- Email: [email protected]
The management of C1 cytology in the assessment of breast lumps: Audit to ensure oncologically safe practice
ABSTRACTS operating characteristic curve (ROC) and calculation of area under curve (AUC). Results: 93 patients had only 1 positive SLN. On the multivariate analysis, having further positive non-SLNs (26 patients) was associated with HER 2 receptor status, presence of multifocal disease, size of primary tumour, neoadjuvant chemotherapy and LMD (AUC:0.86). In the 78 patients that had more than 1 positive SLN, having further positive nonSLNs (39 patients) was associated with age, number of nodes removed, tumour grade, presence of extracapsular spread, LMD , MV and TMV (AUC:0.8) Conclusions: The measurement of volume and diameter of metastatic deposits in the SLNs helps to estimate the risk of positive non-SLNs. http://dx.doi.org/10.1016/j.ejso.2014.02.105
P106. Does neoadjuvant chemotherapy increase the risk of postoperative complications following mastectomy and immediate DIEP flap reconstruction for early breast cancer? Natasha Jiwa1, Abdul Hakeem1, Natalie Zhang1, Charles Malata2, Parto Forouhi1 1 Cambridge Breast Unit, Addenbrooke’s University Hospital NHS Trust, Cambridge, UK 2 Departments of Plastic and Reconstructive Surgery, Cambridge, UK Introduction: Neoadjuvant chemotherapy (NC) has been beneficial in reducing tumour size in those with early breast cancer, thereby facilitating immediate reconstruction of the breast. However there are concerns with immediate microvascular reconstruction following NC, due to the risk of flap-related vascular and donor & recipient site wound complications, which might delay initiation of adjuvant treatment. This study aims to compare the post-operative complications of those who undergo DIEP (Deep Inferior Epigastric Artery Perforator) flap reconstruction following NC with those without prior NC. Methods: Patients who underwent DIEP flap from May 2009 until May 2013 were retrospectively studied (n¼131). The modified ClavienDindo classification was used to report complications. Results: 72 patients (55.0%) underwent DIEP reconstruction following NC and 59 (45.0%) without NC. All flap transfers were successful (100% flap success rate). There was no difference in breast complications between the group with NC vs. without NC [27 (37.5%) vs. 13 (22.0%); p¼0.060]. Similarly, there was no difference in flap site complications between the two groups [26 (36.1%) vs. 31 (52.5%); p¼0.076]. The group with NC had significantly higher number of grade 2 complications [27 (37.5%) vs. 9 (15.2%); p¼0.005*], whereas those without NC had higher grade 3a [14 (19.4%) vs. 24 (40.7%); p¼0.011*]. Conclusions: The study demonstrates no significant increase in complications in those who have NC before DIEP flap reconstructions in comparison to those without NC. Reporting the complications using the widely accepted Clavien-Dindo classification does demonstrate increase in grade 3a complications with those without prior NC (majority due to seroma aspirations). http://dx.doi.org/10.1016/j.ejso.2014.02.106
P107. The management of C1 cytology in the assessment of breast lumps: Audit to ensure oncologically safe practice Senthurun Mylvaganam, Felicity Page, Paul Chima, George Metaxas, Hemant Ingle Heart of England NHS Trust, Birmingham, West Midlands, UK Introduction: Fine needle aspiration cytology is commonly used for pathological assessment of breast lumps as part of triple assessment. A C1 (inadequate sample) result is returned in 8-23% of cases. Department of Health (DoH) ‘Best practice diagnostic guidance for patients presenting with breast symptoms’, suggests repeating a C1 result only for triple
641 assessment discordance or suspicion. Local policy must be robust to identify patients who can be safely discharged without biopsy repeat. Aims: Assess oncological safety of current practice in managing a C1 cytology result and adherence to DoH guidance. Methods: Retrospective analysis of patients seen in breast clinic at Heart of England NHS Trust (HEFT) between January 1st 2011 to December 31st 2011 with an initial C1 pathological assessment. Results: 254 patients. Mean age 50. 46 patients showed discordance of triple assessment. 12 of these patients had further pathological assessment, 26 patients discharged following review of triple assessment at MDT and 7 underwent repeat clinical and radiological assessment prior to discharge. 4 patients with initial C1 cytology were subsequently diagnosed with cancer on repeat biopsy. No patients discharged with C1 cytology, where biopsy not repeated, returned with invasive disease during 12-month follow-up. Discussion: HEFT practice for C1 cytology assessments is oncologically safe. 34 patients with C1 cytology and discordance did not have a repeat biopsy following review at MDT meeting. This underlines the importance of multidisciplinary review in planning further management and safe discharge of patients. Continuous audit of this MDT outcome is essential to maintain oncological safety of C1 assessments. http://dx.doi.org/10.1016/j.ejso.2014.02.107
