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Prospective study to determine the biopsychosocial factors contributing to mastalgia in a clinic-based sample
ABSTRACTS Introduction: Ductal carcinoma in situ (DCIS) is a non-invasive disease. However, patients with DCIS who undergo a mastectomy have simultaneous sentinel lymph node biopsy (SLNB) due to the risk of uncovering occult invasive disease. We performed a small study to determine the number of positive sentinel nodes in this group of patients. Methods: This is a retrospective study of patients who underwent mastectomy and SLNB from April 2011 to July 2012 at the Queen Elizabeth Hospital in Gateshead. An online pathology system (ICE) was used to extract the data after using medical coding to identify relevant patients. Results: Eighty five patients were identified. Of these, 26 patients (31%) had DCIS, and 59 patients (71%) had invasive disease. Pre-operative biopsies correlated with post-operative pathology. Twenty patients (77%) with DCIS had high grade disease, and the mean area size was 42mm. All lymph nodes from patients with DCIS were free from metastasis. Conclusions: The results add weight to research that has showed patients with DCIS are very unlikely to have positive lymph nodes. This is an important finding, particularly as the majority of patients were at high risk of occult invasive disease (extensive DCIS, high grade). However, it is a small study, so not readily generalisable. The study will be expanded to improve understanding of lymph node behaviour with DCIS and improve applicability to clinical practice. http://dx.doi.org/10.1016/j.ejso.2013.01.155
P120. Mammographic imaging of women under 40 presenting to symptomatic clinics: is it worth it? E. Jane Macaskill, Dina Fouad, Janet Clarke, Elaine D. Anderson Edinburgh Breast Unit, Edinburgh, UK
Introduction: Association of Breast Surgery guidelines recommend mammographic imaging of women over 40, and of women age 35 with clinically suspicious lesions in combination with ultrasound. Practice within the Edinburgh Breast Unit had been to perform mammography on all symptomatic women over 35 years age. We aimed to assess the diagnostic usefulness of mammography in women age 35-39 presenting to symptomatic breast clinic. Methods: Data from all women age 35-39 who had mammography performed for symptomatic presentation from Jan 2010 to Dec 2011 at either Edinburgh Breast Unit or St Johns Hospital, Livingstone were collected and correlated to all patients diagnosed with breast cancer from the local cancer audit database. Results: In 1099 patients, 1114 mammograms were performed. Twenty five cancers were diagnosed in 24 patients (one bilateral; 23 invasive and 2 DCIS; overall invasive disease detection rate 2.1%). In twentytwo cancer cases both mammogram and ultrasound were abnormal; in one patient presenting with breast lumpiness mammogram was abnormal but ultrasound normal; in two patients with lump mammograms were normal but ultrasound was abnormal. One patient with bilateral disease had normal clinical findings unilaterally but suspicious mammogram and ultrasound. No patient with a normal clinical and ultrasound examination had a cancer detected on mammogram. Conclusions: From our two year series, omitting mammograms in women presenting with symptomatic breast disease may have resulted in one missed cancer from 1114 mammograms performed (0.09%) provided action was taken if ultrasound or clinical findings were abnormal. http://dx.doi.org/10.1016/j.ejso.2013.01.156
P121. Predicting additional positive non-sentinel lymph nodes after macrometastasis at sentinel lymph node biopsy e it’s a numbers game Robert Milligan, Helen Hawkins, Michael Carr, Magdi Youssef Wansbeck General Hospital, Ashington, UK
