Survivorship in Breast Cancer - factors affecting quality of life

986 cancer, even in patients with no palpable nodes. Such patients can be offered further axillary treatment such as Axillary Node Clearance (ANC) without undergoing staging operations such as Axillary Node Sample (ANS) or Sentinel Node Biopsy (SNBx). The aim of this study was to determine the value of USS with FNAC in patients with potentially resectable invasive breast cancer. Methods: All patients with biopsy confirmed primary invasive breast cancer underwent axillary USS, with FNAC performed if enlarged/abnormal nodes present, in the period between Jan 2009 - Dec 2010. Patients with cytological evidence of nodal metastases were offered ANC depending on performance status and patient wishes. Patients with negative USS or negative FNAC and no clinical suspicion of nodal metastases were offered surgical axillary staging (ANS/SNBx). Results: 41/319 (12.9%) of patients undergoing definitive cancer surgery had positive axillary FNAC and therefore underwent ANC without SNBx/ANS. All of these patients had axillary nodal metastases at ANC. Patients with positive FNAC had a greater number of total axillary nodes involved (Median 4 nodes (IQ range 2-8) vs. Median 1 (IQ range 0-4) p¼0.01 (unpaired 2-sample t-test)). Conclusion: Preoperative axillary USS with FNAC avoided unnecessary surgery (SNBx/ANS) in 12.9% of patients and its specificity for identifying nodal metastases was 100%. This justifies its routine use in the management of invasive breast cancer. Furthermore, patients undergoing ANC with positive FNAC had a greater total number axillary metastases compared to those with positive sentinel nodes and therefore the argument for performing ANC in these patients is clearer. P10. A comparison of triple negative versus triple positive breast cancers Muneer Ahmed, A. Basit, R. Kirby, S. Narayanan, J. Adjogatse University Hospital of North Staffordshire, Newcastle Road, Stoke-onTrent, ST4 6QG Triple positive breast cancer (TPBC) and triple negative breast cancer (TNBC) represent a heterogeneous group of tumours that may have poor outcome. TNBC tumours are more likely to occur at a younger age, and have a higher histopathological grade. We examined ER, PgR and HER2 negative tumours and compared them with TPBC patients over a three year period. Retrospective review of 316 TNBC patients, with known ER, PgR, HER2 negative status, were compared with 127 TPBC breast cancer patients, all treated between February 2008-2011. The mean age of TNBC and TPBC patients was 61 years. TPBC patients had 82% Ductal and 12% lobular cancers; TNBC patients had 96% ductal and only 3% were lobular cancers. 35% of TPBC were screen-detected as compared to 28% of TNBC. Nearly half of the TPBC patients were node negative, but more than half (61%) TNBC were node negative. Histopathological Grade-3 in TNBC was 88% as compared with 35% in TPBC (P¼0.020). The general held view that TNBC occur more frequently at a younger age and have a higher risk of distant recurrence has not been substantiated by our first 3 years of post-operative analysis that has shown no difference in local control and outcome in the two groups of patients. A significant majority of TNBC patients were Grade 3 Ductal. However, no difference was noted in the method of presentation, size of tumour and node positivity between the two groups though TNBC may have chemosensitive disease with excellent survival. P11. Choroidal Metastasis from breast carcinoma: A rare initial presentation of undiagnosed advanced breast cancer Peter Coyne, R. Westley, O.I. Wuchukwu Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP Introduction: Primary breast carcinoma is a common pathology within the UK. It can present with metastatic deposits. Choroidal

