- Email: [email protected]
P318 Accuracy of frozen section or cytology of sub-nipple tissue to predict nipple involvement for cancer
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Poster Abstracts II / The Breast 24S1 (2015) S87–S150
system resulting in a sensitivity of 100%. The tissue from the core needle biopsy showed lymph tissue with a micro metastases. The frozen section of the full SLN was negative. The re-evaluation of the SLN after the finding in the core needle biopsy also revealed isolated tumor cells. The SLN-staging would have been false negative. Finally, the new method was evaluated on 6 patients. 5–14 biopsie samples were taken from each SLN. All contained tumor-free lymph tissue. This was in all cases confirmed by the evaluation of the surgically extracted SLNs. The vacuum-assisted biopsy introduced no complications that needed surgical revision or led to post-surgical trauma. Conclusion: The SentiGuide method introduces a reliable technique to perform non-surgical SLNB. It effectively identifies and stages the SLNs. First results show did not show any complications. The results led to the design of a randomized study with 288 patients to compare the performance between the surgical and non-surgical approaches in sentinel lymph node staging and complication reduction. Results of the first study phase will be presented in March 2015. Disclosure of Interest: I am a consultant for SurgicEye GmbH Friedenstr. 18A D-81671 Munchen. ¨ P318 Accuracy of frozen section or cytology of sub-nipple tissue to predict nipple involvement for cancer G.M. Duarte *, A. Oliveira, M.V. Thomazin, F. Tocchet, L. Moreira, A. Worchech, R.Z. Torresan. Breast Surgery, UNICAMP – State University of Campinas, Campinas, Brazil Goals: Occult nipple involvement for cancer occurs about 10–14%. Sub-nipple tissue (SNT) exam has been used by some surgeons to preserve or not the nipple in nipple sparing mastectomy. Then, intraoperative exam of SNT becomes an important tool. However, it is uncertain if the SNT evaluation can safely predict the nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of intraoperative frozen section and imprint cytology, and postoperative paraffin histopathology of SNT to predict involvement of the nipple in breast carcinoma women. Methods: It was realized a prospective study with 68 consecutive breast carcinoma women (stage 0, I, II and III) undergone mastectomy. It was excluded inflammatory carcinoma and clinical evident nipple involvement. After mastectomy, the nipple areolar complex was dissected simulating nipple-sparing flap. Then, the SNT was removed and submitted to frozen section and imprint cytology in intraoperative time. Subsequently, it was submitted to routine paraffin histopathology. The nipple was examined separately by paraffin histopathology (gold standard). We considered any atypical cells like positive findings in all exams (cytology, frozen and paraffin). Results: Occult nipple involvement rate was 11.7%; the mean age was 60.8 years; the mean tumor size was 29.7 mm in clinical exam and 27.7 mm in pathological exam. The mean distances from tumor to nipple were 24.3 mm and 33.5 mm in clinical and mammographic exams, respectively. The frozen section, imprint cytology, and paraffin of SNT showed: accuracy 86.8%, 76.5% and 86.8%; sensitivity 50%, 37.5% and 62.5%; specificity 91.7%, 81.7% and 90%; PPV 44.4%, 21.4% and 45.5%; NPV 93.2%, 90.7% and 94.7% respectively. Accuracy of frozen section was similar to paraffin (p = 0.77) and both were better than imprint cytology (p = 0.01). False negative rate were 6.8% of frozen section and 9.3% of cytology. Conclusion: Our data suggests that SNT evaluation is a good method to predict nipple occult involvement; on the other hand it is not totally safe. The outcomes showed a good accuracy and low false negative rate of intraoperative exam of SNT (frozen section and cytology). When we compared both exams, frozen section had better accuracy than imprint cytology. Disclosure of Interest: No significant relationships.
