipsilateral axillary recurrence for an axillary relapse incidence of 0.41%. And there were
Sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients
T. Kinoshita1 , T. Hojo1 , T. Nagao1 , N. Tamura1 , S. Tanaka1 , Y. Fujiwara2 . 1 Breast Surgery Division, 2 Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan Goals: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PST were investigated. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical tumor/nodal status before PST were analyzed. Methods: Between 2003 and 2008, 200 patients with Stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor >3 cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/ II axillary lymph node dissection (ALND). Results: The median patient age was 49 years, and the median primary tumor size was 4.9 cm. The overall SLN identification rate was 94.5% (189 of 200). In 178/189 patients (94%) the SLN accurately predicted the axillary status. Eleven patients had a false-negative SLN biopsy, yielding a false-negative rate of 12.9%. There were no significant differences in the SLN identification rate according to tumor classifications before PST, the clinical nodal status before PST, the clinical tumor response after PST, or pathological response of the tumor after PST, although the SLN identification rate tended to be lower in patients with a T4 primary tumor. Conclusion: Our data suggested that SLNB was a feasible method for axillary staging in breast cancer patients who received PST even in patients who initially with lymph node positive disease. However, false-negative rate of SLNB in patients with clinical and pathological complete tumor response tended to be higher than other groups. Disclosure of Interest: None Declared
P242 Long-term follow-up results of sentinel lymph node biopsy using periareolar injection in breast cancer patients
S57
Accuracy of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients
M. Takahashi1 , H. Jinno1 , T. Hayashida1 , M. Sakata1 , M. Mukai2 , Y. Kitagawa1 . 1 Department of surgery, 2 Department of Pathology, Keio University School of Medicine, Tokyo, Japan Goals: Sentinel lymph node biopsy (SLNB) has become an accurate alternative procedure to axillary lymph node dissection (ALND) for clinically node negative breast cancer patients. Neoadjuvant chemotherapy (NAC) is a standard of care for patients with locally advanced breast cancer and indications of NAC have been widespread to operable breast cancer patients to facilitate breast conserving surgery. However, the accuracy of SLNB in breast cancer patients who received NAC is still controversial. Methods: Ninety-six patients with stage II/III breast cancer who received NAC between January 2001 and July 2010 were included in the study. All patients underwent SLNB followed by completion ALND. Sentinel lymph node (SLN) was detected using a combined method of blue dye and technetium-99m-labeled tin colloid peritumorally and subcutaneously. SLNs were evaluated by means of H&E and immunohistochemical staining. Results: The overall SLN identification rate was 87.5% (84/96) and the mean number of SLNs per case was 3.0. Of the 84 cases with successful SLN mapping, 42 cases (50.0%) revealed lymph node metastasis after ALND. Twelve (28.5%) of these 42 patients had false-negative SLNB. Negative predictive value and accuracy of SLNB after NAC was 77.8% (42/54) and 85.7% (72/84), respectively. False-negative rate (FNR) in
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
Friday, 18 March 2011 cells (ITC) in SLN positivity and 22.82% if excluding ITC. These results are not significantly different and suggest that OSNA could detect ITC. Conclusion: For infiltrant breast cancer surgery, SLN positivity rate using OSNA or standard final histology is the same, but thanks to OSNA 24.32% of patients avoided a second surgery for ALND. Disclosure of Interest: None Declared
P239
Examination about the adaptation of sentinel lymph node biopsy after neoadjuvant chemotherapy using 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in breast cancer
T. Shigekawa1 , I. Sugitani1 , H. Takeuchi1 , M. Misumi1 , N. Nakamiya1 , M. Sugiyama1 , N. Fujiuchi1 , A. Osaki1 , T. Saeki1 . 1 Breast Oncology, Saitama Medical University, Hidaka, Japan Goals: An accurate evaluation of axillary lymph node (ALN) involvement is essential for the therapeutic indication of sentinel lymph node (SLN) biopsy (SLNB). Although SLNB after primary systemic chemotherapy (PSC) has been examined in many studies, the reliability of it remains controversial. The aim of this study was to examine the utility of 18F-FDG PET/CT for selecting optimal patients who were suitable for SLNB after PSC in advanced breast cancer. Methods: Between June 2007 and April 2010, 79 patients with AJCC Stage II or III breast cancer, treated with anthracycline and/or taxane-based PSC and who underwent SLNB followed by complete ALN dissection, were enrolled for this study and 61 patients underwent 18F-FDG PET/CT before and after PSC for axillary staging. Visual assessment of 18F-FDG uptake for the axilla was performed by two experienced nuclear medicine radiologists and any abnormal axillary uptake greater than background activity was defined as metastasis positive lymph node. Results: An SLN was successfully identified in 60 patients (76%). The sensitivity of SLNB was 79.5% (31 of 39 patients) and the falsenegative rate was 20.5% (8 of 39 patients). Using 18F-FDG PET/CT criteria, patients with metastasis negative lymph node both before and after PSC (16 patients) had a better identification rate (87.5%; 14 of 16 patients), sensitivity (100%; 6 of 6 patients) and false-negative rate (0%; 0 of 6 patients) compared with those with metastasis positive lymph node before and/or after PSC (75.6%, 79.2%, and 20.8%, respectively). Conclusion: In patients who were metastasis negative both before and after PSC using 18F-FDG PET/CT criteria. The false-negative rate was very good (0%). So it was thought that these patients were suitable for SLNB after PSC. Disclosure of Interest: None Declared