495 Introduction: Positive Sentinel Lymph Node Biopsy (SLNB) is generally followed by Axillary Lymph Node Dissection (ALND) which is often negative. Breast surgeons are now moving towards a more conservative approach to the axilla, and as such, nomograms have been created in order to stratify patients’ risk of additional positive non-sentinel lymph nodes after SLNB. Here we used the validated MD Anderson Cancer Center Nomogram to retrospectively predict additional positive non-sentinel lymph nodes in patients who underwent positive SLNB with macrometastasis. Method: Data was collected retrospectively regarding 225 consecutive patients who underwent SLNB across two hospitals within an NHS Trust over a two year period (2010 and 2011). Age, sex, tumour size and type, and nodal status at SLNB and subsequent ALND were recorded. Results: 33/36 patients with positive SLNB underwent ALND, of which only 7 (21.2%) were positive. 1/8 (12.5%)patients had further positive nodes at ALND where predicted positive additional nodes was low (029%). 2/19 (10.5%) patients with moderate risk of additional positive nodes (30-59%) had additional positive nodes. 4/6 (66.7%) patients with high risk of additional positive nodes (60-89%) had further positive nodes at ALND. Conclusion: The MD Anderson Cancer Center Nomogram may be used as and adjunct in calculating the benefit of ALND in certain patient groups; it appears accurate for very high and low risk patients, but over-estimated patients with moderate risk of further axillary disease. Where axillary conservation is considered, patients must have all available information to allow an informed decision; nomograms may improve patient knowledge of risk of further axillary disease. http://dx.doi.org/10.1016/j.ejso.2013.01.157
P122. Prospective study to determine the biopsychosocial factors contributing to mastalgia in a clinic-based sample Jessica Mok Lancashire Hospital Trust, Preston, Lancashire, UK
Mastalgia is a common presentation in breast new patient clinic in the UK and poses significant pressure on the utilisation of breast services. We assessed the aetiology of breast pain in a clinic based sample using a questionnaire distributed to patients presenting with breast pain over a 3 month period and assessed the associated pattern of healthcare utilisation. Over the 3 months period, 526 patients attended breast clinic, of those 115 presented with breast pain (22%). 32 (28%) of these patient were under age 35. Imaging studies was performed in 96% of patients and they were found to be normal or benign in 99% of cases. None of the patients under 35 had abnormal scans. Lifestyle questionnaire reviewed a weak association with lifestyle factors such as smoking (20%), moderate to high caffeine intake (15%), alcohol (5%). 45% patients suffers from other pain issues. Breast pain is a common condition affecting patient’s activity. It is associated with high use of imaging in young women. Should we continue to perform investigations in patients with breast pain alone and normal clinical examination or should we tailor to age/risk? Further studies needed to understand the pathology and associated factors. http://dx.doi.org/10.1016/j.ejso.2013.01.158
P123. Why some of our patients with mastectomy chose not to have an immediate breast reconstruction? Patients’ views from our breast unit at Kettering General Hospital Salam Musa Kettering General Hospital, Kettering, Northamptonshire, UK
Introduction: All women facing mastectomy should be offered an immediate reconstruction. Some patients chose not to have an immediate reconstruction for different reasons.
P120. Mammographic imaging of women under 40 presenting to symptomatic clinics: is it worth it? E. Jane Macaskill, Dina Fouad, Janet Clarke, Elaine D. Anderson Edinburgh Breast Unit, Edinburgh, UK
Introduction: Association of Breast Surgery guidelines recommend mammographic imaging of women over 40, and of women age 35 with clinically suspicious lesions in combination with ultrasound. Practice within the Edinburgh Breast Unit had been to perform mammography on all symptomatic women over 35 years age. We aimed to assess the diagnostic usefulness of mammography in women age 35-39 presenting to symptomatic breast clinic. Methods: Data from all women age 35-39 who had mammography performed for symptomatic presentation from Jan 2010 to Dec 2011 at either Edinburgh Breast Unit or St Johns Hospital, Livingstone were collected and correlated to all patients diagnosed with breast cancer from the local cancer audit database. Results: In 1099 patients, 1114 mammograms were performed. Twenty five cancers were diagnosed in 24 patients (one bilateral; 23 invasive and 2 DCIS; overall invasive disease detection rate 2.1%). In twentytwo cancer cases both mammogram and ultrasound were abnormal; in one patient presenting with breast lumpiness mammogram was abnormal but ultrasound normal; in two patients with lump mammograms were normal but ultrasound was abnormal. One patient with bilateral disease had normal clinical findings unilaterally but suspicious mammogram and ultrasound. No patient with a normal clinical and ultrasound examination had a cancer detected on mammogram. Conclusions: From our two year series, omitting mammograms in women presenting with symptomatic breast disease may have resulted in one missed cancer from 1114 mammograms performed (0.09%) provided action was taken if ultrasound or clinical findings were abnormal. http://dx.doi.org/10.1016/j.ejso.2013.01.156
