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Patient-reported outcomes of breast reconstruction using implant and biomesh: Our experience
ABSTRACTS Imprint cytology is neither costly nor time consuming thus we feel it is a worthwhile addition to breast cancer surgery even when the axilla is deemed negative on pre-operative ultrasound. http://dx.doi.org/10.1016/j.ejso.2014.02.071
P072. Patient-reported outcomes of breast reconstruction using implant and biomesh: Our experience Anuradha Apte, Angela Haigh, Sankaran Chandrasekharan, Arunmoy Chakravorty Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK Introduction: Breast aesthetics and patient awareness have made breast reconstruction an integral part of breast cancer surgery alongside mastectomy and breast conservation. Our objective was to evaluate patient-reported outcomes after immediate breast reconstruction (IBR) using implant and biomesh (Strattice). Methods: In this prospective ongoing study, consecutive patients who had an IBR using implant and Strattice from February 2012 received a questionnaire 6 weeks post-surgery. Questionnaire included pre-operative, operative and post-operative outcomes including patient satisfaction, cosmesis, return to activity and complications. Results: Between February 2012 and October 2013, 19 patients (2 bilateral, 14 Left, 7 Right) underwent single-stage immediate breast reconstruction with fixed volume profile implants and Strattice. Options of different reconstructive procedures were discussed along with specialistnurse consultation. Unavailability of long-term data of using biomesh was clearly stated. One patient didn’t reply. There were 5 ILC, 9 IDC, 2 Mixed, 5 DCIS with 16 ER-and 2 HER-2 positive cancers. NPI range was 2.2-5.8. Adjuvant-treatment included radiotherapy (3), chemotherapy (3), Herceptin (2). Average hospital stay was 1.59 days (range 1-3 days). Return to light and normal activities was 2.24 and 5.57 weeks respectively.72% patients were comfortable with and 66.66% without bra. No lifestyle changes in 15. Complications included implant loss in two (one after 3 months), haematoma (1), seroma (3), distant metastasis (2). Eighteen would recommend reconstruction and 83% patients were very satisfied. Conclusion: IBR using implant and biomesh is a good option in selected cases, considering less operating time, early recovery, return to normal activities and well-balanced patient reported outcomes. http://dx.doi.org/10.1016/j.ejso.2014.02.072
P073. Novel classification to facilitate recognition of breast cancer morphology on confocal endomicroscopy Tou Pin Chang1, Sami Shousha3, Dimitri J. Hadjiminas4, Rathi Ramakrishnan3, Ragheed Al-Mufti4, Kumuthan Sriskandarajah1, Guang Zhong Yang2, Ara Darzi1, Daniel R. Leff1 1 Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London, UK 2 The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK 3 Department of Histopathology, Charing Cross Hospital, London, UK 4 Imperial Breast Unit, Charing Cross Hospital, London, UK Introduction: National data suggests that a significant proportion of breast cancer patients require re-excision. Novel intra-operative visualisation tools may aid real-time assessment of cavity margin status. Our work demonstrated that breast cancer morphology could be visualised in realtime using confocal endomicroscopy (CE). This study assesses the ability of pathologists and surgeons to differentiate CE images of neoplastic from non-neoplastic breast morphology using a novel classification. Methods: CE images obtained from 71 freshly excised, acriflavinestained breast tumour and non-diseased sections from 50 patients were
631 reviewed with two experienced breast pathologists. A classification based on description of CE morphology unique to normal breast tissue constituents, non-invasive and invasive disease was developed. Seventeen pathologists and surgeons underwent a pattern recognition training session based on this classification and subsequently, were subjected to objective assessment of 50 CE images while blinded to histopathology results. Results: The mean sensitivity, specificity and accuracy for the detection of breast cancer for pathologists was 96% (range 88-100%), 92% (range 84-100%) and 94% (range 90-100%), respectively. Surgeons had a mean sensitivity of 97% (range 92-100%), specificity of 86% (range 68-96%) and accuracy of 92% (range 84-98%). Overall inter-observer agreement for pathologists was ‘almost perfect’, k¼0.82 (95%CI, 0.790.85); and ‘substantial’ for surgeons, k¼0.74 (95%CI, 0.70-0.78). Conclusions: CE morphological features of breast cancer are objectively distinguishable from that of normal breast. There might be a potential role for the use of CE intraoperatively as an adjunct to current techniques for in situ detection of residual cancerous foci based on realtime cavity scanning. http://dx.doi.org/10.1016/j.ejso.2014.02.073