P319 Role of breast MRI in prediction of malignant invasion of nipple areolar complex H. Lai1 *, H. Wu2 , D. Chen1 , C. Chen3 , S. Kuo1 , S. Chen1 . 1 Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan, 2 Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan, 3 Department of Surgerical Pathology, Changhua Christian Hospital, Changhua, Taiwan Goals: Nipple sparing mastectomy is increasingly used as a surgical treatment for breast cancer. To correctly predict the possibility of nipple invasion pre-operatively is critical important to prevent occult nipple invasion or early nipple recurrence. The objective of our study is to assess the diagnostic accuracy of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex (NAC). Methods: From January 2011 to December 2013, patients with primary operable breast cancer diagnosed and treated at Changhua Christian Hospital (CCH), Taiwan were searched. The inclusion criteria were primary operable breast cancer patients, who received pre-operative breast MRI, and received breast cancer operation at CCH. The exclusion criteria were patients whose primary tumor was removed before definite cancer operation, those who received neoadjuvant chemotherapy, or patient’s detailed data not available. Breast MRI examinations were retrospectively reviewed for nipple invasion or retraction, periareolar skin thickening, nipple areolar complex enhancement, relationship to the subareolar mass, malignant mass pattern, thickness of nipple-areolar complex enhancement, tumor-nipple distance, and tumor size and were correlated with pathologic findings. The accuracy of breast MRI to predict nipple invasion was compared with pre-operative image and post-operative pathologic reports. Results: A total 704 primary operable breast cancers with preoperative MRI and post operative pathologic reports were enrolled in our current study. Among them 371 (52.7%) patients received total mastectomy, and 333 (47.3%) received partial mastectomy. In the total 704 patients, MRI showed signs of suspect NAC invasion in 160 (22.7%) patients. Total 41 (25.6%) patients were pathologic proven malignant invasion of NAC. In the final pathologic analysis, 57 pathologic confirmed NAC invasions were found in the 704 patients. The overall nipple invasion rate was 8.1% (57/704) in this current study. The sensitivity of Breast MRI to predict NAC involvement was 71.9% (41/57). The Specificity of breast MRI to NAC invasion is 81.6% (528/647). The positive predictive value of breast MRI is 25.6% (41/160). The negative predictive value of breast MRI is 97.1% (528/544). The accuracy of breast MRI to predict NAC involvement is 80.8% ([41+528]/704). Conclusion: MRI is an useful diagnostic image method for the evaluation of malignant invasion of the nipple-areolar complex. Through preoperative breast MRI evaluation of NAC status, more personalized oncoplastic breast surgery could be performed. Disclosure of Interest: No significant relationships. P320 Evaluation of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies Y. Ogasawara *, M. Hatono, K. Kawasaki. Breast and Endocrine Surgery, Kagawa Prefectural Central Hospital, Takamatsu City, Japan Goals: Recently, CT lymphography (CTLG) employing a nonionic contrast medium has achieved sentinel lymph node (SLN) identification. This CTLG can visualize the drainage lymphatic pathway clearly and demonstrate the accurate location of SLN. In this study, risk factors for developing lymphedema in breast cancer patients undergoing sentinel lymph node biopsies (SLNBs) were evaluated using CTLG.
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
system resulting in a sensitivity of 100%. The tissue from the core needle biopsy showed lymph tissue with a micro metastases. The frozen section of the full SLN was negative. The re-evaluation of the SLN after the finding in the core needle biopsy also revealed isolated tumor cells. The SLN-staging would have been false negative. Finally, the new method was evaluated on 6 patients. 5–14 biopsie samples were taken from each SLN. All contained tumor-free lymph tissue. This was in all cases confirmed by the evaluation of the surgically extracted SLNs. The vacuum-assisted biopsy introduced no complications that needed surgical revision or led to post-surgical trauma. Conclusion: The SentiGuide method introduces a reliable technique to perform non-surgical SLNB. It effectively identifies and stages the SLNs. First results show did not show any complications. The results led to the design of a randomized study with 288 patients to compare the performance between the surgical and non-surgical approaches in sentinel lymph node staging and complication reduction. Results of the first study phase will be presented in March 2015. Disclosure of Interest: I am a consultant for SurgicEye GmbH Friedenstr. 18A D-81671 Munchen. ¨ P318 Accuracy of frozen section or cytology of sub-nipple tissue to predict nipple involvement for cancer G.M. Duarte *, A. Oliveira, M.V. Thomazin, F. Tocchet, L. Moreira, A. Worchech, R.Z. Torresan. Breast Surgery, UNICAMP – State University of Campinas, Campinas, Brazil Goals: Occult nipple involvement for cancer occurs about 10–14%. Sub-nipple tissue (SNT) exam has been used by some surgeons to preserve or not the nipple in nipple sparing mastectomy. Then, intraoperative exam of SNT becomes an important tool. However, it is uncertain if the SNT evaluation can safely predict the nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of intraoperative frozen section and imprint cytology, and postoperative paraffin histopathology of SNT to predict involvement of the nipple in breast carcinoma women. Methods: It was realized a prospective study with 68 consecutive breast carcinoma women (stage 0, I, II and III) undergone mastectomy. It was excluded inflammatory carcinoma and clinical evident nipple involvement. After mastectomy, the nipple areolar complex was dissected simulating nipple-sparing flap. Then, the SNT was removed and submitted to frozen section and imprint cytology in intraoperative time. Subsequently, it was submitted to routine paraffin histopathology. The nipple was examined separately by paraffin histopathology (gold standard). We considered any atypical cells like positive findings in all exams (cytology, frozen and paraffin). Results: Occult nipple involvement rate was 11.7%; the mean age was 60.8 years; the mean tumor size was 29.7 mm in clinical exam and 27.7 mm in pathological exam. The mean distances from tumor to nipple were 24.3 mm and 33.5 mm in clinical and mammographic exams, respectively. The frozen section, imprint cytology, and paraffin of SNT showed: accuracy 86.8%, 76.5% and 86.8%; sensitivity 50%, 37.5% and 62.5%; specificity 91.7%, 81.7% and 90%; PPV 44.4%, 21.4% and 45.5%; NPV 93.2%, 90.7% and 94.7% respectively. Accuracy of frozen section was similar to paraffin (p = 0.77) and both were better than imprint cytology (p = 0.01). False negative rate were 6.8% of frozen section and 9.3% of cytology. Conclusion: Our data suggests that SNT evaluation is a good method to predict nipple occult involvement; on the other hand it is not totally safe. The outcomes showed a good accuracy and low false negative rate of intraoperative exam of SNT (frozen section and cytology). When we compared both exams, frozen section had better accuracy than imprint cytology. Disclosure of Interest: No significant relationships.
