ABSTRACTS

Background: The detection and preoperative assessment of invasive

lobular breast carcinoma (ILC) remains a challenge. NICE recommends
preoperative MRI prior to breast conserving surgery, but incorporating
this into routine practice requires additional resources. This audit examines
current practice in a District General Hospital and evaluates the role of preoperative MRI.
Methods: A retrospective audit was carried out on patients diagnosed with ILC between 1st January 2008 and 31st October 2009. Patients with histologically confirmed ILC were selected from the
hospital database. Those with mixed lobular and ductal carcinoma
were excluded.
Results: 28 patients were included (age range 42-95 years, median 65
years). Pre-operative MRI scans were performed in 6 cases. Bilateral disease was present in one patient. MRI showed 3 cancers that were undetected by mammogram or ultrasound. Histology revealed multifocal
disease in 2 cases, one of which was detected only by pre-operative
MRI and ultrasound but not by mammography. 88% of cases were graded
as M3 or greater on mammography. The remaining cancers were picked up
by ultrasound and/or MRI. One case was reported as benign disease on
mammogram and USS, but was malignant on MRI. Three patients had
completion mastectomies due to involved margins, none of whom underwent pre-operative MRI. Mammography and MRI findings correlated
best with histological tumour size.
Conclusion: Our findings suggest that MRI confers additional benefit
in the detection of ILC and in preoperative treatment planning. A larger
study with MRI for all cases of ILC would be more conclusive.

P31. Management of Isolated Tumour Cells, Micrometastases and the

Solitary Positive Sentinel Lymph Node in Breast Cancer
Michael Puttick, I. Cranshaw, W. Jones, A. Ng
Auckland City Hospital, Department of Surgery, Grafton Road, Auckland,
New Zealand
Introduction: Conventionally, an axillary node dissection (AND) is
performed when there is a positive SLNB. However the optimal management of the axilla when isolated tumour cells (ITCs) or micrometastases
(MMs) are found is still not clear. There are also a number of cases
where only the sentinel node is positive and an unnecessary AND is
performed.
Methods: Records from a Regional Breast Cancer Register were retrieved for patient who had an operation between 2000 and 2009. Those
in whom there were ITCs, MMs or a single positive node were studied. Tumour size and grade were analysed to see if there were factors for predicting a solitary positive SLNB.
Results: Data was retrieved on 3218 SLNBs
51 patients had ITCs in a SLNB. Of these 7 went on to have AND but
no other positive nodes were found. 17 patients had a limited axillary node
sample without finding any further tumour.
63 patients had MMs in a Sentinel node. Of these 43 had AND with no
further positive nodes being found.
264 patients had a solitary sentinel lymph node. There was no statistical difference between these patients and those with multiple positive nodes with regard to tumour stage and grade.
Conclusions: If MMs or ITCs are seen in the sentinel node, further axillary surgery is not required. However, if there is a solitary positive sentinel lymph node then it is not possible to determine the status of the
rest of the nodes on basis of tumour size and grade.
P32. Association between breast pain, history of breast cancer and
wearing mis-fitting bras
Debasish Debnath, A. Izhar, L. Park, W. Ismail
Queens Hospital, Department of Surgery, Romford, RM7 0AG
Introduction: Breast pain can be a worrying symptom for patients. We
aimed to assess any association between breast pain and previous breast
conditions including cancer, and wearing mis-fitting bras.

991
Methods: Prospective study based on questionnaires, which were distributed amongst patients presenting to the breast clinic.
Results: Out of 500 questionnaires distributed, 494 (98.8%) were returned. 309 patients (62.6%) complained of breast pain. Patients with
breast pain were significantly younger (42.7
0.9 years) than those without
(46.0
1.2 years) [p0.03]. 171 patients declared history of previous breast
conditions, including six patients who had breast cancers. No association
was noted between breast pain and any previous breast condition
[p0.99]. An increased incidence of breast pain was associated with recent
change of bra size (n65, 69.1% of 94), than no change of bra size
(n213, 65.5% of 337) [p0.28]. An increased incidence of breast pain
was also noted to be associated with wearing under wired bra (n221,
66.5% of 332), than non-under wired bra (n61, 59.8% of 102)
[p0.21]. A significant association was noted between increased occurrence of breast pain and recent change of weight (n129, 70.4% of
183), compared to no change of weight (n143, 59.0% of 242) [p0.015].
Conclusions: Breast pain was a frequent symptom and noted significantly amongst younger patients. History of breast cancer was not a common association of breast pain. Recent weight loss, change of bra size and
wearing underwired bras were associated with increased occurrence of
breast pain. The latter might imply mis-fitting bras as a potentially important cause of breast pain.
P33. Audit of blue dye guided axillary surgery
Sankaran Chandrasekharan, S. Marsh, L. Pennell
Colchester Hospital NHS Trust, Essex County Hospital, Lexden Road,
CO3 3NB
Aim: The aim of this audit was to look at the identification rate of sentinel nodes using blue dye only.
Background: The current practise in our unit is to do a blue dye
guided sample until we finish the audit phase of the New Start programme.
Over the past five years all three surgeons use blue dye routinely for all
axillary surgery procedures.
Methodology & Results: This was a retrospective audit looking at 837
patients who had blue dye guided axillary surgery from 2003 -2010. Out of
this in 802 patients the blue node(s) were identified. 265 patients had positive nodes and 537 had negative nodes.

Blue nodes seen

Blue nodes not seen

Positive

Negative

Total

265
9

537
26

802
35

In the 537 where the blue sentinel node was negative, 23 patients had
other non-blue positive nodes. Out of these 8 patients had heavy nodal disease with more than 5 nodes positive, 7 had more than 2 nodes positive and
8 had one node positive.
Discussion & Conclusion: The combined technique is the gold standard for SLNB. In our unit in this retrospective audit our sentinel node
pick up rate using blue dye only is 95.81 and the false negative rate of
4.28% is acceptable and is comparable with the combined technique. In
district general hospitals where getting nuclear medicine time for lymphoscintigram may be difficult, blue dye guided axillary sample may be
a good alternative in experienced surgeons practice.
P34. 23 Hour Model for Breast Surgery: Early experience
Alison Hainsworth, A. Chakravorty, C. Lobo, A. Sharma, D. Banerjee
St Georges Hospital, Blackshaw Road, London, SW17 0QT
Introduction: 23-hour or ambulatory breast surgery is an approach for
enhancing patient recovery facilitated by discharge on the same, or the following day, after surgery - hence improving the quality of patient experience. The aim of this study was to assess the feasibility of safely
discharging patients under this model, as one of thirteen national spread
sites selected by NHS Improvement to pilot the project across England.