invisible dcis; gaining an insight into the unknown

662 ABSTRACTS

P177. Re-excision of margins: Always a necessary procedure?

Laura Sweeney, Maurice Stokes

Mater Misericordiae University Hospital, Dublin, Ireland

Introduction: Any breast procedure can prove to be a very stressful

and worrisome ordeal for a patient: especially if it is a second or follow

up procedure. One such procedure would be re-excision of margins

(ReM) after a wide local excision (WLE), with suspicious histology at

or near the original specimen margin. With the patient having undergone

initial surgery for removal of a lesion, they then have the worry of having

to undergo a second surgical procedure with the local risks and risks of

general anaesthetic.

Method: We retrospectively reviewed 326 cases of ReM over six years,

between 2007 and 2013. We looked at each case, seeing what were the his-

tological margins at the initialWLE specimen and whether or not the further

ReM histology were clear, satisfactory or required further ReM.

Results: 186 cases (n¼326) or ReM showed clear margins with no evi-

dence of carcinoma in situ, invasive carcinoma or atypical hyperplasia at

the new margin. 85 cases showed either carcinoma in situ, invasive carci-

noma or atypical hyperplasia (or a combination) within an accepted margin

of>2mm from edge of specimen. 55 cases had either carcinoma in situ, inva-

sive carcinoma or atypical hyperplasia (or a combination) at or <1mm from

resected margin. [Further breakdown margin size data available]

Conclusion: Given that a large amount of our study (43%) had a sus-

picious lesion present in the ReM specimen, it does show the importance

of going back to re-excise suspicious and close margins. However, almost

57% of all ReM cases had clear histology, leading to the question of

possibly unnecessary prodedures and worry for the patient for an already

cleared lesion at inital WLE.

http://dx.doi.org/10.1016/j.ejso.2014.02.176

P178. Breast reconstruction in the ‘elderly’ e A feasible reality

Natalie Chand, Anthony Skene, Dexter Perry

Royal Bournemouth Hospital, Bournemouth, UK

Introduction: The national population continues to age, but advances

have allowed safer surgical treatment for breast cancer in older women.

Post-mastectomy reconstruction is an important part of holistic treatment

but does involve lengthier surgery and carries added risks of potential com-

plications. Evidence has shown that age itself is not a risk factor for poor

surgical outcomes, but concern over this causes surgeons to be wary of of-

fering elderly patients the opportunity of reconstruction.

Methods: We examined our local reconstructive database between

January 2009 and December 2012 (including breast reconstruction and/

or symmetrisation) with regards to demographics and post-operative com-

plications. Demographic data was compared with national data gained via

Hospital Episode Statistics.

Results: 129 reconstructions and 85 other oncoplastic procedures were

performed over this time period. The mean age at diagnosis of breast can-

cer was 60 years, compared with 56 years nationally. The local recon-

structed population contained a higher-than-national proportion of

patients over 65 years and 75 years. 17 surgical complications docu-

mented: 1 (0.4%) loss of implant to infection, 1 (0.4%) iatrogenic pneumo-

thorax, 5 (2.2%) wound infections, 6 (2.7%) partial wound breakdowns,

and 4 (1.8%) returns to theatre for bleeding.

Conclusion: Population demographics vary nationally. The choice of

reconstruction candidate should be based on objective measures of surgical

fitness, taking into account type of reconstruction and patient choice. In

line with national recommendations, our unit discusses reconstructive op-

tions with all appropriate candidates, irrespective of age. Breast recon-

struction in the ‘elderly’ is a reality, and is feasible without an excess of

complications.


P179. Use of oncoplastic techniques for breast conserving surgery

Tamara Kiernan, Claudia Mackean

Countess of Chester Hospital, Chester, UK

Introduction: Statement 3 of NICE Quality Standards (QS12) states

that: People with early breast cancer undergoing breast conserving surgery,

which may include the use of oncoplastic techniques, have an operation

that both minimises local recurrence and achieves a good aesthetic

outcome.

To assess compliance with this statement a four month audit of breast

conservation, at the Countess of Chester Hospital, was conducted.

Methods: Case-notes on all patients undergoing breast conserving sur-

gery (BCS) for breast cancer were identified and type of operation per-

formed and histological results were collected.

An oncoplastic excision was defined as an operation with an incision

placed off the breast mound in the circumareolar region, inframammary

fold or using a breast reduction technique.

Results: Of 39 cases, 20 (51%) patients underwent BCS using an onco-

plastic technique. Of these 8 (40%) required re-excision to clear margins.

This was a higher re-excision rate than the standard wide local excision

(21%), but still in keeping with national standards.

Excluding therapeutic mammoplasties (3), the average weight for the

oncoplastic group was 47.71g which is lower than the standard group

(59.46g).

There was a positive association between the extent of DCIS in the

specimen and the re-excision rate.

Conclusions: The higher re-excision rate in oncoplastic incisions may

be due to intra-operative difficulty with an incision remote to the lesion.

Surgeons should ensure that oncological safety is not compromised

when planning an oncoplastic excision.


P180. Invisible DCIS; gaining an insight into the unknown

Amy Light, Alice Leaver, Heather Humphreys, Mujahid Pervaz

Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK

Introduction: Re-operation rate following breast conserving surgery

(BCS) is 20%. Where histological size is far greater than on pre-operative

imaging, the term “invisible DCIS” may be applied. This is extremely

problematic; the true extent of disease is unknown. There is a paucity of

evidence into this topic. We investigated invisible DCIS cases in our

centre, gaining insight into this group of patients whom little is known

about.

Methods: Data was collected from pathology and theatre records on all

patients between Jan 2011-2013 who underwent BCS. Radiological and

histological sizes were compared. Invisible DCIS cases were assessed

for patient and tumour characteristics, regression analysis was used to

identify any correlations.

Results: A total of 508 BCS were undertaken. Re-operation rate was

15%. Of these cases, 58 were undertaken for residual disease. In the re-

maining 17 cases requiring re-operations, “invisible DCIS” was found.

The rate of invisible DCIS following BCS was therefore estimated at

3.3%. The mean age was 58. In 11 cases there was an absence of calcifi-

cation on core.

Conclusion: Invisible DCIS is uncommon but does contribute to re-op-

erations following BCS. This is distressing for patients and poses the addi-

tional anxiety surrounding future surveillance. As this is uncommon our

data is too few to fully form conclusions as to how these cases can be bet-

ter predicted. Given the low estimated occurrence of invisible DCIS

following BCS, we would advocate a multi-centre study to gain a better

insight into this troublesome condition.






invisible dcis; gaining an insight into the unknown

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