163. male breast cancer – the same disease as female breast cancer?

2
minutes. A non-statistically significant trend was observed between vol- ume of magnetic tracer injected and iron content of SLNs (P¼0.07). Conclusion: Magnetic SLNB is feasible with a range of volumes of magnetic tracer. The manipulation of volumes of magnetic tracer injected can determine the level of echelon nodes excised and increasing the time between injection and SLNB improves transcutaneous ’hotspot’ identifica- tion. Application of these findings may help to improve clinical outcomes. Conflict of interest: Board of directors: Professor Quentin Pankhurst is the co-founder and sits as a non-executive director on the Board of Directors of Endomagnetics Ltd (Cambridge, UK). http://dx.doi.org/10.1016/j.ejso.2014.08.155 161. Validating the ’10 per cent Rule’ for magnetic sentinel lymph node biopsy in breast cancer M. Ahmed 1 , B. Anninga 1 , M. Douek 1 1 King’s College London, Research Oncology, London, United Kingdom Background: Magnetic sentinel lymph node biopsy (SLNB) is an emerging technique in the axillary staging of breast cancer. There is no ev- idence available to determine a suitable threshold of ex vivo magnetometer counts for node excision. Consequently, the ‘10 per cent rule’ derived from radioisotopes is applied. We assess the largest study of magnetic SLNB (SentiMAG Multicentre Trial) to determine the validity of the ’10 per cent rule’. Materials and methods: A total of 347 patients across 7 centres un- derwent SLNB with both magnetic and standard techniques. The ex vivo counts and histopathology of all nodes was prospectively collected. The distribution of magnetometer and radioactive counts of all nodes was as- sessed. The nodes excised for each patient were then classified as a per- centage of the node with the highest count (hottest node). The false negative rates (FNR) as a decreasing function of the threshold of magne- tometer and radioactive counts was examined. Results: A total of 855 nodes were excised of which 747 were identi- fied using the magnetic and 794 using the standard technique. The peak distribution of counts for all nodes using both techniques was in the range 0-500. The majority of metastatically involved nodes had the highest mag- netic (62 per cent) and radioactive (58 per cent) uptake. The application of the 10 per cent threshold resulted in a false negative rate of 0 per cent versus 2.8 per cent for the magnetic and radioisotope techniques respectively. Conclusion: The ‘10 per cent rule’ of the hottest ex vivo node is an acceptable threshold for the safe performance of magnetic SLNB. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.156 162. Why should breast surgeons use ultrasound? M. Ahmed 1 , N.A. Abdullah 2 , S. Cawthorn 3 , S.I. Usiskin 4 , M. Douek 1 1 King’s College London, Research Oncology, London, United Kingdom 2 Universiti Kebangsaan Malaysia Medical Centre, Division of Breast Reconstructive Surgery Department of Surgery, Kuala Lumpur, Malaysia 3 Frenchay Hospital North Bristol NHS Trust, Breast Surgery, Bristol, United Kingdom 4 St Bartholomew’s Hospital, Breast Radiology, London, United Kingdom Background: Portable ultrasound is now used in a variety of clinical settings by specialties outside of radiology. Despite increased accessibility to ultrasound the overall performance of ultrasound by breast surgeons is consistently low. We discuss the reasons why this is unacceptable for future patient care and answer the question, ’Why should breast surgeons use ultrasound?’ Methods: We reviewed the literature for evidence assessing the out- comes of breast surgeon-performed ultrasound both intra-operatively and in the outpatient department. Results: Intra-operative ultrasound (IOUS) performed by surgeons re- duces re-excision rates in breast conserving surgery. Outpatient-based ul- trasound performed by surgeons frees up the resources of radiology departments, allowing them to focus upon patients requiring more complex diagnostic and interventional procedures. For surgeons to competently perform intra-operative and outpatient-based ultrasound a period of formal ultrasound training is necessary to acquire knowledge of ultrasound skills and techniques. This should be followed by a period of mentorship and su- pervised training with an experienced breast radiologist. Conclusions: Breast surgeon-performed ultrasound is beneficial to the multi-disciplinary care of breast cancer patients. To further improve multi- disciplinary care, breast surgeons and radiologists should work more collaboratively to optimise imaging applications both in the operating theatre and outpatient department. Current advances in therapeutic percu- taneous techniques are of interest to both surgeons and radiologists. In future a hybrid specialization should be considered to incorporate accred- itation in both specialties for breast interventional procedures. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.157 163. Male breast cancer e the same disease as female breast cancer? M. Jevric 1 , V. Posarac 1 , S. Susnjar 1 , Z. Neskovic-Konstantinovic 1 , D. Gavrilovic 1 , S. Jokic 1 , I. Markovic 1 , R. Dzodic 1 1 Insitute of Oncology and Radiology, Surgery, Belgrade, Serbia Introduction: Breast cancers (BC) in males are rarely diagnosed and comprise about 1% of all BC pts. Patients and methods: We analyzed a group of male BC pts who were treated at the Institute of Oncology and Radiology of Serbia from 1994 to 2010. The majority of them were operated on depending on disease stage at diagnosis and (neo)adjuvant chemotherapy [(N)ACT] with CMF and FAC and Tamoxifen were given where indicated. Postoperative radio- therapy was performed in all N+ and T4 BC pts. Hormone receptors (HR) were determined prospectively either by biochemical DCC method, or by immunohistochemistry (IHC), while HER2 status was determined by IHC. Study endpoints were PFS, DFS and OS. Statistics includes Hi square and Log rank tests. Results: In total 110 male pts median ages of 65 (range 29-84) years were analyzed. After median follow-up period of 56.6 mos (range 5-199 mos) disease relapse were confirmed in 42/110 (38%) pts, while 55/110 (50%) died. Sixty three pts (57%) were diagnosed in stage I/II, 86/110 (78%) had ductal invasive and 81/110 (74%) grade 2 BC. HRs were deter- mined in 68/110 (62%) pts and among them 63/68 (93%) were ER+ and/or PR+, while HER2 status was negative in 21/21 pts in whom it was measured (only 2/21 were triple neg BC). Radical surgery was performed in 87/110 (79%) of pts, radiotherapy in 77/110 (70%) of pts, (N)ACT received 45/110 (42%) and Tamoxifen 71/110 (66%) of pts. The following factors significantly influenced the disease outcome: a) stage 1/2 vs. stage 3 at diagnosis: longer DFS (Log-Rank test, p¼ 0.0), PFS (p¼ 0.0) and OS (p¼ 0.0); b) T 1/2 vs. T3/4: longer DFS (p¼ 0.005), PFS (p¼ 0.0) and OS (p¼ 0.0); c) number of involved regional lymph nodes in radically oper- ated pts: N0 vs. N 3 4 longer DFS (p<0.0001), PFS (p<0.0001) and OS (p¼ 0.0001) and N1-3 vs. N 3 4: longer DFS (p¼ 0.007) and PFS (p¼ 0.01). Patients who were radically operated had better disease outcome compared to pts w/o radical surgery: longer PFS (p¼ 0.011) and OS (p¼ 0.002). Type of systemic therapy and radiotherapy did not influence disease outcome. Similarly, PR status did not influenced disease outcome in ER+ BC pts. Conclusion: Endocrine responsiveness was shown in a majority of pts with known HRs and luminal A/B subtypes were detected in almost all pts with known HER2 status. Our results confirmed that stage of disease at diagnosis, radical surgery and nodal status in operated pts are the most important factors influencing disease outcome. ABSTRACTS S71