ABSTRACTS metastasis are a rare but recognised site of secondary metastatic deposits being more frequent than primary uveal malignancy. Methods: We present a retrospectively review case study of a case of breast cancer presenting with choroidal metastasis and its management. Results: A 55 year-old lady was referred to a consultant ophthalmologist with a several week history of blurred vision in her right eye. A choroidal mass was identified. This was atypical for a primary lesion. Imaging demonstrated a left sided breast lesion confirmed on ultrasound and mammography with mediastinal lymphadenopathy and indeterminate lung lesions. Core biopsy confirmed this to be a Grade 2 invasive ductal carcinoma (oestrogen receptor positive). She was commenced on Letrozole and underwent radiotherapy to the orbit to prevent blindness (20Gy in 5 fractions). She remained clinically stable but recent CT showed disease progression with liver lesions and bony metastasis. Conclusion: Choroidal metastasis is rare, but are crucial consideration for ophthalmologists dealing with choroidal lesions. A thorough search for primary sites is required with lung and breast being the most common. When advanced disease is present initial therapy can be done to save a patient’s sight. Close collaboration is needed between surgical, oncology and ophthalmology colleagues. There has recently been argumentation over routine uveal screening in patients with advanced or metastatic breast carcinoma however at present this would not seem beneficial as rates of choroidal metastasis are low. P12. Isolated breast metastasis from primary peritoneal carcinoma a rare site of disease recurrence Peter Coyne, L. Kenny, E. Barnes, E. Ward, M. Jane, O. Iwuchukwu Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP Introduction: Metastatic disease to the breast from extra-mammary sources is rare. A number of sites have previously been implicated as primary site metastasising to the breast including ovarian cancer. Methods: We present a case of a breast metastasis from primary peritoneal carcinoma who presented to our fast tract breast clinic. Results: A 78 year old female who was treated for a primary peritoneal carcinoma presented to our fast track breast clinic a year later with a lump. The patient had undergone neo-adjuvant chemotherapy followed by optimal cytoreductive surgery (laparotomy, TAH, BSO, omentectomy with optimal debulking) and 2 cycles of post-operative chemotherapy. Postoperative follow-up CT scan showed no evidence of macroscopic residual disease or recurrence. She then developed a right breast lump. Histological examination showed fibro-fatty tissue extensively replaced by necrotic tumour. The core biopsies taken were compared to the histology from the previous laparotomy for peritoneal carcinoma. The biopsy demonstrated a papillary serous carcinoma, this infiltrated down into the tissue suggesting a primary peritoneal carcinoma rather than ovarian. The breast histology matched the initial samples and immunohistochemical stains were also compatible. Conclusion: Metastases to the breast from ovarian primary is rare but noted less, but recognised as in this case, a metastases to breast tissue from peritoneal origin. Although diagnostic difficulties can arise in the poorly differentiated nature of peritoneal and ovarian carcinoma, this case highlights that close clinico-pathological correlation is required when tissue is analysed and patients have undergone treatment for other cancers. P13. Survivorship in Breast Cancer - factors affecting quality of life Peter Coyne, M. Navidi, O. I. Wuchukwu Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP Introduction: The majority of breast cancers are diagnosed in women over the age of 60 years and diagnosis impacts not only on a patient’s health but also on their psycho-social wellbeing, having a large effect on quality of life. Often there is a large clinical and support focus within both primary and secondary care surrounding diagnosis and treatment but patients often face uncertainty and longer term reduction in quality

ABSTRACTS of life due to diagnosis as they enter a survivorship phase after treatment finishes. Methods: We conducted a literature search and analysed the available literature regarding survivorship in breast cancer looking at individual factors and the effect that they have on patients once they enter a survivorship phase. Results: Amongst the literature multiple factors impacted on quality of life after diagnosis. Several factors were identified as having an impact including age, sex, rurality, exercise, nationality, race, treatment undertaken, socio-economic factors, perceived social support, spirituality/religion, marital status and disease status. Evidence was conflicting and there was significant overlap between the above factors with interwoven associations highlighting multi-factorial and complicated patient effects and factors. Conclusions: The knowledge of these factors can be instrumental in identifying and supporting patients with breast cancer entering a survivorship phase. Survivorship programs within secondary care can help with many issues and provide a platform for issues raised, but the information can target “at risk groups” for reduction in quality of life and provide additional support. P14. Laterality of Breast Cancer - is it true? Faidah Badru, C. Chianakwalam, V. Stevenson William Harvey Hospital, Willesborough, Ashford, Kent, TN24 0LZ Introduction: There is a perception that breast cancer occurs more frequently in the left than the right breast with some studies reporting an excess of left-sided breast cancer in ratios varying from 1.05 to 1.26. Though many theories have been proposed to explain this difference including handiness, size difference, detection bias, nursing preference and brain structure, the reason for the disparity remains unclear. The aim of this study is to review the laterality of breast cancer in patients treated in a District General Hospital. Methods: The database was searched for all patients diagnosed with in-situ and invasive breast cancer over a ten year period from January 2000 to December 2009. Data was collected for laterality. Bilateral and recurrent breast cancers were excluded. Statistical analysis was done with the Chi-square test. Result: Of the 2083 newly diagnosed patients, 1076 were left sided whilst 1007 were on the right (ratio 1.07; P¼0.14). For invasive cancers there were 960 Left vs 913 Right (ratio 1.05; P¼0.29) and in-situ cancers 116 Left vs 94 Right (ratio 1.23; P¼0.15) There were 49 bilateral cancers. Conclusion: Although not statistically significant, there is a slightly higher incidence of both in-situ and invasive breast cancer in the left breast. P15. S100A4: A marker of epithelial mesenchymal transition in gastric adenocarcinoma Ahmad Mirzaa, I. Welcha, S. Pritcharda, C. Westb a Department of General Surgery, University Hospital of South Manchester, South Moor Road, Manchester, M23 2RW b The Translational Radiobiology Group, The University of Manchester Introduction: Epithelial-mesenchymal transition (EMT) is a complex patho-physiological and histo-morphological phenomenon. It is the process of conversion of columnar epithelial cells to mesenchymal phenotype and acquisition of proteins which promote tumour invasion and metastases. Increased expression of S100A4, an EMT protein, has been identified to be associated with poor prognosis. We aimed to investigate the expression of S100A4 in gastric adenocarcinomas and its prognostic significance. Methods: Formalin fixed resection specimens from 78 patients who underwent partial or total gastrectomy were collected. H & E slides were used to identify luminal surface (LS), invasive edge (IE) and tumour body (TB). Three core tissue biopsies were obtained from each region using trephine biopsy apparatus to construct tissue microarrays. These were subjected to immunohistochemical staining. S100A4 expression was