P121. Predicting additional positive non-sentinel lymph nodes after macrometastasis at sentinel lymph node biopsy e it’s a numbers game Robert Milligan, Helen Hawkins, Michael Carr, Magdi Youssef Wansbeck General Hospital, Ashington, UK
495 Introduction: Positive Sentinel Lymph Node Biopsy (SLNB) is generally followed by Axillary Lymph Node Dissection (ALND) which is often negative. Breast surgeons are now moving towards a more conservative approach to the axilla, and as such, nomograms have been created in order to stratify patients’ risk of additional positive non-sentinel lymph nodes after SLNB. Here we used the validated MD Anderson Cancer Center Nomogram to retrospectively predict additional positive non-sentinel lymph nodes in patients who underwent positive SLNB with macrometastasis. Method: Data was collected retrospectively regarding 225 consecutive patients who underwent SLNB across two hospitals within an NHS Trust over a two year period (2010 and 2011). Age, sex, tumour size and type, and nodal status at SLNB and subsequent ALND were recorded. Results: 33/36 patients with positive SLNB underwent ALND, of which only 7 (21.2%) were positive. 1/8 (12.5%)patients had further positive nodes at ALND where predicted positive additional nodes was low (029%). 2/19 (10.5%) patients with moderate risk of additional positive nodes (30-59%) had additional positive nodes. 4/6 (66.7%) patients with high risk of additional positive nodes (60-89%) had further positive nodes at ALND. Conclusion: The MD Anderson Cancer Center Nomogram may be used as and adjunct in calculating the benefit of ALND in certain patient groups; it appears accurate for very high and low risk patients, but over-estimated patients with moderate risk of further axillary disease. Where axillary conservation is considered, patients must have all available information to allow an informed decision; nomograms may improve patient knowledge of risk of further axillary disease. http://dx.doi.org/10.1016/j.ejso.2013.01.157
P122. Prospective study to determine the biopsychosocial factors contributing to mastalgia in a clinic-based sample Jessica Mok Lancashire Hospital Trust, Preston, Lancashire, UK
Mastalgia is a common presentation in breast new patient clinic in the UK and poses significant pressure on the utilisation of breast services. We assessed the aetiology of breast pain in a clinic based sample using a questionnaire distributed to patients presenting with breast pain over a 3 month period and assessed the associated pattern of healthcare utilisation. Over the 3 months period, 526 patients attended breast clinic, of those 115 presented with breast pain (22%). 32 (28%) of these patient were under age 35. Imaging studies was performed in 96% of patients and they were found to be normal or benign in 99% of cases. None of the patients under 35 had abnormal scans. Lifestyle questionnaire reviewed a weak association with lifestyle factors such as smoking (20%), moderate to high caffeine intake (15%), alcohol (5%). 45% patients suffers from other pain issues. Breast pain is a common condition affecting patient’s activity. It is associated with high use of imaging in young women. Should we continue to perform investigations in patients with breast pain alone and normal clinical examination or should we tailor to age/risk? Further studies needed to understand the pathology and associated factors. http://dx.doi.org/10.1016/j.ejso.2013.01.158
P123. Why some of our patients with mastectomy chose not to have an immediate breast reconstruction? Patients’ views from our breast unit at Kettering General Hospital Salam Musa Kettering General Hospital, Kettering, Northamptonshire, UK
Introduction: All women facing mastectomy should be offered an immediate reconstruction. Some patients chose not to have an immediate reconstruction for different reasons.