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ABSTRACTS S71

minutes. A non-statistically significant trend was observed between vol-

ume of magnetic tracer injected and iron content of SLNs (P¼0.07).

Conclusion: Magnetic SLNB is feasible with a range of volumes of

magnetic tracer. The manipulation of volumes of magnetic tracer injected

can determine the level of echelon nodes excised and increasing the time

between injection and SLNB improves transcutaneous ’hotspot’ identifica-

tion. Application of these findings may help to improve clinical outcomes.

Conflict of interest: Board of directors: Professor Quentin Pankhurst is the

co-founder and sits as a non-executive director on the Board of Directors

of Endomagnetics Ltd (Cambridge, UK).

http://dx.doi.org/10.1016/j.ejso.2014.08.155

161. Validating the ’10 per cent Rule’ for magnetic sentinel lymph

node biopsy in breast cancer

M. Ahmed1, B. Anninga1, M. Douek1

1 King’s College London, Research Oncology, London, United Kingdom

Background: Magnetic sentinel lymph node biopsy (SLNB) is an

emerging technique in the axillary staging of breast cancer. There is no ev-

idence available to determine a suitable threshold of ex vivo magnetometer

counts for node excision. Consequently, the ‘10 per cent rule’ derived from

radioisotopes is applied. We assess the largest study of magnetic SLNB

(SentiMAG Multicentre Trial) to determine the validity of the ’10 per

cent rule’.