P240
Poster Session II. Surgery/Sentinels/DCIS
7 ipsilateral breast recurrence and 7 distant metastases. Disease-Free survival was 96.6%, and overall survival was 97.7%. Conclusion: The incidence of axillary recurrence for the areolar injection method was relatively low and consistent with previous reports in other observational studies using other injection methods. Disclosure of Interest: None Declared
P241
S.H. Cho1 , M.R. Lee1 , D.C. Kim2 , K.C. Lee3 , J.H. Lee4 , H.C. Kwon5 , H.S. Lee6 , S. Lee5 . 1 Department of Surgery, 2 Department of Pathology, 3 Department of Plastic and Reconstructive Surgery, 4 Department of Radiology, 5 Department of Internal Medicine, 6 Department of Radiation Oncology, Dong-A Medical Center, Busan, Korea, Republic of Goals: Injection for sentinel lymph node biopsy (SLNB) in breast cancer surgery has been adopted by many institutions. However, there are a few studies that have reported the follow-up results for patients whose SLNB was performed with this injection method alone. Methods: Five hundred twenty nine patients with breast cancer underwent SLNB with periareolar injection of only radiotracer between March 2002 and March 2010. The follow-up examinations consisted of a physical examination, laboratory examination, mammography and ultrasonography every 6 months. Results: Of 529 patients with SLNB, 483 were found to have negative sentinel lymph nodes so that no axillary lymph node dissection (ALND) was performed. There were 22 macrometastases, 4 micrometastases and 20 isolated tumor cells in postoperative pathologic examination. So these were excluded from this study. Identification rate of SLN using periareolar injection with radiotracer was 100%. Median follow-up periods were 35.7 months (range 7–96.3). 2 of the 483 patients developed ipsilateral axillary recurrence for an axillary relapse incidence of 0.41%. And there were
Sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients
T. Kinoshita1 , T. Hojo1 , T. Nagao1 , N. Tamura1 , S. Tanaka1 , Y. Fujiwara2 . 1 Breast Surgery Division, 2 Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan Goals: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PST were investigated. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical tumor/nodal status before PST were analyzed. Methods: Between 2003 and 2008, 200 patients with Stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor >3 cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/ II axillary lymph node dissection (ALND). Results: The median patient age was 49 years, and the median primary tumor size was 4.9 cm. The overall SLN identification rate was 94.5% (189 of 200). In 178/189 patients (94%) the SLN accurately predicted the axillary status. Eleven patients had a false-negative SLN biopsy, yielding a false-negative rate of 12.9%. There were no significant differences in the SLN identification rate according to tumor classifications before PST, the clinical nodal status before PST, the clinical tumor response after PST, or pathological response of the tumor after PST, although the SLN identification rate tended to be lower in patients with a T4 primary tumor. Conclusion: Our data suggested that SLNB was a feasible method for axillary staging in breast cancer patients who received PST even in patients who initially with lymph node positive disease. However, false-negative rate of SLNB in patients with clinical and pathological complete tumor response tended to be higher than other groups. Disclosure of Interest: None Declared
P242 Long-term follow-up results of sentinel lymph node biopsy using periareolar injection in breast cancer patients
S57
Accuracy of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients
M. Takahashi1 , H. Jinno1 , T. Hayashida1 , M. Sakata1 , M. Mukai2 , Y. Kitagawa1 . 1 Department of surgery, 2 Department of Pathology, Keio University School of Medicine, Tokyo, Japan Goals: Sentinel lymph node biopsy (SLNB) has become an accurate alternative procedure to axillary lymph node dissection (ALND) for clinically node negative breast cancer patients. Neoadjuvant chemotherapy (NAC) is a standard of care for patients with locally advanced breast cancer and indications of NAC have been widespread to operable breast cancer patients to facilitate breast conserving surgery. However, the accuracy of SLNB in breast cancer patients who received NAC is still controversial. Methods: Ninety-six patients with stage II/III breast cancer who received NAC between January 2001 and July 2010 were included in the study. All patients underwent SLNB followed by completion ALND. Sentinel lymph node (SLN) was detected using a combined method of blue dye and technetium-99m-labeled tin colloid peritumorally and subcutaneously. SLNs were evaluated by means of H&E and immunohistochemical staining. Results: The overall SLN identification rate was 87.5% (84/96) and the mean number of SLNs per case was 3.0. Of the 84 cases with successful SLN mapping, 42 cases (50.0%) revealed lymph node metastasis after ALND. Twelve (28.5%) of these 42 patients had false-negative SLNB. Negative predictive value and accuracy of SLNB after NAC was 77.8% (42/54) and 85.7% (72/84), respectively. False-negative rate (FNR) in