Role of nipple discharge smear cytology in the diagnosis of patients with blood stained nipple discharge

1184 being offered Herceptin. 9 were too old/frail for chemotherapy, 4 declined chemotherapy & 1 had cardiac contra-indications. 4 had metastatic disease diagnosed in the post-operative period. Conclusions: HER-2 testing on the diagnostic core biopsies has provided the MDT with timely results. This has enabled suitable discussion for all cases of HER-2+ breast cancer. P72. Late re-operations after immediate breast reconstruction: Longterm data are relevant to decision-making Jennifer Rusby, D. England, R. Waters University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH Introduction: Immediate breast reconstruction after mastectomy has psychological and aesthetic advantages. The National Reconstruction Audit is investigating access to immediate reconstruction and short term outcome. This study focuses on the number of procedures required to obtain an acceptable result with sufficient follow up to ensure that relevant late reoperations are not overlooked. Methods: Cases of skin-sparing mastectomy with immediate reconstruction dating from 1998 onwards were reviewed. Hospital notes were retrieved and the following data extracted: Patient age at the time of reconstruction, smoking history, mastectomy weight, pathology data, adjuvant therapy, type of reconstruction and re-operations. Contralateral surgery for symmetry, nipple reconstruction and tattooing were noted but not counted as re-operations. Similarly evacuation of an early haematoma was recorded but not included in the analysis. Results: Fifty two case notes were reviewed. Median follow up is 5.6 years. The mean number of re-operations was 1.8, but this varied from 0.4 for patients undergoing extended latissimus dorsi reconstruction to 2.7 for patients who had implant-only reconstruction. The median time at which patients underwent their most recent re-operation was 1.5 and 3.6 years post-reconstruction for DIEP flap and implantonly reconstruction respectively. Importantly, 22 of the 33 patients who required re-operations underwent surgery more than 2 years postreconstruction. Conclusions: Rates of re-operation vary according to immediate breast reconstruction technique. Late re-operations should be discussed with patients choosing between immediate reconstruction techniques. They are also a considerable burden on reconstructive surgeons and should be taken into account in financial and job planning.

P73. Spiculated lesions of the breast: Radiological estimate of tumour size versus Pathological tumour size- How accurate is radiological measurement? Rehan Saif, A. Macnair, B. Kaye, L. Mclean, C. Griffith Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, NE1 4LP Introduction: Spiculated lesions are a common presenting feature of invasive breast cancer on mammography. It is debatable whether spiculations should be included when measuring the lesion. Some suggest that thick spicules should be measured as they might contain cancerous cells rather then just be fibrous stromal changes. We aimed to ascertain the accuracy of imaging of spiculated lesions by comparing the mammographic and ultrasound measurement to the pathological size. Methods: The mammograms of 253 screened women over 18 months with a diagnosis of invasive breast cancer were reviewed. Mammographic size, ultrasound size and pathological size were obtained from the patients’ radiology packets. A Consultant Radiologist re-measured the mammographic tumour size. Two measurements of maximum diameter were taken, one of the central part of the lesion only and the other with spiculations and then compared to the pathological size.

ABSTRACTS Results:  56 cases were studied out of a cohort of 253 (22%).  Mammography had no significant difference compared to pathological size (p > 0.987), however, ultrasound did (p > 0.045).  There was a significant difference between re-measurement of the lesions including spiculations and pathological size (p > 0.0001).  However, 12% (n ¼ 7) of lesions when measured including spicules had the correct pathological size. Conclusions: 1. Mammographic measurement was more accurate than ultrasound measurement in estimating tumour size. 2. Thin, wispy, spicules should not be measured. Thick spicules should be included, especially when the central mass is poorly defined. P74. Role of nipple discharge smear cytology in the diagnosis of patients with blood stained nipple discharge Venkitaraman Sathya, S. Jaleel, A. Nair, N. Aluwihare, B. Isgar New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, WV10 0QP Aim: To evaluate the usefulness of nipple discharge smear cytology in the diagnosis of patients with blood stained nipple discharge. Methods & Materials: Medical records and histopathology results were reviewed retrospectively to obtain 74 consecutive patients, who underwent nipple discharge smear cytology from 2002 to 2007. 78.4% underwent further procedure to obtain histological diagnosis. Results: The true positive and false negative rates for smear cytology for malignancy were 41.7% each. The presence of epithelial cells (83.3%) and atypical cells (66.7%) in the smear increases the possibility of an underlying malignancy. However, further operative procedures were guided by patient symptoms and imaging studies rather than cytology results. Of the 12 cancer patients in the study, ten patients underwent radiological evaluation during the initial workup, which revealed an underlying suspicious lesion in five patients. Patients with benign imaging underwent procedures such as Hadfield’s, which confirmed malignancy before a definitive operation was offered. Conclusion: It is our view that nipple discharge smear cytology does not influence the diagnosis of patients with blood stained nipple discharge. A definitive histology is essential to rule out malignancy and surgery should be offered to this group of patients. P75. Routine Staging For Early Breast Cancer, Winners and losers? Veeranna Shatkar, S. Brown, W. Ismail, A. Ogedegbe Queens Hospital, Rom Valley Way, Romford. Essex, RM7 0AG Introduction: In an era of increasing financial constraints, clinicians have to critically re-evaluate practices that have no clinical benefit for patients or economic advantage. Our study is designed to assess whether preoperative liver ultrasound and chest x-ray staging are necessary in all the invasive breast cancer patients. There are no universal guidelines. Methods: We studied 200 consecutive cases of newly diagnosed invasive breast cancer patients who underwent liver ultrasound scan and chest x-rays preoperatively during the period January 2006 to October 2007. Results: The patients were subdivided in to two groups. Early stage disease that included pT0-T1, pN0-N1 and late stage disease including pT2pN1 and worse. Our analysis revealed only 1 true positive liver metastasis (0.5%) belonging to late stage disease and 4 false positive liver scans that required further evaluation. None of the chest x-rays showed lung metastasis. Interestingly, majority of patients were T1 (52%) N0 (65%) but most of these were Grade 2 and 3 (74%). Conclusion: Liver ultrasound scan and chest x-rays are not indicated as routine staging investigations in all the newly diagnosed invasive breast cancers. These tests should be performed only in later stage disease and in those with clinical features of metastasis. This avoids undue anxiety for