P108. Therapeutic mammoplasty: Oncologically effective and cosmetically acceptable for breast conserving surgery in large volume disease Senthurun Mylvaganam, Manas Dube, Pilar Matey Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK Introduction: Breast conserving surgery (BCS) undertaken for large volume disease has a significant re-operation rate (20-29%) to ensure oncological clearance. This can produce poor cosmetic results particularly following adjuvant radiotherapy. Therapeutic mammoplasty offers a strategy to improve oncological effectiveness at the first operation and provide acceptable cosmetic results. Few studies have looked to determine whether there is a significant oncological and cosmetic advantage in employing this technique with more extensive single focus breast cancer. Aims: Assess the oncological effectiveness and cosmetic satisfaction of patients undergoing therapeutic mammoplasty for breast cancer. Methods: Retrospective analysis of all patients undergoing therapeutic mammoplasty for invasive and non-invasive disease by a single oncoplastic breast surgeon between February 2010 and October 2013. Results: N ¼ 55 patients. Mean age ¼ 54. Mean tumour size 22.8mm (7-63) with 52% having concurrent DCIS. Mean specimen weight 342g. Involved margin rate 8% (4) with 6% (3) undergoing further oncologic breast surgery. The remaining patient undergoing adjuvant chemoradiotherapy. 80% patients had concurrent contralateral surgery for symmetry. 8% required further ipsilateral surgery for cosmetic satisfaction. Discussion: The use of therapeutic mammoplasty allows for extension of BCS for larger volume disease. It offers an oncologically effective surgical resection with much lower reoperation rates than wide local excision even in the presence of DCIS. This is achieved with high cosmetic satisfaction, which can be achieved when synchronous contralateral surgery is performed. http://dx.doi.org/10.1016/j.ejso.2014.02.108
P109. Outcomes in male breast cancers presenting to a tertiary breast unit Ruth James, Emma Bradbury, Lisa Whisker, Eleanor Gutteridge Nottingham University Hospitals, Nottingham, UK
P106. Does neoadjuvant chemotherapy increase the risk of postoperative complications following mastectomy and immediate DIEP flap reconstruction for early breast cancer? Natasha Jiwa1, Abdul Hakeem1, Natalie Zhang1, Charles Malata2, Parto Forouhi1 1 Cambridge Breast Unit, Addenbrooke’s University Hospital NHS Trust, Cambridge, UK 2 Departments of Plastic and Reconstructive Surgery, Cambridge, UK Introduction: Neoadjuvant chemotherapy (NC) has been beneficial in reducing tumour size in those with early breast cancer, thereby facilitating immediate reconstruction of the breast. However there are concerns with immediate microvascular reconstruction following NC, due to the risk of flap-related vascular and donor & recipient site wound complications, which might delay initiation of adjuvant treatment. This study aims to compare the post-operative complications of those who undergo DIEP (Deep Inferior Epigastric Artery Perforator) flap reconstruction following NC with those without prior NC. Methods: Patients who underwent DIEP flap from May 2009 until May 2013 were retrospectively studied (n¼131). The modified ClavienDindo classification was used to report complications. Results: 72 patients (55.0%) underwent DIEP reconstruction following NC and 59 (45.0%) without NC. All flap transfers were successful (100% flap success rate). There was no difference in breast complications between the group with NC vs. without NC [27 (37.5%) vs. 13 (22.0%); p¼0.060]. Similarly, there was no difference in flap site complications between the two groups [26 (36.1%) vs. 31 (52.5%); p¼0.076]. The group with NC had significantly higher number of grade 2 complications [27 (37.5%) vs. 9 (15.2%); p¼0.005*], whereas those without NC had higher grade 3a [14 (19.4%) vs. 24 (40.7%); p¼0.011*]. Conclusions: The study demonstrates no significant increase in complications in those who have NC before DIEP flap reconstructions in comparison to those without NC. Reporting the complications using the widely accepted Clavien-Dindo classification does demonstrate increase in grade 3a complications with those without prior NC (majority due to seroma aspirations). http://dx.doi.org/10.1016/j.ejso.2014.02.106
