492 ABSTRACTS

P109. Delayed-immediate breast reconstruction - widening the

indications for breast reconstruction

Layal El-Asirb, James Harveya, Henry Cainb, Jo O’Donoghueb, Stewart

Nicholsonb

a University Hospital of South Manchester, Wythenshawe, Manchester, UKbRoyal Victoria Infirmary, Newcastle-upon-Tyne, UK

Introduction: In women who have a mastectomy and wish to have

breast reconstruction, the best timing of breast reconstruction depends on

whether radiotherapy (XRT) is needed. If there is pre-operative uncertainty

about the need for XRT, patients can be offered a delayed-immediate recon-

struction (DIBR). This is where after performing skin sparing mastectomy,

a tissue expander or implant is placed until definitive pathology is known.

If no XRT is needed, immediate reconstruction can follow, if XRT is neces-

sary, it is performedwith the implant in-situwith the hope of preserving skin.

There are no published series of DIBR on a UK population.

Methods: Retrospective data collection of all women undergoing

DIBR between June 2006 and December 2012. Written hospital records

and electronic files were handsearched for the necessary datasets. PROM

data is currently being collected for these women.

Results: 24 patients had DIBR. Median age 49 (range 27-69). Mean

tumour size on pre-operative assessment was 43mm (range 9-120). 3 pa-

tients had explantation of their implant/expander due to infection, one of

these had DIEP flap performed at the same time. Ten patients required ad-

juvant chest wall XRT. Definitive reconstruction has been performed in

eight patients, with a mixture of DIEP, LD and implant. All patients having

reconstruction following XRT have had autologous reconstruction. No pa-

tients have had local recurrence.

Conclusions: DIBR is a safe procedure with low risk of implant loss.

DIBR gives women the choice of preserving native skin, which is likely to

improve long-term cosmesis.

http://dx.doi.org/10.1016/j.ejso.2013.01.145

P110. Mammographic findings and rates of ultrasound and biopsy

following wide local excision for breast cancer in patients treated

with intraoperative radiotherapy (IORT) versus external beam

whole breast radiotherapy (EBRT)

Beatrix Elsbergera, Andrea Romsauerovaa, Douglas Brownb,

John Dewara, Sarah Vinnicombea, Patsy Whelehana, Andy Evansa

a Dundee Cancer Centre, Clinical Research Centre, University of Dundee,

Ninewells Hospital and Medical School, Dundee, UKbBreast Unit, Ninewells Hospital and Medical School, Dundee, UK

Introduction: As part of the TARGIT-A trial, breast cancer patients

were prospectively randomised to either EBRT or a single dose of IORT,

with comparable results in local recurrence and complication rates. Our

aim was to compare follow-up mammographic findings and rates of ad-

junctive ultrasound and biopsy between the two groups.

Methods: Follow-up mammograms from TARGIT trial participants

were independently reviewed by two radiologists blinded to the treatment

received. Between-group differences were compared using chi-square

test.

Results: The cohort consisted of 141 patients (EBRT n¼80/IORT

n¼61). Patient and disease characteristics were similar between the two

groups, as were the number of follow-up mammograms and length of fol-

low-up (EBRT/IORT n¼2.0/2.4; 4.3yr/5.1yr; p¼0.386). There were no sig-

nificant differences in mammographic scar or calcification appearances of

the post-operative site. However, increased breast density and generalised

skin thickening were more common in the EBRT compared to the IORT

group (p¼0.002; p¼ 0.030 respectively). Ultrasound at follow-up was

required slightlymore frequently in the IORTgroup (15 of 61 (24.6%) versus

11 of 80 (13.8%)) but the difference was not statistically significant

(p¼0.100). No disease recurrence was demonstrated on any of the breast bi-

opsies taken.Only one biopsywas reported as fat necrosis in the IORTgroup.

Conclusions: Generalised reactions on mammography are more com-

mon following EBRT compared with IORT. A slight, non-statistically sig-

nificant increase in the need for ultrasound at follow-up was seen in the

IORT group. However, IORT does not significantly increase mammo-

graphic interpretation problems or diagnostic intervention rates at fol-

low-up mammography.

http://dx.doi.org/10.1016/j.ejso.2013.01.146

P111. Reliability of a questionnaire for long-term follow of breast

cancer patients

Michael Greena, Pippa Barkb

a South Devon Healthcare Foundation Trust, Torquay, UKbUCL, London, UK

Aim: Routine face-to-face follow-up of breast cancer patients does not

improve survival outcomes and is poor at detecting psychological morbid-

ity. Furthermore follow-up strategies and data collection on outcomes lack

structure across the healthcare community. This study tests the reliability

of a short questionnaire intended for detection of physical and psycholog-

ical morbidity, triage of patient symptoms and recording clinical outcomes.

Methods: The 10-question Likert-scale questionnaire covered breast

symptoms and local recurrence, arm/shoulder morbidity, adjuvant treatment

and side-effects, psychological morbidity and secondary breast cancer.

13 low/moderate risk (NottinghamPrognostic Index) breast cancer patients

in routine follow-up twoormoreyears post-operationwere purposively selected

to complete the questionnaire and subsequent semi-structured interview. Anal-

ysis of transcriptions was undertaken and validated by an independent rater.

Results: All patients were able to complete the questionnaire and were

confident in their response to most questions. Their understanding of the

syntax was correct and no patients found any questions unacceptable.

The questionnaire was reliable for local recurrence, shoulder/arm morbid-

ity, adjuvant treatment and side-effects, and psychological morbidity.

The questionnaire was unreliable for detecting secondary cancer be-

cause of poor patient understanding of cancer symptoms and confounded

by other diagnoses such as respiratory disease and arthritis.

Patients were uncertain of the time-scale for reporting symptoms and

over-reported some which had resolved.

Conclusion: The short questionnaire is acceptable to patients and reli-

able in detecting new morbidity. However inadequate patient understand-

ing of secondary cancer symptoms compromise reliability in some

patients with other chronic symptomatic disease. This might be resolved

through better patient education.

http://dx.doi.org/10.1016/j.ejso.2013.01.147

P112. A comparison of the Memorial Sloan Kettering (MSK)

nomogram and OSNA copy number to predict the risk of positive

non-sentinel lymph nodes (SLN) in SLN positive patients

Sam Williams, Jonathan Horsnell, Jim Wood, Zoe Winters,

Zenon Rayter

University Hospitals Bristol NHS Foundation Trust, Bristol, UK

Introduction: Identification of sentinel lymph node (SLN) positive pa-

tients at risk of further non-SLN metastases would allow a more targeted ap-

proach to axillary lymph node clearance (ALNC) and potentially spare low

risk patients unnecessary further surgery. OSNA, an intra-operative node as-

sessment technology, provides a quantitativemeasure of themetastatic burden

in the axilla. This study aimed to compare the efficacy of theOSNAcopynum-

ber at predicting non-SLN metastasis to the MSK nomogram.