987 assessed by two independent scorers. Patient’s clinicopathologic factors were collected. Results: The mean patient age was 71 years (95%CI, 69 to 74). The staining for S100A4 was positive in 58 (74%) at TB, 49 (63%) at IE and 57 (73%) at LS. Increased expression of S100A4 at TB was associated with significant advanced local T stage (p¼0.02). There was no correlation with nodal stage and disease recurrence. There was no significant correlation between overall, cancer specific survival and S100A4 expression. Conclusions: S100A4 expression is associated with advanced local T stage of the gastric cancer. S100A4 interaction with other EMT related protein expression will help to explain the process of epithelial mesenchymal transition in gastric cancers. P16. One Step Nucleic Acid Amplification (OSNA) of Sentinel Lymph Nodes in Breast Cancer Anushka Chaudhry, E. Massey, J. Cook, M. Jenkins, Z. Winters, Z. Rayter Department of Breast Surgery, Bristol Royal Infirmary, Malborough Street, Bristol, BS1 3NU Introduction: Analysis of sentinel nodes by OSNA uses a polymerase chain reaction to measure mRNA giving a quantitative assessment of the presence of CK19, a cytokeratin present in breast epithelial cells. Method: Prospective analysis of patients between February 2010 to May 2011 was performed. Sentinel node identification was performed using dual localisation technique. Nodes were cut into 4 slices A,B,C and D. Slices A and C were processed in OSNA and slices B and D underwent histological assessment by H&E staining. Tumour characteristics were identified for each patient and correlation between OSNA and histopathology was assessed. Results: Two hundred and fifty one nodes were taken from 112 patients with a mean age of 55 years. 116 nodes were compared histologically. Thirty were found to have macrometastases or micrometastases. The sensitivity and specificity of OSNA was 93% and 89% respectively. If on the basis that tissue allocation bias, we excluded micrometastases (17 cases), specificity was 94%. There was no correlation between node positivity and tumour grade, size or receptor status. Exclusions: Nodes that were not available for histological comparison i) nodes weighing <0.05g (n¼34) were processed whole. ii) departmental agreement from mid March 2011 to process nodes whole via OSNA (n¼51); 6 of these had micro or macrometastases. Conclusion: OSNA spared 24 patients (21%) from a second procedure. Based on these findings, whole node analysis by OSNA is an acceptable, cost effective and highly sensitive method. HISTOLOGY OSNA

Positive

Negative

Total

Positive: MACRO ++ n ¼ 13 Positive: MICRO + n ¼ 17 Negative - n ¼ 136

4 9 1

9 8 135

30 136

Total

14

152

166

P17. Breast pain - does it need a mammogram? Velin Voynov, R. Vidya, E. Nael, R. Gendy Mid Staffordshire NHS Foundation Trust, Breast Care Unit, Stafford Hospital, Weston Road, ST16 3SA Introduction: Mastalgia without underlying pathology is common and affects up to 70-80% of women in their lifetime. It has a natural history of remission and relapse and can be severe enough to interfere with quality of life. Rarely is mastalgia the only symptom of breast cancer. Aim: Our aim was to audit the effectiveness of mammography in investigation of breast pain. Materials and methods: It was a retrospective study conducted between 01/05/2009 - 01/08/2009. All new patients who presented with