- Email: [email protected]
Routine follow-up of benign phylloides tumours is not indicated
496
ABSTRACTS
Aim: To explore the reasons behind declining an immediate reconstruction. Methods: Between January 2010 and January 2012, all patients with mastectomy were identified. We excluded all patients when either an immediate reconstruction was done or not offered to them at the time of diagnosis. 34 patients were identified in which an immediate reconstruction was discussed but the patient chose not to have it. The patients filled in a questionnaire about the possible reasons behind their choice. Some patients selected more than one answer. Results: The reasons behind their choice are listed in this table:
Answer
Number of times selected
My aim to get the cancer sorted out first. Not interested because of my age. The time was too short for me to consider anything more than mastectomy. I was not concerned about my appearance. I was afraid of the complications and the long recovery time. There was too much information to take in at that time. Not be safe to have it done with the cancer.
21 18 17 9 8 6 4
Discussion: Patient’s anxiety because of the diagnosis of cancer, age and too short time to consider and decide are the main factors behind not having immediate reconstruction. Considering all these reasons and allowing more time with more information and support may help patients to consider this option in a better and positive way. http://dx.doi.org/10.1016/j.ejso.2013.01.159
P124. Routine follow-up of benign phylloides tumours is not indicated Senthurun Mylvaganama, Lucinda Frankb, Clare Toroa, Sarah Vesteyb, Steven Thrusha a Worcestershire Acute NHS Trust, Worcester, Worcestershire, UK b Gloucestershire Hospital NHS Trust, Gloucester, Gloucestershire, UK
Introduction: Phylloides tumours are rare fibroepithelial breast tumours accounting for 1% of breast cancers. They occur more commonly with increasing age and are usually cured with local excision. No clear national guidance exists on the assessment, treatment and follow-up of these patients. Aims: To determine the current follow-up practice and assess the recurrence rate of phylloides tumours across 2 trusts (10 breast surgeons). Methods: Multicentre retrospective analysis of all cases of phylloides tumours on core and/or excision biopsy from March 2006 to July 2012 at Worcestershire Acute NHS Trust and Gloucestershire Hospitals NHS Trust. Results: N ¼ 94. Mean age 48. Mean clinical size 31.7mm, mean radiological size 35.4mm. Excision margin of >1mm achieved in 62%. All 4 malignant phylloides reported as B3 Benign on core biopsy. 23 different follow-up regimes were observed. Follow-up length ranged from postoperative discharge to 4yr follow-up. 6 recurrent phylloides tumours were seen, 4 benign and 2 malignant. All benign recurrences were local and found independently of follow-up. The earliest recurrence was at 6 yrs and the latest at 10yrs. The 2 malignant recurrences were seen at 1 and 3 years post-operatively. Discussion: There is no standard for the follow-up of benign or malignant phylloides tumours, which is demonstrated by the varying number of
regimes demonstrated. This study suggests that in the benign group, the risk of recurrence is small and when it occurs is identified by the patient. We advocate no routine follow-up of this group. Malignant (or indeterminate) Phylloides tumours do require follow-up surveillance. http://dx.doi.org/10.1016/j.ejso.2013.01.160
P125. Selective tissue adhesion reducing seroma formation in extensive breast surgery: the application of TissuGluÒ - only problematic case solver or possible standard procedure? Stefan Paepke, Marion Kiechle Klinikum Rechts der Isar, TU M€unchen, Frauenklinik and Poliklinik, Munich, Germany
Background: Seroma development remains a common postoperative complication after breast surgery.In up to 8-12% seroma formation leads to severe problems during postoperative care such as repeated fluid puncture and aspiration, wound healing disorders, surgical revision and therefore delayed start of adjuvant treatment. Postoperative seroma formation is a multifactorial process with an integral self-sustaining component as the fluid accumulation leads to spreading of the tissue surfaces averting local mechanisms promoting surface adherence and wound healing processes. The cavity and shearing forces between the tissue layers supports further seroma production. The surgical adhesive TissuGluÒ is a lysine-derived urethane curing moisture behavior. The adhesive is resorbable and biocompatible and forms a bond between tissue layers. Operation principle lies in the reduction of the resection area through selective tissue adhesion and therefore reduction of the exudative surface. Methods: Initially in our collective TissuGluÒ was used in cases with excessive postoperative seroma formation needing surgical revision (n¼3). After experimental verification of post interventional good response and smooth wound healing the indication was extended to primary usage in patients receiving mastectomy at high risk for wound healing disorders (n¼4). Results: In our patient collective a reduced seroma rate and a lower wound healing deficit could be surveyed. Accordingly the average length of time for drain removal could be shortened. Conclusions: Our experience on few patients showed a benefit in problematic cases and may also indicate a reduction of seroma formation in subgroups of patients with extensive breast surgery with an expectedly high incidence of wound exsudate. Protectively collected date will clarify future use and economic profitability. http://dx.doi.org/10.1016/j.ejso.2013.01.161
P126. Is intra-operative touch imprint cytology of sentinel lymph nodes for breast cancer cost-effective in a district general hospital setting? Andrea Pisesky, Wahidun Nabi, Victor Chow, Bavithra Vijayakumar, Andrzej Karmolinski, Peter Frecker, Md Zaker Ullah Whipps Cross University Hospital, London, UK
Introduction: Touch imprint cytology (TIC) of sentinel lymph nodes intra-operatively is an established method of analyzing lymph node status for breast cancer patients. Due to a lack of resources and cytological expertise, this test is not universally available within the NHS. We have calculated the cost-effectiveness of intra-operative TIC of sentinel lymph nodes (SLN) since its introduction in our DGH. Method: Data was collected between April 2010 and April 2012. 102 consecutive patients with invasive breast carcinoma were studied. Using a double-dye technique, SLN biopsies were sent intra-operatively for
ABSTRACTS
Aim: To explore the reasons behind declining an immediate reconstruction. Methods: Between January 2010 and January 2012, all patients with mastectomy were identified. We excluded all patients when either an immediate reconstruction was done or not offered to them at the time of diagnosis. 34 patients were identified in which an immediate reconstruction was discussed but the patient chose not to have it. The patients filled in a questionnaire about the possible reasons behind their choice. Some patients selected more than one answer. Results: The reasons behind their choice are listed in this table:
Answer
Number of times selected
My aim to get the cancer sorted out first. Not interested because of my age. The time was too short for me to consider anything more than mastectomy. I was not concerned about my appearance. I was afraid of the complications and the long recovery time. There was too much information to take in at that time. Not be safe to have it done with the cancer.
