ABSTRACTS 639

P098. The impact of One-Step Nucleic Acid Amplification (OSNA) on

the identification and management of micrometastases in the axilla

Ghaleb Goussous, Niamh Smyth, Lay-In Lim, Melissa Lay-Hui Tan,

Sankaran Narayanan, Soni Soumian, Robert Mark Kirby

University Hospital of North Staffordshire, Stoke on Trent, UK

Background: Axillary lymph node status remains the most important

prognostic factor in breast cancer. Management of sentinel lymph node

(SLN) micrometastases is controversial and there is emerging evidence sup-

porting axillary sparing. NICE now recommends OSNA for intraoperative

assessment of SLNs. We adopted this technology in November 2012. In

this study we wanted to assess the impact of introducing OSNA on detection

rates of micrometastases and its implications on further axillary treatment.

Methodology: A retrospective review of patients with micrometastases

over a five-year period (January 2009 - December 2013) was undertaken.

Data regarding demographics, presentation, tumour characteristics, SLN

detection, micrometastases and subsequent axillary node clearance

(ANC) were collected from the pathology database (pre-OSNA) and our

OSNA database.

Results: Seventy-six patients with micrometastases were identified.

Seventy-five (98.7%) were women; average age was 59.5 years (32 e

84). Thirty-three (43.4%) were screen-detected. Thirty-four (44.7%) un-

derwent ANC. In the 4 years preceding OSNA, a total of 36 patients

were detected with SLN micrometastases (9/year) in contrast to 40 patients

in the year OSNA was adopted (40/year) despite a stable annual case vol-

ume. Prior to introduction of OSNA, further axillary metastases were

found in 30.7% of ANC specimens compared to 12.5% in the OSNA era.

Conclusion: In our cohort the detection rate of SLN micrometastases

using OSNA is much higher than by using conventional histopathology

whilst the rate of further axillary involvement is considerably lower. There

is therefore an argument to avoid ANC in patients with micrometastases

identified by OSNA.

http://dx.doi.org/10.1016/j.ejso.2014.02.098

P099. Internet access in patients attending a one-stop breast clinic

Alice Yi-Chien Tsai, Sa’ed Ramzi, Peter Cant

Derriford Hospital, Plymouth, UK

Introduction: Using internet as a source of information on breast dis-

eases has become increasingly popular. There is yet a comprehensive study

on the effect of internet on patient presentation in one-stop breast clinics.

This study examines the relationship between internet access, clinical pre-

sentation and cancer diagnosis in a teaching hospital.

Method: All new patients seen in the breast clinic by one of the breast

surgeons between August 2010 and June 2011 were included and divided

into 2 groups: direct internet access (DIA) and no direct internet access

(NIA). Correlations between internet access and history of breast lumps,

presence of true lumps, and cancer diagnosis were analysed with Person’s

Chi-Square test and Student’s t-test.

Result: 564 patients were included: 77.5% (n¼437) in DIA and 22.5%

(n¼127) in NIA group with a mean age of 43.2 and 63.3 years respectively.

70.3% (n¼307) of DIA and 54.3% (n¼69) of NIA patients complained a

lump (P¼0.001); out of those 63.0% (n¼191) of DIA and 46.4% (n¼32)

of NIA did not have true lumps (P¼0.014). 46 patients were diagnosed

with cancer: 3.9% (n¼17) of DIA and 22.8% (n¼29) of NIA. In the above

60 age group 31 had cancers: 10.8% (n¼5) of DIA and 36.6% (n¼26) of

NIA (P¼0.02).

Conclusion: Patients with direct internet access were more likely to

seek medical attention with breast lumps. However, the majority did not

have true lumps. Internet access did not aid the diagnosis of breast cancer

regardless of age.

http://dx.doi.org/10.1016/j.ejso.2014.02.099

P100. Consecutive 75 cases of mastectomy for breast cancer using

ultrasonic dissection and without drain: Quilting reduces seroma

formation

Ravi Acharya, Sumohan Chatterjee

Salford Royal NHS Foundation Trust, Salford, UK

Introduction: Seroma is a common occurrence after mastectomy and

repeated aspiration of it is associated with infection and financial implication

for the NHS and negatively affects the patient experience. Various strategies

are described to reduce seroma including quilting, ultrasonic dissectors and

fibrin glue. This study was performed to assess whether quilting (progressive

tension sutures) reduces seroma rate after mastectomy.

Methods: We compared 74 consecutive cases of mastectomy performed

without drains by a single surgeon with ultrasonic scalpel; initially without

and then with quilting using continuous fine absorbable suture (3-0 Biosyn)

Results: In the first 43 patients (28-87years) no quilting was done

(SLN15 & ANC28; day-case 7%) and in the second group (31-90years)

quilting was done in 31 patients (SLN17 & ANC14; day-case 35%).

Both groups were comparable for age, BMI, hypertension, weight of breast

and histological grade & stage.

In the quilting group seroma formation requiring aspiration was signif-

icantly lower (6/31, 19%; average volume 320cc) as compared to the non-

quilting group (31/43, 72%; average volume 556cc) including 1 delayed

infection after repeated aspiration. The length of stay was less in quilting

group (0.76 versus 1.1 days).Incidentally 3 patients who had interrupted

stitches developed seroma in the quilting group and 2 patients were on

clexane/clopidogrel.

Conclusion: Quilting is a simple yet cost effective way of reducing se-

roma, improving patient experience and reducing number of hospital visits.

http://dx.doi.org/10.1016/j.ejso.2014.02.100

P101. Delayed-immediate breast reconstruction with temporary

subcutaneous implants e What is the rate of implant loss and does

it impact on adjuvant therapy?

Ann-Louise Lowson, Avi Agrawal, Sophie Helme, Constantinos

Yiangou, Lucy Mansfield

Queen Alexandra Hospital, Portsmouth, UK

Introduction: Delayed-immediate breast reconstruction (DIBR) de-

scribes the technique of inserting a temporary subcutaneous implant at the

time of mastectomy, allowing preservation of the skin envelope prior to adju-

vant therapies, ultimately completedwith a definitive reconstruction. It can be

indicated when the need for adjuvant radiotherapy is calculated to be likely

and can achieve some of the cosmetic benefit of immediate reconstruction.

The aim of this study was to assess implant loss rates and potential de-

lays to adjuvant therapies.

Methods: Theatre records were interrogated to identify patients under-

going mastectomy and DIBR between 1st November 2008 and 31st October

2013. Electronic and paper patient records provided information regarding

complications and timing of adjuvant therapies.

Results: 31 patients underwent 37 DIBRs during the specified period. 7

implants were removed unplanned from 6 patients. 4 implants were removed

prior to radiotherapy in 3 patients due to infection, giving an implant loss rate

due to infection of 10.8% (4/37). 3 implants were removed for pain/discom-

fort in 3 patients, 1 of these following radiotherapy. 5 patients had a docu-

mented delay in adjuvant treatment (chemotherapy/radiotherapy).

Conclusions: Delayed-immediate reconstructionwith subcutaneous im-

plants provides a satisfactory temporising approach for patients deemed

likely to be recommended adjuvant radiotherapy with a loss rate secondary

to infection of 10.8%. Patient selection remains key to a successful outcome.

It is important that patients are counselled with regards to this and the poten-

tial for delays in adjuvant therapies should complications arise.

http://dx.doi.org/10.1016/j.ejso.2014.02.101