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• W2160223811 abstract "S 811 questionnaire including cosmesis, arm edema ,total cost, psychological satisfaction and quality of life were given. Loco regional and distant metastasis evaluation, was conducted by the surgeon Results: 310/389 in the study arm and 292/373 in the conventional arm had excellent.51/389 and 47/373 had very good 28/389 and 34/373 respectively had good cosmetic outcome.4/389 in the study arm 13/373 in the conventional arm developed mild to moderate Arm edema.0/389 in study arm,2/373 developed local recurrence .Quality of life evaluation 98% reported excellent in study arm 90% in conventional arm, psychological satisfaction was 100% in study arm while 90% reported in conventional arm. Total cost of treatment showed 40% more in conventional arm due to lengthy hospital stay. Conclusion: This novel drain less oncoplastic surgery (Thomas Technique) is cost effective, helps in faster rehabilitation in terms of psychological, occupational, and sexual aspects, reduces morbidity, shortens adjuvant treatment time interval, reduces hospital stay (just 24 hrs) and costs incurred, better cosmetic outcome, and improves quality of life. 240. Radiological failure to identify sentinel lymph nodes in high-grade invasive breast cancer e An indication for primary axillary node clearance? R.J. Egan, S. Ghosh, K.F. Gomez 1 Nevill Hall Hospital, Department of General Surgery, Abergavenny, United Kingdom Background: Sentinel lymph node biopsy (SLNB) is now the gold standard for axillary staging in the surgical management of breast cancer. Initial experience with SLNB imaging had a radiological negative rate approaching 25%, with the majority of failures due to technical problems. We hypothesise that in the modern era of SLNB, radiologically negative cases occur as a result of the normal architecture of the lymphatic channels being disrupted and replaced by cancer cells, not by technical difficulties. Materials and methods: Four hundred and twenty-two consecutive patients undergoing definitive breast surgical treatment and SLNB, within a local health board over a 20-month period were included in the analysis. Each patient underwent a 0.2 ml intra-dermal technetium99/ Nanocoll infiltration pre-operatively, as per protocols, followed by radiological assessment and marking of sentinel lymph nodes (SLN). Those cases where no SLN(s) were identified, even on delayed images, were classified as a radiological ’no-shows’. Intra-operative identification of SLN(s) is augmented by the additional use of patent blue dye in our unit. Results: Ten of these patients (2.4%), each with biopsy proven grade 2 or 3 invasive ductal or lobular carcinoma, were classified as radiological ’no-shows’. Of these 10 patients, eight (80%) had SLN positive disease. The remaining two patients had no evidence of disease in one and five lymph nodes, respectively. The 10 patients in the grade 2/3 ’no-show’ sub-group had a significantly higher mean number of positive nodes excised per patient [10.6 (range 0-34)], mean ratio of positive nodes: nodes excised at initial operation [0.75; mean 6.1:8.1], and mean ratio of positive nodes: nodes taken in total, including axillary node clearance (ANC) [0.53; mean 10.6:20.0], when compared to the cohort in whom SLN(s) were radiologically identified (p 2,5cm. We set out to analyse if final pathology showed invasive tumor in these patients necessitating SNB-staging and how often SNB showed malignancy. Materials and Methods: All patients operated between 2007 and 2010 for a preoperatively stereotactically diagnosed DCIS were included. Stereotactic biopsy procedures were performed with on a Lorad designated biopsy table (Lorad ) . A number of 6 stereotactic biopsies (Vacora, Bard , 10 gauge) were performed in each patient. SNB procedures were performed as advised in Dutch guidelines. Final pathology findings and SNB pathology were compared to the preoperative diagnosis (DCIS or DCIS with invasive component). Results: From 2007 to 2010 103 patients were operated for DCIS. In 46 patients no SNB was performed, in none of these patients an invasive component was found in the excised specimen. In 57 patients a SNB was performed. 39 of these patients were treated with breast conserving therapy, 18 were treated with mastectomy. In 11 patients an invasive component was found in the postoperative specimen. (1x multiple micro-invasive components, 3x invasive component of 5mm (pT1b)). In two cases the SNB showed malignancy (1xmultiple micro-invasive components, 1x no invasive component identified). Conclusion: Although the frequency of positive SNB’s is low, there is a sufficient number of cases in which a postoperative specimen shows an invasive component > 5mm (7/571⁄412%), that justifies SNB staging during the first operative procedure. Further analysis to improve selection in DCIS cases for SNB procedure is undertaken. 242. Quality control after benign stereotactical biopsy in patients with non-palpable breast lesions J. Merkus, J. Fris, P. Warmerdam, F. Bot, I. Jannink, H. Mulder 1 HagaZiekenhuis, Surgical Oncology, the Hague, The Netherlands HagaZiekenhuis, Radiology, the Hague, The Netherlands HagaZiekenhuis, Pathology, the Hague, The Netherlands Background: Stereotactical biopsies are the state-of-the art diagnostic for non-palpable breast lesions. Insufficient accuracy of a benign diagnosis by stereotactic biopsy may delay diagnosis of a (pre-)malignant lesion. In our breast clinic we monitored the accuracy of a benign diagnosis by repeat mammography 6 months after biopsy. Materials and Methods: All consecutive patients with a non-palpable breast lesion that underwent stereotactic biopsy were included. Biopsies were performed on a diagnostic table (Lorad ) with a vacuum assisted biopsy needle (Vacora, Bard ). In all patients 6 biopsies were obtained. All cases were multidisciplinary discussed between radiologist, pathologist and surgical oncologist. Patients with (pre-)malignant lesions or atypia in the biopsy, or in whom the pathological findings were not found to be representative for the radiological lesion, were scheduled for surgery. When the pathological findings were benign and biopsies were found to be representative for the radiological lesion patients were not operated, and a follow-up mammography was scheduled 6 months after biopsy. Results: From January 2007 till December 2009 stereotactical biopsies were performed in 331 patients. Patients were referred from the national breast cancer screening program (60%), and the general" @default.
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• W2160223811 title "240. Radiological failure to identify sentinel lymph nodes in high-grade invasive breast cancer – An indication for primary axillary node clearance?" @default.
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