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P74. Knowledge of skin cancer excision margins in healthcare providers
1126 (79.4%) and prior to neo-adjuvant chemotherapy (72.1%). Routinely 4.4% would stage all newly diagnosed cancers. First line investigations commonly performed were CT (76.1%), bone scan (68.7%) and liver USS (7.5%). 85.1% performed dual technique SLN biopsy for axillary staging. If SLN positive, 93.3% proceeded to axillary clearance. Conclusion: Survey response was poor overall. However the data shows widespread variation in practice and some non conformity to current NICE guidelines. Further education and dissemination of staging standards are necessary to ensure uniformity of practice. P74. Knowledge of skin cancer excision margins in healthcare providers Nicholas Segaren1, James Taylor1, Onur Gilleard2 1 St Thomas’ Hospital, London, UK 2 Queen Victoria Hospital, East Grinstead, UK Introduction: Skin cancer is the most common malignancy worldwide. In 2009 there were 11,877 new cases of melanoma diagnosed in the U.K and more than 91,000 BCC’s and SCC’s reported. It is imperative for healthcare providers involved in skin cancer to be familiar with the correct surgical excision margins. Methods: We asked 10 doctors from each of the following cohorts: Plastic Surgery trainees, GP’s undertaking minor operations, General Surgery Registrars and Dermatologists the following questions: 1) 2) 3) 4) 5)
What is the excision margin of a primary BCC? What is the excision margin of a recurrent BCC? What is the primary excision margin of a melanoma? What is the excision margin of an SCC? Where can you find the current skin cancer guidelines?
Each question was scored either 0 or 1. Results: Plastic Surgery registrars scored the highest marks with a mean of 4.7 and a range of 4/5 to 5/5. General Surgery registrars scored the lowest marks with a mean of 3.0 and a range of 2/5 e 4/5. 58% of people surveyed were not able to tell us where the latest guidelines could be found. Conclusions: The effective management of skin cancer requires a multi-disciplinary approach. The results of this study suggest that clinicians who are undertaking initial excisions of skin cancer lesions are not up to date on the latest guidelines which can be found on the British Association of Dermatologists website. P75. Ultrasound guided fine needle aspiration of axillary lymph nodes in patients with newly diagnosed breast cancer: An essential component of pre-operative staging and operative planning. Hannah Winter, Kate Spacey, Gavin Haslehurst, Robert Buhain, Neil Rothnie, Emma Gray Southend University Hospital, Southend, Essex, UK Introduction: Sentinel lymph node biopsy (SLNB) has reduced the number of unnecessary axillary lymph node clearances (ANC) performed in patients with breast cancer. Careful pre-operative assessment of the axilla with ultrasonography combined with fine needle aspiration (FNA) can identify patients who will require ANC and therefore prevent unnecessary SLNB prior to clearance. Within a busy district general hospital we sought to identify the sensitivity and specificity of ultrasound guided FNA in correctly identifying these patients. Methods: All primary invasive breast cancers assessed in both screening and symptomatic clinics between 1st August 2011 and 31st January 2012 were included. Those in whom surgery was not performed were excluded. Retrospective analysis of patient records, including imaging, cytology and histopathology was performed. Results: 108 eligible cancers were identified in 105 patients. At surgery 26% (28/108) had axillary nodal metastases. 75% of these patients
