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P327 Comparative study of preoperative core needle biopsy and surgical specimens in breast cancer
14th St.Gallen International Breast Cancer Conference / The Breast 24S1 (2015) S87–S150
P326 ARM in breast cancer with enlarged lymph node: a Chinese single center experience X. Ding *. Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China Goals: To study the success rate and safety of axillary reverse lymphatic mapping (ARM) and the their effects on the function and lymph edema of ipsilateral upper limb, and the quality of life of patients with early breast cancer after operation, further explore the related factors affecting the success rate of ARM. Methods: Among of 60 cases of female patients with enlarged axillary lymph nodes in early breast cancer confirmed by the clinical examination, preoperative lymphoscintigraphy by nano carbon was injected into the ipsilateral areola region by clockwise markering (named sentinel lymph node biopsy, SLNB), and intraoperative lymphoscintigraphy by methylene blue were injected into the subcutaneous and intramuscular of the ipsilateral medial arm by reverse markering (named axillary reverse mapping, ARM). In operation, we tried to protect the imaging lymph glands by reverse markering of upper limb (ARM), and only cleanned the axillary lymph nodes by clockwise markering (SLNB). Both the ARM nodes and the cross staining lymph nodes by methylene blue and nano carbon were carried out the intraoperative frozen section examination. We compared to the ipsilateral limb circumference and function and the quality of life of patient between the ARM success and ARM failure group, and actualized the normality test, t test and multivariate Logistic regression analysis for the potential factors of influencing ARM, such as age and body mass index (BMI). Results: Among of 60 cases patients, 38 cases (63.3%) with successful ARM, 17 cases (28.3%) were not successful, 5 cases (8.3%) with cross staining or cannot distinguish lymph node stained color. Only 1 node was found existing isolated cancer nests in 31 ARM lymph nodes, and 2 nodes were found metastatic carcinoma in 5 cross staining lymph nodes. Whether the ARM success has no statistical difference in the quality of life, but the ARM success group has slightly superiority. In the function of the ipsilateral upper limb, except in the abduction (P = 0.062) and external rotation (P = 0.083) in ARM success group closing to statistical significance, all the rest patients had no significantly difference (P > 0.05). The body mass index (BMI) and degree of upper limb lymphedema in ARM success group were significantly lower than in the ARM failure group (P < 0.05), but had nothing to do with age (P > 0.05). Multivariate analysis showed whether success of ARM was the independent risk factor of ipsilateral upper limb lymphedema (P < 0.05). Conclusion: To seek ARM in early breast cancer are safe and feasible, it can reduce the occurrence of ipsilateral upper limb edema, and is expected to improve upper limb function, as well as improve the quality of life. Whether ARM success is an independent risk factor for upper limb lymphedema after ALND. Disclosure of Interest: No significant relationships. P327 Comparative study of preoperative core needle biopsy and surgical specimens in breast cancer P. Grigoropoulos1 *, A. Drakou2 , N. Papakonstantinou2 , D. Karoutsos2 , M. Tsompalioti2 , O. Dagadaki2 , A. Tsipoura2 , D. Issaiadis2 , S. Ammari2 . 1 Surgical Clinic, General Oncological Hospital Ag. Anargyroi, Nea Makri, Greece, 2 General Oncological Hospital of Kifissia Ag. Anargyroi, Athens, Greece Goals: Core needle biopsy (CNB) is often used as a diagnostic tool in patients who suffer from breast cancer. The purpose of our study is to compare the concordance between the results of the CNB and those of the surgical excision specimens.