Materials and methods: A total of 347 patients across 7 centres un-

derwent SLNB with both magnetic and standard techniques. The ex vivo

counts and histopathology of all nodes was prospectively collected. The

distribution of magnetometer and radioactive counts of all nodes was as-

sessed. The nodes excised for each patient were then classified as a per-

centage of the node with the highest count (hottest node). The false

negative rates (FNR) as a decreasing function of the threshold of magne-

tometer and radioactive counts was examined.

Results: A total of 855 nodes were excised of which 747 were identi-

fied using the magnetic and 794 using the standard technique. The peak

distribution of counts for all nodes using both techniques was in the range

0-500. The majority of metastatically involved nodes had the highest mag-

netic (62 per cent) and radioactive (58 per cent) uptake. The application of

the 10 per cent threshold resulted in a false negative rate of 0 per cent

versus 2.8 per cent for the magnetic and radioisotope techniques

respectively.

Conclusion: The ‘10 per cent rule’ of the hottest ex vivo node is an

acceptable threshold for the safe performance of magnetic SLNB.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.156

162. Why should breast surgeons use ultrasound?

M. Ahmed1, N.A. Abdullah2, S. Cawthorn3, S.I. Usiskin4, M. Douek1

1 King’s College London, Research Oncology, London, United Kingdom2Universiti Kebangsaan Malaysia Medical Centre, Division of Breast

Reconstructive Surgery Department of Surgery, Kuala Lumpur, Malaysia3 Frenchay Hospital North Bristol NHS Trust, Breast Surgery, Bristol,

United Kingdom4 St Bartholomew’s Hospital, Breast Radiology, London, United Kingdom

Background: Portable ultrasound is now used in a variety of clinical

settings by specialties outside of radiology. Despite increased accessibility

to ultrasound the overall performance of ultrasound by breast surgeons is

consistently low. We discuss the reasons why this is unacceptable for

future patient care and answer the question, ’Why should breast surgeons

use ultrasound?’

Methods: We reviewed the literature for evidence assessing the out-

comes of breast surgeon-performed ultrasound both intra-operatively and

in the outpatient department.

Results: Intra-operative ultrasound (IOUS) performed by surgeons re-

duces re-excision rates in breast conserving surgery. Outpatient-based ul-

trasound performed by surgeons frees up the resources of radiology

departments, allowing them to focus upon patients requiring more complex

diagnostic and interventional procedures. For surgeons to competently

perform intra-operative and outpatient-based ultrasound a period of formal

ultrasound training is necessary to acquire knowledge of ultrasound skills

and techniques. This should be followed by a period of mentorship and su-

pervised training with an experienced breast radiologist.

Conclusions: Breast surgeon-performed ultrasound is beneficial to the

multi-disciplinary care of breast cancer patients. To further improve multi-

disciplinary care, breast surgeons and radiologists should work more

collaboratively to optimise imaging applications both in the operating

theatre and outpatient department. Current advances in therapeutic percu-

taneous techniques are of interest to both surgeons and radiologists. In

future a hybrid specialization should be considered to incorporate accred-

itation in both specialties for breast interventional procedures.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.157

163. Male breast cancer e the same disease as female breast cancer?

M. Jevric1, V. Posarac1, S. Susnjar1, Z. Neskovic-Konstantinovic1, D.

Gavrilovic1, S. Jokic1, I. Markovic1, R. Dzodic1

1 Insitute of Oncology and Radiology, Surgery, Belgrade, Serbia

Introduction: Breast cancers (BC) in males are rarely diagnosed and

comprise about 1% of all BC pts.

Patients and methods:We analyzed a group of male BC pts who were

treated at the Institute of Oncology and Radiology of Serbia from 1994 to

2010. The majority of them were operated on depending on disease stage

at diagnosis and (neo)adjuvant chemotherapy [(N)ACT] with CMF and

FAC and Tamoxifen were given where indicated. Postoperative radio-

therapy was performed in all N+ and T4 BC pts. Hormone receptors

(HR) were determined prospectively either by biochemical DCC method,

or by immunohistochemistry (IHC), while HER2 status was determined by

IHC. Study endpoints were PFS, DFS and OS. Statistics includes Hi square

and Log rank tests.

