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P323 Nomogram predicting axillary PCR after neoadjuvant chemotherapy in node-positive breast cancer
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Poster Abstracts II / The Breast 24S1 (2015) S87–S150
P323 Nomogram predicting axillary PCR after neoadjuvant chemotherapy in node-positive breast cancer J.Y. Kim *, S. Kim, J. Ryu, H.S. Park, S. Park, S.I. Kim. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea Goals: The purpose of this study was to investigate the factors that predict the axillary pathologic complete response (pCR) and develop a nomogram predicting the probability of axillary pCR in cytologically-proven axillary node-positive breast cancer patients who received neoadjuvant chemotherapy. Methods: We reviewed the records of 415 patients with cytologically-proven node-positive breast cancer who were treated with neoadjuvant chemotherapy and followed by surgery between 2008 and 2012. Baseline patient and tumor characteristics, chemotherapy regimen, tumor and nodal response were analyzed. Nomogram was developed using a multivariable logistic regression model in a training cohort and validated in an external cohort of 110 patients between 2013 and 2014. Results: Axillary pCR was achieved in 38.8% of the patients who underwent ALND after NCT. Axillary pCR was associated with early clinical nodal status, negative estrogen receptor status, positive HER2 status treated with trastuzumab, clinical nodal response and clinical tumor response on the multivariate analysis. Nomogram was developed on the basis of significant and predefined predictors. It had good performance with discrimination (AUC 0.822, 95% CI 0.781–0.862) and calibration (P = 0.8806). The nomogram was validated (AUC 0.828, 95% CI 0.754–0.903), indicating good predictive power of the model when applied to the external validation data set. Conclusion: Our nomogram may be useful to predict the axillary pCR after neoadjuvant chemotherapy in patients with node-positive breast cancer. Patients with a high probability of achieving axillary pCR could be spared axillary lymph node dissection, avoiding postoperative morbidity. Disclosure of Interest: No significant relationships. P324 Endoscopic breast surgery can be navigated by virtual mode of 3D-CT K. Yamashita *. Breast Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Goals: The conventional breast surgery, including breast conserving surgery (BCS), makes many large wound scars on the breast with granulated ugly scars. We devised endoscopic video-assisted breast surgery (VABS) to perform partial and total mastectomy without any wound on the breast. We have performed on more than 400 patients since 2001. To obtain the minimum clear surgical margins and to improve the aesthetics of the breast after surgery, we tried to navigate VABS by the virtual mode of 3D-CT with endoscopic ultrasonographic probe. We evaluated the long term results of the aesthetics and curability over 10 years after surgery and the efficacy of the new navigation techniques. Methods: VABS consists of BCS, mastectomy, sentinel node (SN) biopsy, axillary node dissection, and breast reconstructions. It uses periareolar approach and/or axillary approach. Trans-axillary retromammary approach (TARM) is a single port surgery with an axillary skin incision. The each wound length is usually 2.5 cm, but 1 cm for SN biopsy. We cut the mammary gland with clear surgical margin from behind the mammary gland. The virtual endoscopic mode of 3D-CT images are overlaid on the endoscopic view to navigate precise SN biopsy and clear cutting at surgical margin of mammary gland. The endoscopic ultrasonographc probe can show precise position of the tumor and surgical margin from the backside of the mammary gland. The postoperative aesthetic results were
evaluated by ABNSW. The sensory tests were performed on the skin of breast and axilla after surgery chronically. Results: The endoscopic SN biopsy was performed on 400 patients, and 3D-CT lymphography on 300 patients. The virtual navigation helped to detect precise SN successfully. BCS was performed on 300 patients and skin-sparing mastectomy on 50 patients. The operative cost is very low as the conventional one. There was no significant difference in operational infestation. There was no serious complication after surgery. Surgical margin was minimally positive in 2 patients. The original shapes of the breast were preserved well. The follow-up is 160 months at maximum. There is 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.5%. The postoperative esthetic results were excellent and better. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusion: VABS can be considered as a good surgical procedure concerning locoregional control and esthetics. The endoscopic navigation system is useful for SN biopsy and partial mastectomy. Disclosure of Interest: No significant relationships. P325 Lymphedema incidence over time with sentinel lymph node dissection alone of Japanese women A. Ogiya1 *, D. Kitagawa1 , T. Sakai1 , Y. Miyagi1 , K. Iijima1 , H. Morizono1 , M. Makita1 , R. Horii2 , F. Akiyama3 , T. Iwase1 . 1 Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, 2 Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, 3 Pathology, Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan Goals: To elucidate the frequency of lymphedema occurrence over time with sentinel lymph node dissection alone of Japanese women. Methods: This study focused on 355 patients with primary breast cancer who allowed measurements to be taken of their arms before surgery between November 2009 and June 2010. The following circumferences were measured on both arms at the time of surgery and 1 and 3 years postoperatively at (1) 5 cm proximal to the olecranon, (2) 5 cm distal to the olecranon, (3) the wrist, and (4) the dorsum of the hand. We defined the “L” measurement as: (difference in circumference) = (postoperative circumference of the affected limb − preoperative circumference of the affected limb) − (postoperative circumference of the healthy limb − preoperative circumference of the healthy limb). Edema was considered present when (1) L ≥ 2 cm in at least one instance or (2) it was clearly recognizable to the naked eye (“observable edema”). In the absence of observable edema, a patient was considered to have “latent edema” if L was ≥2 in at least one instance. Results: There were 239 subjects in the dissection omitted group (SN group) and 116 subjects in the dissection group (Ax group). At 1 year postoperative, the frequencies of lymphedema in the SN and Ax groups were 4% and 13% latent edema and 0% and 9% observable edema, respectively. Three years postoperative, the frequency of lymphedema was 6.5% and 12% in patients with latent edema in the SN and Ax groups, respectively, and 0% and 15% in patients with observable edema in the SN and Ax groups, respectively. Among the nine subjects in the SN group who displayed lymphedema at 1 year postoperative, lymphedema disappeared in three by the third postoperative year. Most cases of lymphedema in the SN group that appeared 1–3 years postoperative were located 5 cm proximal to the elbow. Conclusion: The frequency of lymphedema occurrence over time increased in the SN group, and all were cases of latent edema. Disclosure of Interest: No significant relationships.
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
P323 Nomogram predicting axillary PCR after neoadjuvant chemotherapy in node-positive breast cancer J.Y. Kim *, S. Kim, J. Ryu, H.S. Park, S. Park, S.I. Kim. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea Goals: The purpose of this study was to investigate the factors that predict the axillary pathologic complete response (pCR) and develop a nomogram predicting the probability of axillary pCR in cytologically-proven axillary node-positive breast cancer patients who received neoadjuvant chemotherapy. Methods: We reviewed the records of 415 patients with cytologically-proven node-positive breast cancer who were treated with neoadjuvant chemotherapy and followed by surgery between 2008 and 2012. Baseline patient and tumor characteristics, chemotherapy regimen, tumor and nodal response were analyzed. Nomogram was developed using a multivariable logistic regression model in a training cohort and validated in an external cohort of 110 patients between 2013 and 2014. Results: Axillary pCR was achieved in 38.8% of the patients who underwent ALND after NCT. Axillary pCR was associated with early clinical nodal status, negative estrogen receptor status, positive HER2 status treated with trastuzumab, clinical nodal response and clinical tumor response on the multivariate analysis. Nomogram was developed on the basis of significant and predefined predictors. It had good performance with discrimination (AUC 0.822, 95% CI 0.781–0.862) and calibration (P = 0.8806). The nomogram was validated (AUC 0.828, 95% CI 0.754–0.903), indicating good predictive power of the model when applied to the external validation data set. Conclusion: Our nomogram may be useful to predict the axillary pCR after neoadjuvant chemotherapy in patients with node-positive breast cancer. Patients with a high probability of achieving axillary pCR could be spared axillary lymph node dissection, avoiding postoperative morbidity. Disclosure of Interest: No significant relationships. P324 Endoscopic breast surgery can be navigated by virtual mode of 3D-CT K. Yamashita *. Breast Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Goals: The conventional breast surgery, including breast conserving surgery (BCS), makes many large wound scars on the breast with granulated ugly