P319 Role of breast MRI in prediction of malignant invasion of nipple areolar complex H. Lai1 *, H. Wu2 , D. Chen1 , C. Chen3 , S. Kuo1 , S. Chen1 . 1 Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan, 2 Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan, 3 Department of Surgerical Pathology, Changhua Christian Hospital, Changhua, Taiwan Goals: Nipple sparing mastectomy is increasingly used as a surgical treatment for breast cancer. To correctly predict the possibility of nipple invasion pre-operatively is critical important to prevent occult nipple invasion or early nipple recurrence. The objective of our study is to assess the diagnostic accuracy of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex (NAC). Methods: From January 2011 to December 2013, patients with primary operable breast cancer diagnosed and treated at Changhua Christian Hospital (CCH), Taiwan were searched. The inclusion criteria were primary operable breast cancer patients, who received pre-operative breast MRI, and received breast cancer operation at CCH. The exclusion criteria were patients whose primary tumor was removed before definite cancer operation, those who received neoadjuvant chemotherapy, or patient’s detailed data not available. Breast MRI examinations were retrospectively reviewed for nipple invasion or retraction, periareolar skin thickening, nipple areolar complex enhancement, relationship to the subareolar mass, malignant mass pattern, thickness of nipple-areolar complex enhancement, tumor-nipple distance, and tumor size and were correlated with pathologic findings. The accuracy of breast MRI to predict nipple invasion was compared with pre-operative image and post-operative pathologic reports. Results: A total 704 primary operable breast cancers with preoperative MRI and post operative pathologic reports were enrolled in our current study. Among them 371 (52.7%) patients received total mastectomy, and 333 (47.3%) received partial mastectomy. In the total 704 patients, MRI showed signs of suspect NAC invasion in 160 (22.7%) patients. Total 41 (25.6%) patients were pathologic proven malignant invasion of NAC. In the final pathologic analysis, 57 pathologic confirmed NAC invasions were found in the 704 patients. The overall nipple invasion rate was 8.1% (57/704) in this current study. The sensitivity of Breast MRI to predict NAC involvement was 71.9% (41/57). The Specificity of breast MRI to NAC invasion is 81.6% (528/647). The positive predictive value of breast MRI is 25.6% (41/160). The negative predictive value of breast MRI is 97.1% (528/544). The accuracy of breast MRI to predict NAC involvement is 80.8% ([41+528]/704). Conclusion: MRI is an useful diagnostic image method for the evaluation of malignant invasion of the nipple-areolar complex. Through preoperative breast MRI evaluation of NAC status, more personalized oncoplastic breast surgery could be performed. Disclosure of Interest: No significant relationships. P320 Evaluation of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies Y. Ogasawara *, M. Hatono, K. Kawasaki. Breast and Endocrine Surgery, Kagawa Prefectural Central Hospital, Takamatsu City, Japan Goals: Recently, CT lymphography (CTLG) employing a nonionic contrast medium has achieved sentinel lymph node (SLN) identification. This CTLG can visualize the drainage lymphatic pathway clearly and demonstrate the accurate location of SLN. In this study, risk factors for developing lymphedema in breast cancer patients undergoing sentinel lymph node biopsies (SLNBs) were evaluated using CTLG.