Results: In total 110 male pts median ages of 65 (range 29-84) years

were analyzed. After median follow-up period of 56.6 mos (range 5-199

mos) disease relapse were confirmed in 42/110 (38%) pts, while 55/110

(50%) died. Sixty three pts (57%) were diagnosed in stage I/II, 86/110

(78%) had ductal invasive and 81/110 (74%) grade 2 BC. HRs were deter-

mined in 68/110 (62%) pts and among them 63/68 (93%) were ER+ and/or

PR+, while HER2 status was negative in 21/21 pts in whom it was

measured (only 2/21 were triple neg BC). Radical surgery was performed

in 87/110 (79%) of pts, radiotherapy in 77/110 (70%) of pts, (N)ACT

received 45/110 (42%) and Tamoxifen 71/110 (66%) of pts. The following

factors significantly influenced the disease outcome: a) stage 1/2 vs. stage

3 at diagnosis: longer DFS (Log-Rank test, p¼ 0.0), PFS (p¼ 0.0) and OS

(p¼ 0.0); b) T 1/2 vs. T3/4: longer DFS (p¼ 0.005), PFS (p¼ 0.0) and OS

(p¼ 0.0); c) number of involved regional lymph nodes in radically oper-

ated pts: N0 vs. N 34 longer DFS (p<0.0001), PFS (p<0.0001) and OS

(p¼ 0.0001) and N1-3 vs. N 34: longer DFS (p¼ 0.007) and PFS (p¼0.01). Patients who were radically operated had better disease outcome

compared to pts w/o radical surgery: longer PFS (p¼ 0.011) and OS

(p¼ 0.002). Type of systemic therapy and radiotherapy did not influence

disease outcome. Similarly, PR status did not influenced disease outcome

in ER+ BC pts.

Conclusion: Endocrine responsiveness was shown in a majority of pts

with known HRs and luminal A/B subtypes were detected in almost all pts

with known HER2 status. Our results confirmed that stage of disease at

diagnosis, radical surgery and nodal status in operated pts are the most

important factors influencing disease outcome.

S72 ABSTRACTS

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.158

164. Open access follow up for breast cancer patients at East Surrey

hospital: The way forward for breast cancer care

K. Chadha1, T. Patrick1, S. Trowbridge1, A. Conway1, S. Waheed1

1 East Surrey Hospital, Breast Unit, Redhill Surrey, United Kingdom

Background: In the UK there has been a nationwide movement to-

wards patient led follow up care after breast cancer treatment. This open

access follow up has been found to be more effective, enabling cancer sur-

vivors to take control of their condition and get on with their lives. This

study aimed to assess the impact of an open access follow up system for

breast cancer patients at East Surrey hospital. Instead of a routine appoint-

ment, follow up patients with a benign mammogram would be given open

access telephone contact with breast care nurses and offered a hospital

appointment only when necessary.

Materials and methods: Mammogram results were reviewed for

follow up breast cancer patients attending clinic for their annual review.

Results were divided into those reported as benign and those as indetermi-

nate or suspicious. Patient selection for entrance to open access was deter-

mined by questionnaire consent. Following the introduction of open

access, breast care nurses monitored phone calls received over a one month

period. Questionnaires were used to grade the appropriateness of the

queries and any actions required to resolve them.

Results: Of 100 clinic encounters analysed, 69 had mammograms that

were reported as benign and 31 as indeterminate or suspicious. On average,

2080 breast cancer patients are seen in follow up clinics at East Surrey hos-

pital per annum. Of these approximately 69%, or 1435 patients, will have a

benign mammogram. Following introduction of open access, an increase in

call volume was reported by breast care nurses. However, further analysis

showed that 98% of telephone encounters were entirely managed by breast

care nurses and none required a hospital appointment. The cost of a single

follow up clinic appointment is £150, so £215,250 per year is spent at East

Surrey hospital on patients who may not have needed to attend.

Conclusions: This study demonstrated that open access follow up pro-

vided adequate and timely support for patients after breast cancer treat-

ment, while simultaneously preventing unnecessary hospital attendances.

Furthermore, there are clear financial benefits to the introduction of open

access follow up for this patient group. As a result, open access is being

proposed by the East Surrey Breast Unit for follow up patients with a

benign mammogram. Further analysis is needed to evaluate the long

term impact. Nevertheless, the initial results are promising.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.159

165. Can we safely avoid axillary clearance when sentinel node is

minimally involved in early breast cancer?