P107. The management of C1 cytology in the assessment of breast lumps: Audit to ensure oncologically safe practice Senthurun Mylvaganam, Felicity Page, Paul Chima, George Metaxas, Hemant Ingle Heart of England NHS Trust, Birmingham, West Midlands, UK Introduction: Fine needle aspiration cytology is commonly used for pathological assessment of breast lumps as part of triple assessment. A C1 (inadequate sample) result is returned in 8-23% of cases. Department of Health (DoH) ‘Best practice diagnostic guidance for patients presenting with breast symptoms’, suggests repeating a C1 result only for triple
641 assessment discordance or suspicion. Local policy must be robust to identify patients who can be safely discharged without biopsy repeat. Aims: Assess oncological safety of current practice in managing a C1 cytology result and adherence to DoH guidance. Methods: Retrospective analysis of patients seen in breast clinic at Heart of England NHS Trust (HEFT) between January 1st 2011 to December 31st 2011 with an initial C1 pathological assessment. Results: 254 patients. Mean age 50. 46 patients showed discordance of triple assessment. 12 of these patients had further pathological assessment, 26 patients discharged following review of triple assessment at MDT and 7 underwent repeat clinical and radiological assessment prior to discharge. 4 patients with initial C1 cytology were subsequently diagnosed with cancer on repeat biopsy. No patients discharged with C1 cytology, where biopsy not repeated, returned with invasive disease during 12-month follow-up. Discussion: HEFT practice for C1 cytology assessments is oncologically safe. 34 patients with C1 cytology and discordance did not have a repeat biopsy following review at MDT meeting. This underlines the importance of multidisciplinary review in planning further management and safe discharge of patients. Continuous audit of this MDT outcome is essential to maintain oncological safety of C1 assessments. http://dx.doi.org/10.1016/j.ejso.2014.02.107
P108. Therapeutic mammoplasty: Oncologically effective and cosmetically acceptable for breast conserving surgery in large volume disease Senthurun Mylvaganam, Manas Dube, Pilar Matey Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK Introduction: Breast conserving surgery (BCS) undertaken for large volume disease has a significant re-operation rate (20-29%) to ensure oncological clearance. This can produce poor cosmetic results particularly following adjuvant radiotherapy. Therapeutic mammoplasty offers a strategy to improve oncological effectiveness at the first operation and provide acceptable cosmetic results. Few studies have looked to determine whether there is a significant oncological and cosmetic advantage in employing this technique with more extensive single focus breast cancer. Aims: Assess the oncological effectiveness and cosmetic satisfaction of patients undergoing therapeutic mammoplasty for breast cancer. Methods: Retrospective analysis of all patients undergoing therapeutic mammoplasty for invasive and non-invasive disease by a single oncoplastic breast surgeon between February 2010 and October 2013. Results: N ¼ 55 patients. Mean age ¼ 54. Mean tumour size 22.8mm (7-63) with 52% having concurrent DCIS. Mean specimen weight 342g. Involved margin rate 8% (4) with 6% (3) undergoing further oncologic breast surgery. The remaining patient undergoing adjuvant chemoradiotherapy. 80% patients had concurrent contralateral surgery for symmetry. 8% required further ipsilateral surgery for cosmetic satisfaction. Discussion: The use of therapeutic mammoplasty allows for extension of BCS for larger volume disease. It offers an oncologically effective surgical resection with much lower reoperation rates than wide local excision even in the presence of DCIS. This is achieved with high cosmetic satisfaction, which can be achieved when synchronous contralateral surgery is performed. http://dx.doi.org/10.1016/j.ejso.2014.02.108
P109. Outcomes in male breast cancers presenting to a tertiary breast unit Ruth James, Emma Bradbury, Lisa Whisker, Eleanor Gutteridge Nottingham University Hospitals, Nottingham, UK