21 18 17 9 8 6 4
Discussion: Patient’s anxiety because of the diagnosis of cancer, age and too short time to consider and decide are the main factors behind not having immediate reconstruction. Considering all these reasons and allowing more time with more information and support may help patients to consider this option in a better and positive way. http://dx.doi.org/10.1016/j.ejso.2013.01.159
P124. Routine follow-up of benign phylloides tumours is not indicated Senthurun Mylvaganama, Lucinda Frankb, Clare Toroa, Sarah Vesteyb, Steven Thrusha a Worcestershire Acute NHS Trust, Worcester, Worcestershire, UK b Gloucestershire Hospital NHS Trust, Gloucester, Gloucestershire, UK
Introduction: Phylloides tumours are rare fibroepithelial breast tumours accounting for 1% of breast cancers. They occur more commonly with increasing age and are usually cured with local excision. No clear national guidance exists on the assessment, treatment and follow-up of these patients. Aims: To determine the current follow-up practice and assess the recurrence rate of phylloides tumours across 2 trusts (10 breast surgeons). Methods: Multicentre retrospective analysis of all cases of phylloides tumours on core and/or excision biopsy from March 2006 to July 2012 at Worcestershire Acute NHS Trust and Gloucestershire Hospitals NHS Trust. Results: N ¼ 94. Mean age 48. Mean clinical size 31.7mm, mean radiological size 35.4mm. Excision margin of >1mm achieved in 62%. All 4 malignant phylloides reported as B3 Benign on core biopsy. 23 different follow-up regimes were observed. Follow-up length ranged from postoperative discharge to 4yr follow-up. 6 recurrent phylloides tumours were seen, 4 benign and 2 malignant. All benign recurrences were local and found independently of follow-up. The earliest recurrence was at 6 yrs and the latest at 10yrs. The 2 malignant recurrences were seen at 1 and 3 years post-operatively. Discussion: There is no standard for the follow-up of benign or malignant phylloides tumours, which is demonstrated by the varying number of
regimes demonstrated. This study suggests that in the benign group, the risk of recurrence is small and when it occurs is identified by the patient. We advocate no routine follow-up of this group. Malignant (or indeterminate) Phylloides tumours do require follow-up surveillance. http://dx.doi.org/10.1016/j.ejso.2013.01.160
P125. Selective tissue adhesion reducing seroma formation in extensive breast surgery: the application of TissuGluÒ - only problematic case solver or possible standard procedure? Stefan Paepke, Marion Kiechle Klinikum Rechts der Isar, TU M€unchen, Frauenklinik and Poliklinik, Munich, Germany
Background: Seroma development remains a common postoperative complication after breast surgery.In up to 8-12% seroma formation leads to severe problems during postoperative care such as repeated fluid puncture and aspiration, wound healing disorders, surgical revision and therefore delayed start of adjuvant treatment. Postoperative seroma formation is a multifactorial process with an integral self-sustaining component as the fluid accumulation leads to spreading of the tissue surfaces averting local mechanisms promoting surface adherence and wound healing processes. The cavity and shearing forces between the tissue layers supports further seroma production. The surgical adhesive TissuGluÒ is a lysine-derived urethane curing moisture behavior. The adhesive is resorbable and biocompatible and forms a bond between tissue layers. Operation principle lies in the reduction of the resection area through selective tissue adhesion and therefore reduction of the exudative surface. Methods: Initially in our collective TissuGluÒ was used in cases with excessive postoperative seroma formation needing surgical revision (n¼3). After experimental verification of post interventional good response and smooth wound healing the indication was extended to primary usage in patients receiving mastectomy at high risk for wound healing disorders (n¼4). Results: In our patient collective a reduced seroma rate and a lower wound healing deficit could be surveyed. Accordingly the average length of time for drain removal could be shortened. Conclusions: Our experience on few patients showed a benefit in problematic cases and may also indicate a reduction of seroma formation in subgroups of patients with extensive breast surgery with an expectedly high incidence of wound exsudate. Protectively collected date will clarify future use and economic profitability. http://dx.doi.org/10.1016/j.ejso.2013.01.161
P126. Is intra-operative touch imprint cytology of sentinel lymph nodes for breast cancer cost-effective in a district general hospital setting? Andrea Pisesky, Wahidun Nabi, Victor Chow, Bavithra Vijayakumar, Andrzej Karmolinski, Peter Frecker, Md Zaker Ullah Whipps Cross University Hospital, London, UK
Introduction: Touch imprint cytology (TIC) of sentinel lymph nodes intra-operatively is an established method of analyzing lymph node status for breast cancer patients. Due to a lack of resources and cytological expertise, this test is not universally available within the NHS. We have calculated the cost-effectiveness of intra-operative TIC of sentinel lymph nodes (SLN) since its introduction in our DGH. Method: Data was collected between April 2010 and April 2012. 102 consecutive patients with invasive breast carcinoma were studied. Using a double-dye technique, SLN biopsies were sent intra-operatively for