E. Esposito1, V. Sollazzo1, R. Di Micco1, M. Cervotti1, G. Ciancia2, P.

Forestieri1, G. Limite1

1 University Department of Clinical Medicine and Surgery Breast Unit

Federico II University Medical School, Breast Surgery, Naples, Italy2Advanced Biomedical Science Federico II University Medical School,

Pathology, Naples, Italy

Background: Sentinel Lymph Node Biopsy (SLNB) represents a mini-

mally invasive technique for axillary staging in early breast cancer. SLNB

is useful in surgical complications risk reducing compared to complete

axillary lymph node dissection (CALND). Micrometastases (MM) prog-

nostic value has been recently challenged. The 2011 St Gallen Consensus

Conference recommended that micrometastases in a single sentinel node

should not be an indication for axillary dissection irrespective of the

type of breast surgery given. Results from IBCSG 23-01 trial have shown

that the rate of disease recurrence is reassuringly low in the undissected

axilla (<1%) with minimally sentinel node involvement and that overall

survival did not differ in patients spared from CALND compared to those

whom had been treated with. Endpoints of this study were micrometastases

incidence in SLNB evaluation; Non Sentinel Nodes (NSNs) involvement

rate when sentinel node positive for MM and predictive variables of metas-

tasis in NSNs finding out when MM were detected at sentinel node biopsy.

Materials and methods: Histopathological features of 901 patients

with breast cancer cT1 e T2 �3 cm cN0 treated with SLNB have been

evaluated from single institution database. 566 of them underwent axillary

clearance. Patients presenting MM or ITC underwent CALND as well as

patients with macrometastases in SLNB. Tumour size, histotype, grading,

lymphatic vessel infiltration, age at diagnosis have been analyzed and

correlated to Non Sentinel Nodes (NSNs) risk of metastasis.

Results: 270 patients were found to have SN positive (29.9%). Metas-

tasis distribution in the sentinel node was 74% for macrometastases; 24%

for micrometastases; 2% for ITC. After complete axillary dissection the

rate of Non Sentinel Nodes positive when sentinel node was minimally

involved with micrometastases was 3.5%. Non sentinel node positive

were found in only in two cases (one multicentric and one T2, high grade,

lobular cancer). Overall survival and disease free survival were 100% in

median 5 years (49.5 months) followeup for patients presenting microme-

tastases at SLNB.

Conclusions: Outcomes from our research group can confirm that

complete axillary node dissection can be safely omitted when micrometa-

stasis occur in sentinel node biopsy in early breast cancer. Micrometastasis

at sentinel node in multicentric disease and lobular histotype has to be

further investigated.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.160

166. Patterns of care in the administration of neoadjuvant

chemotherapy for breast cancer: A population based study

G. Vugts1, A.J.G. Maaskant-Braat1, G.A.P. Nieuwenhuijzen1, R.M.H.

Roumen2, E.J.T. Luiten3, A.C. Voogd4

1 Catharina Hospital, Surgery, Eindhoven, Netherlands2Maxima Medical Centre, Surgery, Veldhoven, Netherlands3 Amphia Hospital, Surgery, Breda, Netherlands4Maastricht University, Epidemiology, Maastricht, Netherlands

Background: Neoadjuvant chemotherapy (NAC) is used to facilitate

radical surgery for initially irresectable or locally advanced breast cancer.

The indication for NAC has been extended to clinically node negative

(cN0) patients in whom adjuvant systemic therapy is foreseen. No defini-

tive evidence exists regarding the timing of the sentinel node biopsy (SNB)

in relation to NAC. NAC could theoretically sterilize the axilla and thus

reduce the need for axillary lymph node dissection (ALND). On the other

hand, patients could be subjected to a potentially worse oncological

outcome if SNB is performed after NAC due to the higher false negative

rate. A population based study was conducted to evaluate the use of

NAC and the timing of SNB.

Methods: All female patients with breast cancer, treated in 10 general

hospitals in the Eindhoven Cancer Registry area in the Netherlands be-

tween 2003 and June 2012 were included (N¼18,427).

Results: A total of 1,402 patients (7.6%) were treated with NAC dur-

ing this period, increasing from 2.5% in 2003 to 13.0% in 2011. This in-

crease was significant (P<0.001) for all tumour sizes. Use of NAC

increased from 0.5% up to 2.3% for clinically T1 tumours, from 2.8% to

27.0% for T2, from 30.6% to 70.9% for T3 and from 40.5% to 58.1%

for T4 tumours. In clinically N0 patients use of NAC increased from

1.0% to 4.4% and in clinically N+ from 12.0% to 57.5% (P<0.001). Pa-

tients receiving NAC were younger (P<0.001) and showed a higher clin-

ical T and N status (P<0.001) compared to those undergoing surgery first.