ABSTRACTS (21/28) proceeded straight to ANC having been correctly identified as having axillary disease pre-operatively. The sensitivity when using both ultrasound and FNA was 75% and specificity, 100%. The positive predictive value was 100% and negative predictive value, 91.93%. Only 6.5% (7/ 108) required repeat surgery to the axilla after negative pre-operative assessment. Conclusions: Using ultrasound guided FNA in the pre-operative assessment of the axilla in patients with newly diagnosed breast cancer is essential for reducing the number of patients undergoing unnecessary SLNB. With appropriate experience and rigorous criteria for distinguishing abnormal lymph nodes on ultrasound and performing FNA, the number of patients requiring repeat surgery to the axilla can be minimised. P76. Therapeutic mammaplasty does not cause a delay in the delivery of chemotherapy in high risk breast cancer patients Junaid Khan1, Sophie Barrett2, Sheila Stallard3, Eva Weiler-Mithoff4, Alison Winter-Wright1, Yousef Shahin5, Julie Doughty3, Laszlo Romics Jr.1 1 Victoria Infirmary Glasgow, Glasgow, UK 2 Beatson Cancer Centre, Glasgow, UK 3 Western Infirmary Glasgow, Glasgow, UK 4 Glasgow Royal Infirmary, Glasgow, UK 5 Hull Royal Infirmary, Hull, UK Introduction: Oncosurgical safety of therapeutic mammaplasty (TM) is widely investigated. The interval between surgery and delivery of adjuvant chemotherapy (AC) is an integral part of overall oncological safety. Therefore, we examined the time between TM and AC, and compared it to wide local excision (WLE) and mastectomy (Mx) with or without immediate breast reconstruction (IBR), respectively. Methods: Data of 174 patients who underwent TM, WLE and MxIBR was analyzed retrospectively. All patients were operated within three breast units of Glasgow during a period of 48 months. Time between decision to offer AC and delivery of the first cycle of chemotherapy was analyzed. Significance was calculated with Mann-Whitney and KruskalWallis tests (two and four groups compared, respectively). Results: Median time to AC after TM (n¼36) was 29 [16-58] days, WLE (n¼66) was 29.5 [15-105], Mx only (n¼56) was 29 [15-57], and Mx+IBR (n¼16) was 31 [15-58] days. No significant difference was found in terms of time to AC in patients treated with TM compared to WLE (p¼0.384), Mx only (p¼0.828) or Mx+IBR (p¼0.366). Further, there was no significant difference when a cumulative comparison of the four groups was carried out (p¼0.507). Conclusions: Our data indicate that oncosurgical safety of TM in terms of time to chemotherapy is similar to other high risk breast cancer patients treated WLE or MxIBR. This also suggests that there is no significant difference in postoperative complication rates after the four methods of surgical treatment, which would be the primary cause for a delay in delivering AC. P77. Poly implant prostheses and their impact on a district general hospital Isabella Dash, Cherry Miller, Dorothy Goddard, Jamie McIntosh, Samantha Williams, Richard Sutton Royal United Hospital, Bath NHS Trust, Bath, UK Introduction: In the UK, over 40,000 women have Poly Implant Prosthesis (PIP) breast implants. Following concerns regarding their quality there has been extensive coverage in the media and significant public anxiety. We prospectively assessed the effects of this on our Breast Unit. Methods: Our local primary care trusts agreed to fund additional clinics for women concerned with PIP implants. A prospective database was used to collate information. Results: At present, 61 women have been seen, 59 with PIP implants. Average time since operation was 67 months (range; 3 - 14 years). Thirtynine (66%) had implants inserted by Harley Medical Group or Transform
What is the excision margin of a primary BCC? What is the excision margin of a recurrent BCC? What is the primary excision margin of a melanoma? What is the excision margin of an SCC? Where can you find the current skin cancer guidelines?