P074. Breast cancer detection rates in patients with B3 breast lesions: A 10 year retrospective review Nadia Mcallister, Preet Hamilton, Stewart Nicholson, Nerys Forester The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Introduction: B3 lesions comprise a heterogeneous group of breast lesions with an increased risk of subsequent breast malignancy.1 Surgical excision of such lesions is being replaced by large volume core needle biopsy and 5 yearly mammographic follow up.2 This study aims to establish the incidence, nature and timing of malignancy associated with B3 lesions, and to assess whether such mammographic surveillance programmes are appropriately targeted. Methods: Retrospective, single large centre, review of all screen detected B3 lesions (identified on core or diagnostic excision biopsy) between 1995 and 2006. Results: 131 B3 lesions were identified. Average age was 55 years (range 48-74). Each patient had a median of 4 follow-up mammograms (range 0-9). 8 cases (6%) subsequently developed breast cancer (7 invasive, 1 high grade DCIS). Median time-to-diagnosis was 5 years (range 1-15yrs). 3 patients were diagnosed after 1 year (all at the original site). 6/8 cancers were in the ipsilateral breast, but only 4/8 were at the same site as the index lesion. Conclusions: The observed cancer detection rate of 6% is higher than expected for a screened population. However, in this cohort, subsequent cancer occurred either early, representing a failure of initial assessment, or much later, consistent with studies suggesting that the presence of B3 lesions are a risk factor for breast cancer development.1 We propose a more appropriate and cost effective follow-up strategy of a single mammographic review at one year followed by return to the routine NHS breast screening programme, in conjunction with regular self examination. References 1. Heywang-K€obrunner SH, N€ahrig J, Hacker A, Sedlacek S, H€ofler H. B3 Lesions: Radiological Assessment and Multi-Disciplinary Aspects. Breast Care (Basel) 2010: Aug;5(4):209-217. 2. S. Rajan, A.M. Shaaban, B.J.G. Dall, N. Sharma. New patient pathway using vacuum-assisted biopsy reduces diagnostic surgery for B3 lesions. Clin Radiol 2012: Mar;67(3):244-9. http://dx.doi.org/10.1016/j.ejso.2014.02.074
P072. Patient-reported outcomes of breast reconstruction using implant and biomesh: Our experience Anuradha Apte, Angela Haigh, Sankaran Chandrasekharan, Arunmoy Chakravorty Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK Introduction: Breast aesthetics and patient awareness have made breast reconstruction an integral part of breast cancer surgery alongside mastectomy and breast conservation. Our objective was to evaluate patient-reported outcomes after immediate breast reconstruction (IBR) using implant and biomesh (Strattice). Methods: In this prospective ongoing study, consecutive patients who had an IBR using implant and Strattice from February 2012 received a questionnaire 6 weeks post-surgery. Questionnaire included pre-operative, operative and post-operative outcomes including patient satisfaction, cosmesis, return to activity and complications. Results: Between February 2012 and October 2013, 19 patients (2 bilateral, 14 Left, 7 Right) underwent single-stage immediate breast reconstruction with fixed volume profile implants and Strattice. Options of different reconstructive procedures were discussed along with specialistnurse consultation. Unavailability of long-term data of using biomesh was clearly stated. One patient didn’t reply. There were 5 ILC, 9 IDC, 2 Mixed, 5 DCIS with 16 ER-and 2 HER-2 positive cancers. NPI range was 2.2-5.8. Adjuvant-treatment included radiotherapy (3), chemotherapy (3), Herceptin (2). Average hospital stay was 1.59 days (range 1-3 days). Return to light and normal activities was 2.24 and 5.57 weeks respectively.72% patients were comfortable with and 66.66% without bra. No lifestyle changes in 15. Complications included implant loss in two (one after 3 months), haematoma (1), seroma (3), distant metastasis (2). Eighteen would recommend reconstruction and 83% patients were very satisfied. Conclusion: IBR using implant and biomesh is a good option in selected cases, considering less operating time, early recovery, return to normal activities and well-balanced patient reported outcomes. http://dx.doi.org/10.1016/j.ejso.2014.02.072