S139
Methods: This retrospective comparative study include 45 patients who underwent core needle biopsy (CNB) preoperatively to confirm breast cancer, from 10/2012 to 12/2014 in our clinic. All biopsies were performed under ultrasound-guided with at least five 14-gauge core biopsies being obtained for pathological examination. We examined the histologic type of the cancer, the grade, ER, PR, Her2, Ki67 and p53. In the patients found with Her2 2+ the specimen was examined with FISH or CISH methods. The cut-off of Ki67 was 14%. Specimens are considered positive for ER, PR in cases that staining of the nucleus of the cells is over 1%. Her2 tumors were categorized as positive if >10% of the nuclei was stained. P53 positivity was defined as greater than 5% positivity staining of any intensity in the tissue. All were diagnosed with invasive ductal breast carcinoma. Results: The average age of patients was 59.5 years (range 30–90). The histologic type in core needle biopsy comparing with that of the surgical excision specimen was the same in all cases. The overall concordance rate of modified by Elston and Ellis scale of Bloom– Richardson score between CNB and histology reports was 100%. Immunohistochemical stainings for ER positive were reported in 37 patients’ excisional biopsies (82.2%) and for ER negative in 8 (17.8%). The false positive ER of CNB were 2 (4.44%) and the false negative ER were 1 (2.22%). Immunohistochemical stainings for PR positive were reported in 34 cases (75.6%) and PR negative in 11 (24.4%). 3 (6.66%) false negative PR results of CNB were observed. 8 (17.8%) of our patients were Her2 positive, while 35 (77.8%) diagnosed as Her2 negative. False negative cerb2 observed in 1 case (2.22%) and false positive in 2 (4.44%). As far as p53 concerns, it was positive in 29 patients (64.5%) and negative in 16 (35.5%). False negative and false positive percentage was respectively 4.4% (2 cases) and 6.6% (3 cases). Ki67 is reported <14% in 14 patients (31.1%) and >14% in 31 (68.9%). 3 of these cases (6.6%) had false Ki67 <14% and also 3 cases (6.6%) had false Ki67 >14%. Conclusion: The discordance percentages that are noted between CNB and surgical excision specimens may be due to many factors, such as sampling of the tumor, preparation techniques of immunohistochemical staining, the time of samples fixation etc. Nevertheless, in the majority of cases CNB findings are in concordance with the findings of histologic features. In conclusion, our study supports the recommendation that core needle biopsy considered the first procedure to assess molecular subtypes and receptor status in invasive breast cancer. The detection of those markers is suggested to be verified with the findings of histologic features. Disclosure of Interest: No significant relationships. P328 Does lobular histology matter in the post-Z0011 era? F. Muscara *, P.A. Barry, C. Richardson, J.E. Rusby. Breast Unit, Royal Marsden Hospital, London, United Kingdom Goals: Invasive Lobular Cancer (ILC) presents challenges in the diagnosis of early primary disease and the determination of tumour size and extent. Assessment of axillary lymph node involvement clinically and by ultrasound (US) before surgery is no trivial matter. In the ACOSOG Z0011 trial only 63 eligible patients (across both arms) had ILC. We aimed to analyse the clinical utility of One-Step Nucleic acid Amplification (OSNA) in intra-operative detection of axillary sentinel lymph node (SLN) involvement after negative axillary US and/or FNA for ILC and mixed ILC and IDC. We also examine standard clinico-pathological (C-P) factors which may predict a positive OSNA SLN result and document the rate of non-SLN involvement with ALND. Methods: Retrospective analysis of prospectively stored data on consecutive patients with early BC who underwent surgery with SLN biopsy and OSNA analysis between October 2011 and November 2014 at the Royal Marsden Hospital (UK). ALND was performed only
P326 ARM in breast cancer with enlarged lymph node: a Chinese single center experience X. Ding *. Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China Goals: To study the success rate and safety of axillary reverse lymphatic mapping (ARM) and the their effects on the function and lymph edema of ipsilateral upper limb, and the quality of life of patients with early breast cancer after operation, further explore the related factors affecting the success rate of ARM. Methods: Among of 60 cases of female patients with enlarged axillary lymph nodes in early breast cancer confirmed by the clinical examination, preoperative lymphoscintigraphy by nano carbon was injected into the ipsilateral areola region by clockwise markering (named sentinel lymph node biopsy, SLNB), and intraoperative lymphoscintigraphy by methylene blue were injected into the subcutaneous and intramuscular of the ipsilateral medial arm by reverse markering (named axillary reverse mapping, ARM). In operation, we tried to protect the imaging lymph glands by reverse markering of upper limb (ARM), and only cleanned the axillary lymph nodes by clockwise markering (SLNB). Both the ARM nodes and the cross staining lymph nodes by methylene blue and nano carbon were carried out the intraoperative frozen section examination. We compared to the ipsilateral limb circumference and function and the quality of life of patient between the ARM success and ARM failure group, and actualized the normality test, t test and multivariate Logistic regression analysis for the potential factors of influencing ARM, such as age and body mass index (BMI). Results: Among of 60 cases patients, 38 cases (63.3%) with successful ARM, 17 cases (28.3%) were not successful, 5 cases (8.3%) with cross staining or cannot distinguish lymph node stained color. Only 1 node was found existing isolated cancer nests in 31 ARM lymph nodes, and 2 nodes were found metastatic carcinoma in 5 cross staining lymph nodes. Whether the ARM success has no statistical difference in the quality of life, but the ARM success group has slightly superiority. In the function of the ipsilateral upper limb, except in the abduction (P = 0.062) and external rotation (P = 0.083) in ARM success group closing to statistical significance, all the rest patients had no significantly difference (P > 0.05). The body mass index (BMI) and degree of upper limb lymphedema in ARM success group were significantly lower than in the ARM failure group (P < 0.05), but had nothing to do with age (P > 0.05). Multivariate analysis showed whether success of ARM was the independent risk factor of ipsilateral upper limb lymphedema (P < 0.05). Conclusion: To seek ARM in early breast cancer are safe and feasible, it can reduce the occurrence of ipsilateral upper limb edema, and is expected to improve upper limb function, as well as improve the quality of life. Whether ARM success is an independent risk factor for upper limb lymphedema after ALND. Disclosure of Interest: No significant relationships. P327 Comparative study of preoperative core needle biopsy and surgical specimens in breast cancer P. Grigoropoulos1 *, A. Drakou2 , N. Papakonstantinou2 , D. Karoutsos2 , M. Tsompalioti2 , O. Dagadaki2 , A. Tsipoura2 , D. Issaiadis2 , S. Ammari2 . 1 Surgical Clinic, General Oncological Hospital Ag. Anargyroi, Nea Makri, Greece, 2 General Oncological Hospital of Kifissia Ag. Anargyroi, Athens, Greece Goals: Core needle biopsy (CNB) is often used as a diagnostic tool in patients who suffer from breast cancer. The purpose of our study is to compare the concordance between the results of the CNB and those of the surgical excision specimens.