Each question was scored either 0 or 1. Results: Plastic Surgery registrars scored the highest marks with a mean of 4.7 and a range of 4/5 to 5/5. General Surgery registrars scored the lowest marks with a mean of 3.0 and a range of 2/5 e 4/5. 58% of people surveyed were not able to tell us where the latest guidelines could be found. Conclusions: The effective management of skin cancer requires a multi-disciplinary approach. The results of this study suggest that clinicians who are undertaking initial excisions of skin cancer lesions are not up to date on the latest guidelines which can be found on the British Association of Dermatologists website. P75. Ultrasound guided fine needle aspiration of axillary lymph nodes in patients with newly diagnosed breast cancer: An essential component of pre-operative staging and operative planning. Hannah Winter, Kate Spacey, Gavin Haslehurst, Robert Buhain, Neil Rothnie, Emma Gray Southend University Hospital, Southend, Essex, UK Introduction: Sentinel lymph node biopsy (SLNB) has reduced the number of unnecessary axillary lymph node clearances (ANC) performed in patients with breast cancer. Careful pre-operative assessment of the axilla with ultrasonography combined with fine needle aspiration (FNA) can identify patients who will require ANC and therefore prevent unnecessary SLNB prior to clearance. Within a busy district general hospital we sought to identify the sensitivity and specificity of ultrasound guided FNA in correctly identifying these patients. Methods: All primary invasive breast cancers assessed in both screening and symptomatic clinics between 1st August 2011 and 31st January 2012 were included. Those in whom surgery was not performed were excluded. Retrospective analysis of patient records, including imaging, cytology and histopathology was performed. Results: 108 eligible cancers were identified in 105 patients. At surgery 26% (28/108) had axillary nodal metastases. 75% of these patients
ABSTRACTS (21/28) proceeded straight to ANC having been correctly identified as having axillary disease pre-operatively. The sensitivity when using both ultrasound and FNA was 75% and specificity, 100%. The positive predictive value was 100% and negative predictive value, 91.93%. Only 6.5% (7/ 108) required repeat surgery to the axilla after negative pre-operative assessment. Conclusions: Using ultrasound guided FNA in the pre-operative assessment of the axilla in patients with newly diagnosed breast cancer is essential for reducing the number of patients undergoing unnecessary SLNB. With appropriate experience and rigorous criteria for distinguishing abnormal lymph nodes on ultrasound and performing FNA, the number of patients requiring repeat surgery to the axilla can be minimised. P76. Therapeutic mammaplasty does not cause a delay in the delivery of chemotherapy in high risk breast cancer patients Junaid Khan1, Sophie Barrett2, Sheila Stallard3, Eva Weiler-Mithoff4, Alison Winter-Wright1, Yousef Shahin5, Julie Doughty3, Laszlo Romics Jr.1 1 Victoria Infirmary Glasgow, Glasgow, UK 2 Beatson Cancer Centre, Glasgow, UK 3 Western Infirmary Glasgow, Glasgow, UK 4 Glasgow Royal Infirmary, Glasgow, UK 5 Hull Royal Infirmary, Hull, UK Introduction: Oncosurgical safety of therapeutic mammaplasty (TM) is widely investigated. The interval between surgery and delivery of adjuvant chemotherapy (AC) is an integral part of overall oncological safety. Therefore, we examined the time between TM and AC, and compared it to wide local excision (WLE) and mastectomy (Mx) with or without immediate breast reconstruction (IBR), respectively. Methods: Data of 174 patients who underwent TM, WLE and MxIBR was analyzed retrospectively. All patients were operated within three breast units of Glasgow during a period of 48 months. Time between decision to offer AC and delivery of the first cycle of chemotherapy was analyzed. Significance was calculated with Mann-Whitney and KruskalWallis tests (two and four groups compared, respectively). Results: Median time to AC after TM (n¼36) was 29 [16-58] days, WLE (n¼66) was 29.5 [15-105], Mx only (n¼56) was 29 [15-57], and Mx+IBR (n¼16) was 31 [15-58] days. No significant difference was found in terms of time to AC in patients treated with TM compared to WLE (p¼0.384), Mx only (p¼0.828) or Mx+IBR (p¼0.366). Further, there was no significant difference when a cumulative comparison of the four groups was carried out (p¼0.507). Conclusions: Our data indicate that oncosurgical safety of TM in terms of time to chemotherapy is similar to other high risk breast cancer patients treated WLE or MxIBR. This also suggests that there is no significant difference in postoperative complication rates after the four methods of surgical treatment, which would be the primary cause for a delay in delivering AC. P77. Poly implant prostheses and their impact on a district general hospital Isabella Dash, Cherry Miller, Dorothy Goddard, Jamie McIntosh, Samantha Williams, Richard Sutton Royal United Hospital, Bath NHS Trust, Bath, UK Introduction: In the UK, over 40,000 women have Poly Implant Prosthesis (PIP) breast implants. Following concerns regarding their quality there has been extensive coverage in the media and significant public anxiety. We prospectively assessed the effects of this on our Breast Unit. Methods: Our local primary care trusts agreed to fund additional clinics for women concerned with PIP implants. A prospective database was used to collate information. Results: At present, 61 women have been seen, 59 with PIP implants. Average time since operation was 67 months (range; 3 - 14 years). Thirtynine (66%) had implants inserted by Harley Medical Group or Transform