scars. We devised endoscopic video-assisted breast surgery (VABS) to perform partial and total mastectomy without any wound on the breast. We have performed on more than 400 patients since 2001. To obtain the minimum clear surgical margins and to improve the aesthetics of the breast after surgery, we tried to navigate VABS by the virtual mode of 3D-CT with endoscopic ultrasonographic probe. We evaluated the long term results of the aesthetics and curability over 10 years after surgery and the efficacy of the new navigation techniques. Methods: VABS consists of BCS, mastectomy, sentinel node (SN) biopsy, axillary node dissection, and breast reconstructions. It uses periareolar approach and/or axillary approach. Trans-axillary retromammary approach (TARM) is a single port surgery with an axillary skin incision. The each wound length is usually 2.5 cm, but 1 cm for SN biopsy. We cut the mammary gland with clear surgical margin from behind the mammary gland. The virtual endoscopic mode of 3D-CT images are overlaid on the endoscopic view to navigate precise SN biopsy and clear cutting at surgical margin of mammary gland. The endoscopic ultrasonographc probe can show precise position of the tumor and surgical margin from the backside of the mammary gland. The postoperative aesthetic results were
evaluated by ABNSW. The sensory tests were performed on the skin of breast and axilla after surgery chronically. Results: The endoscopic SN biopsy was performed on 400 patients, and 3D-CT lymphography on 300 patients. The virtual navigation helped to detect precise SN successfully. BCS was performed on 300 patients and skin-sparing mastectomy on 50 patients. The operative cost is very low as the conventional one. There was no significant difference in operational infestation. There was no serious complication after surgery. Surgical margin was minimally positive in 2 patients. The original shapes of the breast were preserved well. The follow-up is 160 months at maximum. There is 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.5%. The postoperative esthetic results were excellent and better. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusion: VABS can be considered as a good surgical procedure concerning locoregional control and esthetics. The endoscopic navigation system is useful for SN biopsy and partial mastectomy. Disclosure of Interest: No significant relationships. P325 Lymphedema incidence over time with sentinel lymph node dissection alone of Japanese women A. Ogiya1 *, D. Kitagawa1 , T. Sakai1 , Y. Miyagi1 , K. Iijima1 , H. Morizono1 , M. Makita1 , R. Horii2 , F. Akiyama3 , T. Iwase1 . 1 Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, 2 Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, 3 Pathology, Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan Goals: To elucidate the frequency of lymphedema occurrence over time with sentinel lymph node dissection alone of Japanese women. Methods: This study focused on 355 patients with primary breast cancer who allowed measurements to be taken of their arms before surgery between November 2009 and June 2010. The following circumferences were measured on both arms at the time of surgery and 1 and 3 years postoperatively at (1) 5 cm proximal to the olecranon, (2) 5 cm distal to the olecranon, (3) the wrist, and (4) the dorsum of the hand. We defined the “L” measurement as: (difference in circumference) = (postoperative circumference of the affected limb − preoperative circumference of the affected limb) − (postoperative circumference of the healthy limb − preoperative circumference of the healthy limb). Edema was considered present when (1) L ≥ 2 cm in at least one instance or (2) it was clearly recognizable to the naked eye (“observable edema”). In the absence of observable edema, a patient was considered to have “latent edema” if L was ≥2 in at least one instance. Results: There were 239 subjects in the dissection omitted group (SN group) and 116 subjects in the dissection group (Ax group). At 1 year postoperative, the frequencies of lymphedema in the SN and Ax groups were 4% and 13% latent edema and 0% and 9% observable edema, respectively. Three years postoperative, the frequency of lymphedema was 6.5% and 12% in patients with latent edema in the SN and Ax groups, respectively, and 0% and 15% in patients with observable edema in the SN and Ax groups, respectively. Among the nine subjects in the SN group who displayed lymphedema at 1 year postoperative, lymphedema disappeared in three by the third postoperative year. Most cases of lymphedema in the SN group that appeared 1–3 years postoperative were located 5 cm proximal to the elbow. Conclusion: The frequency of lymphedema occurrence over time increased in the SN group, and all were cases of latent edema. Disclosure of Interest: No significant relationships.