P073. Novel classification to facilitate recognition of breast cancer morphology on confocal endomicroscopy Tou Pin Chang1, Sami Shousha3, Dimitri J. Hadjiminas4, Rathi Ramakrishnan3, Ragheed Al-Mufti4, Kumuthan Sriskandarajah1, Guang Zhong Yang2, Ara Darzi1, Daniel R. Leff1 1 Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London, UK 2 The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK 3 Department of Histopathology, Charing Cross Hospital, London, UK 4 Imperial Breast Unit, Charing Cross Hospital, London, UK Introduction: National data suggests that a significant proportion of breast cancer patients require re-excision. Novel intra-operative visualisation tools may aid real-time assessment of cavity margin status. Our work demonstrated that breast cancer morphology could be visualised in realtime using confocal endomicroscopy (CE). This study assesses the ability of pathologists and surgeons to differentiate CE images of neoplastic from non-neoplastic breast morphology using a novel classification. Methods: CE images obtained from 71 freshly excised, acriflavinestained breast tumour and non-diseased sections from 50 patients were
631 reviewed with two experienced breast pathologists. A classification based on description of CE morphology unique to normal breast tissue constituents, non-invasive and invasive disease was developed. Seventeen pathologists and surgeons underwent a pattern recognition training session based on this classification and subsequently, were subjected to objective assessment of 50 CE images while blinded to histopathology results. Results: The mean sensitivity, specificity and accuracy for the detection of breast cancer for pathologists was 96% (range 88-100%), 92% (range 84-100%) and 94% (range 90-100%), respectively. Surgeons had a mean sensitivity of 97% (range 92-100%), specificity of 86% (range 68-96%) and accuracy of 92% (range 84-98%). Overall inter-observer agreement for pathologists was ‘almost perfect’, k¼0.82 (95%CI, 0.790.85); and ‘substantial’ for surgeons, k¼0.74 (95%CI, 0.70-0.78). Conclusions: CE morphological features of breast cancer are objectively distinguishable from that of normal breast. There might be a potential role for the use of CE intraoperatively as an adjunct to current techniques for in situ detection of residual cancerous foci based on realtime cavity scanning. http://dx.doi.org/10.1016/j.ejso.2014.02.073
P074. Breast cancer detection rates in patients with B3 breast lesions: A 10 year retrospective review Nadia Mcallister, Preet Hamilton, Stewart Nicholson, Nerys Forester The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Introduction: B3 lesions comprise a heterogeneous group of breast lesions with an increased risk of subsequent breast malignancy.1 Surgical excision of such lesions is being replaced by large volume core needle biopsy and 5 yearly mammographic follow up.2 This study aims to establish the incidence, nature and timing of malignancy associated with B3 lesions, and to assess whether such mammographic surveillance programmes are appropriately targeted. Methods: Retrospective, single large centre, review of all screen detected B3 lesions (identified on core or diagnostic excision biopsy) between 1995 and 2006. Results: 131 B3 lesions were identified. Average age was 55 years (range 48-74). Each patient had a median of 4 follow-up mammograms (range 0-9). 8 cases (6%) subsequently developed breast cancer (7 invasive, 1 high grade DCIS). Median time-to-diagnosis was 5 years (range 1-15yrs). 3 patients were diagnosed after 1 year (all at the original site). 6/8 cancers were in the ipsilateral breast, but only 4/8 were at the same site as the index lesion. Conclusions: The observed cancer detection rate of 6% is higher than expected for a screened population. However, in this cohort, subsequent cancer occurred either early, representing a failure of initial assessment, or much later, consistent with studies suggesting that the presence of B3 lesions are a risk factor for breast cancer development.1 We propose a more appropriate and cost effective follow-up strategy of a single mammographic review at one year followed by return to the routine NHS breast screening programme, in conjunction with regular self examination. References 1. Heywang-K€obrunner SH, N€ahrig J, Hacker A, Sedlacek S, H€ofler H. B3 Lesions: Radiological Assessment and Multi-Disciplinary Aspects. Breast Care (Basel) 2010: Aug;5(4):209-217. 2. S. Rajan, A.M. Shaaban, B.J.G. Dall, N. Sharma. New patient pathway using vacuum-assisted biopsy reduces diagnostic surgery for B3 lesions. Clin Radiol 2012: Mar;67(3):244-9. http://dx.doi.org/10.1016/j.ejso.2014.02.074