Patient access to immediate breast reconstruction following cancer surgery. Learning from the National Mastectomy and Breast Reconstruction Audit (NMBRA)

Abstract

s / International Journal of Surgery 11 (2013) 589e685 605 ABSTRACTS 0329: PATIENT ACCESS TO IMMEDIATE BREAST RECONSTRUCTION FOLLOWING CANCER SURGERY. LEARNING FROM THE NATIONAL MASTECTOMY AND BREAST RECONSTRUCTION AUDIT (NMBRA) Senthurun Mylvaganam, Niraj Vethirajan, Khalid Boussouara, George Metaxas, Hemant Ingle. Good Hope Hospital, Heart of England NHS Trust, Sutton Coldfield, Birmingham, UK. Introduction: NICE guidance requires breast reconstruction discussionwith all patients requiring mastectomy. The national mastectomy and reconstruction audit showed significant variation in accessibility and practice in NHS Trusts offering breast reconstruction. Our trust service has evolved since the audit combining breast and dedicated plastic surgeons on site. Aims: Assess current local accessibility and practice for offering immediate breast reconstruction following mastectomy. Methods: Retrospective analysis of patients undergoing mastectomy for cancer at Heart of England NHS trust (HEFT) between September 2011 to July 2012. Data collected on tumour biology, whether reconstruction options offered and if not performed why. Results: N1⁄476. Mean Nottingham Prognostic Index(NPI)1⁄44.03. Mean age1⁄461(31-90) Immediate reconstruction offered 1⁄446%. Immediate reconstruction performed 1⁄425%. Reconstruction techniques; immediate with expander(2), immediate delayed with expander(5), Transverse Rectus Abdominis Myocutaneous(TRAM) free flap(7), Lattissimus Dorsi(LD) pedicled flap(2), LD with implant(2), Deep Inferior Epigastric Perforator(DIEP) free flap(1). Reasons reconstruction not performed; patient choice(8), patient choosing delayed(6). Conclusion: Our trust breast cancer service is a partnership between breast and plastic surgeons with joint MDT and clinic services. The trust rate of discussion of immediate reconstruction is greater than the published NMBRA local cancer network rate(36%). An integrated oncoplastic service is a key measure towards fulfilling NICE guidance. 0331: THE IMPORTANCE OF NEEDLE CORE BIOPSY IN THE DIAGNOSIS OF PHYLLOIDES TUMOURS Senthurun Mylvaganam, Lucinda Frank , Clare Toro , Sarah Vestey , Steven Thrush . Worcester Royal Hospital, Worcestershire Acute NHS Trust, Worcester, Worcestershire, UK; Gloucestershire Hospitals NHS Trust, Gloucester, Gloucestershire, UK. Introduction: Phylloides tumours are rare fibroepithelial breast tumours and are usually clinically and radiological indistinguishable from fibroadenomas. This makes core biopsy the main method of diagnosis. Only small studies have looked at the diagnostic histological accuracy of needle core biopsy(NCB) and none have addressedwhether there is any variability of NCB accuracy between institutions. Aims: To assess the diagnostic accuracy of NCB compared to the gold standard excision biopsy report in 2 separate hospitals trusts. Methods: Multicentre retrospective analysis of all cases of phylloides tumours on core and/or excision biopsy from March 2006 to July 2012 at Worcestershire Acute NHS Trust (WAHNST) and Gloucestershire hospitals NHS Trust (GHNHST). Results: N1⁄494. Mean age1⁄448. Mean clinical size1⁄431.7mm, mean radiological size1⁄435.4mm. WAHNST n1⁄442. NCB Sensitivity1⁄487% and Positive Predictive Value(PPV)1⁄490%. GHNHST n1⁄452 NCB Sensitivity1⁄474% and PPV1⁄4100%. Conclusion: The high sensitivity of NCB shown demonstrates its importance in the diagnosis of Phylloides tumours (comparative study in literature 63%). There does appear to be variation between pathologists in interpretation of NCB, which may be caused by the interpretation of the criteria for diagnosing Phylloides. NCB is not 100% sensitive at diagnosing these tumours so there must be local protocols to ensure tumours are not missed. 0434: BREAST CANCER SURGERY IS SAFE IN THE ELDERLY PATIENT Ramesh Yap Kannan, Nadi Khaldoun, Khawaja Saira, Sumrien Haytham, Holt Simon, Sharaiha Yousef. Prince Philip Hospital, Llanelli, Carmarthenshire, UK. Aims: To assess the safety of surgical resection of breast cancer in patients over 70 years Methodology: A retrospective study of 188 consecutive patients diagnosed with breast cancer at the age of 70 or older (2004 to 2008). Notes were examined for demographics, treatment, complications and final outcome. Patients received surgery with an intent to cure (SC) or conservative treatment (C). Results: 68 patients received C and 120 patients underwent SC. SC was performed in 63.8%(120 of 188), of whom 93.3% had a general anaesthetic. Mastectomy (M) was performed in 51.6%, M following a wide local excision (WLE) in 4.2% and WLE in 44.2%. Axillary surgery (n1⁄493) was either an axillary sampling (AS) in 5%, AS and clearance (AC) in 1%, primaryAC in87.1%, sentinel node biopsy (SNB) in 3.2% and SNB followed by AC in 3.2% (3 of 93). 30 day mortality was 0.008% (1 of 120) following a myocardial infarction. 10 patients had minor complications. Median follow up (SC) was 24 months versus 20 months (C). Overall survival was 89%(SC) versus 50% (C). Conclusion: Elderly patients with breast cancer, can be treated surgically with an intent to cure, safely and this has an impact on survival. 0470: A RETROSPECTIVE ANALYSIS OF PHYLLODES TUMOURS AND B3 LESIONS ON CORE BIOPSY Lucinda Frank, Sarah Vestey, Richard Bryan. Gloucester Royal Hospital,