S139
Methods: This retrospective comparative study include 45 patients who underwent core needle biopsy (CNB) preoperatively to confirm breast cancer, from 10/2012 to 12/2014 in our clinic. All biopsies were performed under ultrasound-guided with at least five 14-gauge core biopsies being obtained for pathological examination. We examined the histologic type of the cancer, the grade, ER, PR, Her2, Ki67 and p53. In the patients found with Her2 2+ the specimen was examined with FISH or CISH methods. The cut-off of Ki67 was 14%. Specimens are considered positive for ER, PR in cases that staining of the nucleus of the cells is over 1%. Her2 tumors were categorized as positive if >10% of the nuclei was stained. P53 positivity was defined as greater than 5% positivity staining of any intensity in the tissue. All were diagnosed with invasive ductal breast carcinoma. Results: The average age of patients was 59.5 years (range 30–90). The histologic type in core needle biopsy comparing with that of the surgical excision specimen was the same in all cases. The overall concordance rate of modified by Elston and Ellis scale of Bloom– Richardson score between CNB and histology reports was 100%. Immunohistochemical stainings for ER positive were reported in 37 patients’ excisional biopsies (82.2%) and for ER negative in 8 (17.8%). The false positive ER of CNB were 2 (4.44%) and the false negative ER were 1 (2.22%). Immunohistochemical stainings for PR positive were reported in 34 cases (75.6%) and PR negative in 11 (24.4%). 3 (6.66%) false negative PR results of CNB were observed. 8 (17.8%) of our patients were Her2 positive, while 35 (77.8%) diagnosed as Her2 negative. False negative cerb2 observed in 1 case (2.22%) and false positive in 2 (4.44%). As far as p53 concerns, it was positive in 29 patients (64.5%) and negative in 16 (35.5%). False negative and false positive percentage was respectively 4.4% (2 cases) and 6.6% (3 cases). Ki67 is reported <14% in 14 patients (31.1%) and >14% in 31 (68.9%). 3 of these cases (6.6%) had false Ki67 <14% and also 3 cases (6.6%) had false Ki67 >14%. Conclusion: The discordance percentages that are noted between CNB and surgical excision specimens may be due to many factors, such as sampling of the tumor, preparation techniques of immunohistochemical staining, the time of samples fixation etc. Nevertheless, in the majority of cases CNB findings are in concordance with the findings of histologic features. In conclusion, our study supports the recommendation that core needle biopsy considered the first procedure to assess molecular subtypes and receptor status in invasive breast cancer. The detection of those markers is suggested to be verified with the findings of histologic features. Disclosure of Interest: No significant relationships. P328 Does lobular histology matter in the post-Z0011 era? F. Muscara *, P.A. Barry, C. Richardson, J.E. Rusby. Breast Unit, Royal Marsden Hospital, London, United Kingdom Goals: Invasive Lobular Cancer (ILC) presents challenges in the diagnosis of early primary disease and the determination of tumour size and extent. Assessment of axillary lymph node involvement clinically and by ultrasound (US) before surgery is no trivial matter. In the ACOSOG Z0011 trial only 63 eligible patients (across both arms) had ILC. We aimed to analyse the clinical utility of One-Step Nucleic acid Amplification (OSNA) in intra-operative detection of axillary sentinel lymph node (SLN) involvement after negative axillary US and/or FNA for ILC and mixed ILC and IDC. We also examine standard clinico-pathological (C-P) factors which may predict a positive OSNA SLN result and document the rate of non-SLN involvement with ALND. Methods: Retrospective analysis of prospectively stored data on consecutive patients with early BC who underwent surgery with SLN biopsy and OSNA analysis between October 2011 and November 2014 at the Royal Marsden Hospital (UK). ALND was performed only