660 ABSTRACTS

Background: Sentinel node biopsy is a critical procedure in the stag-

ing of node-negative breast cancer. Training to perform this procedure is

associated with a steep learning curve and high false negative rates.

Aims: The aims of the audit were to evaluate two training models; New

Start (NS) model and the traditional Apprentice (AP) model of surgical

training. The endpoints were sentinel node localisation rates, false negative

rates and time to achieve standards.

Methods: Data from consecutive patients undergoing mastectomy or

wide local excision between 2007 and 2013 with clinically node negative

disease. Patients with recurrent disease, previous radiotherapy or neo-adju-

vant chemotherapy were excluded. All procedures were undertaken with

blue dye and radiopharmaceutical injection as standard. Axillary node

sampling was undertaken simultaneously to determine false negative rates.

The data analyst was blinded to the training model.

Results: The localization rates in both models were similar

(NS¼94.5%(CI 92.1-98.9) vs AP 99.5% (CI 98.1-99.9)). Both training

methods had no false negatives. The time to achieve standards (as defined

by the NS model) was significantly shorter in the AP model (7.8 months vs

12.3 months, p¼0.02).

Conclusions: While there were no significant differences in the stan-

dards achieved, AP model of surgical training appears superior to the

NS model in the time taken to achieve standards.

http://dx.doi.org/10.1016/j.ejso.2014.02.169

P171. Comparison of combined 18 F-FDG and 18 F-NaF PET/CT vs.

18 F-FDG PET/CT imaging in initial metastatic workup in cases of

locally advanced breast cancer (LABC)

Gurpreet Singh, J. Mohanroop, Baljinder Singh

Postgraduate Institute of Medical Education & Research, Chandigarh,

India

Background: The addition of 18F-FDG PET to the standard work-

up of patients with LABC may lead to the detection of unexpected

distant metastases of which skeleton is the most common site. 18F-

FDG has limitations in detecting osteoblastic malignant skeletal lesions.

Bone scintigraphy (with 99mTc-MDP of 18F-NaF) is the routine imag-

ing modality for the diagnosis of osteoblastic skeletal metastases. We

combined both the 18F-FDG and 18F-NaF PET/CT into a single study

to examine its role in detecting skeletal metastases.

Methods: Female patients with biopsy proven LABC were prospec-

tively evaluated for metastatic disease. All patients underwent 18F-

FDG-alone PET/CT scan and a dual tracer 18F-FDG/18F-NaF PET/

CT scan within a span of 1 week. In the dual tracer PET/CT scans,

focally increased skeletal uptake was read as malignant unless a benign

etiology such as degenerative bone disease was noted on the corre-

sponding CT images. Both patient and lesion based analysis was

performed.

Results: Out of 55 patients, 32 patients (58.2%) were detected to have

skeletal metastases (26 on single and 32 on dual scan). Thus, 6 patients

(10.9%)were upstaged fromM0 toM1. 14patients (25.5%) showedadditional

skeletal lesions on dual scan. 31 additional skeletal lesions were detected in

dual tracer scans, of which 19 lesions being osteoblastic in nature, 5 being os-

teolytic and 7 lesions with no corresponding morphological changes on CT.

Conclusion: Compared to the 18F-FDG only PET/CT scan, the dual

tracer 18F-FDG/18F-NaF PET/CT scan showed increased sensitivity for

detection of osseous lesions.

http://dx.doi.org/10.1016/j.ejso.2014.02.170

P172. Vacuum assisted excision biopsy for B3 lesions: A single centre

experience

Nisheeth Kansal, BrendanWooler, Jacqueline Westgarth, Kevin Clark,

David Browell, Tarannum Fasih

Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK

Introduction: Traditionally the majority of B3 lesions proceeded to

diagnostic surgical biopsy. However with the advent of Vacuum assisted

biopsy (VAB) the number of patients requiring diagnostic surgical bi-

opsy has reduced. We looked at our own experience with this novel

technique.

Methods: We retrospectively looked at our own data from the

commencement of the usage of VAB in 2008 until 2012. Outcome mea-

sures included frequency of diagnostic surgical biopsy, final histological

diagnosis and further surveillance of subjects with follow up in

outpatients.

Results: In the 5 year period (2008-2012) a total number of 123 pa-

tients were identified with B3 pathology. Of these the various histological

subtypes identified included Atypical Ductal Hyperplasia (ADH) consti-

tuting 39%, Lobular Carcinoma in Situ (LCIS) 26.8%, Papilloma 9.7%,

Radial Scar 8.9%, ADH/LCIS 5.6%, ADH papilloma 3.2% and others

6.8%. Amongst the entire group approximately 70% underwent further

VAB and only 15.4% diagnostic surgical biopsy. Out of the total 73.1%

were assessed at yearly follow up and 13% routine recall which included

a follow up every 3 years.

Conclusion: B3 lesions comprise approximately 5% of breast core bi-

opsies and a heterogeneous group of lesions including ADH, ALH, LCIS,

and fibroepithelial lesions with atypical features. The positive predictive

value for carcinoma following B3 core biopsy is in the region of 25%.

Traditionally most B3 lesions proceeded to diagnostic surgical biopsy.

Vacuum assisted biopsy is a relatively new technique that permits addi-

tional non operative sampling of benign but heterogeneous mix of lesions

with low risk of malignant potential.

http://dx.doi.org/10.1016/j.ejso.2014.02.171

P173. The matrix: Strattice vs XCM in immediate implant-based

breast reconstruction

Victoria Fung, Keith Allison

James Cook University Hospital, Middlesbrough, UK

Use of acellular dermal matrices (ADMs) in assisting implant-based

breast reconstruction has gained in popularity since they were intro-

duced. There is continuing uncertainty regarding which ADM is ‘better’.

Complication rates and aesthetic outcomes are important, and ADM

costs are also a significant factor. We have compared the use of 2

ADMs in breast reconstruction in a single NHS trust e Strattice� at

a price of w£1800 per 8x16cm sheet, and XCM� costing w£800 per

8x16cm sheet.

A 2 year retrospective review identified 18 patients with 22 immediate

breast reconstructions using ADM and implant, 9 using XCM� and 13

with Strattice�. Both groups received the same insetting procedure and

postoperative management.

Infection necessitated removal of the implant and ADM in 1 breast

from each group. Red breast syndrome was identified in 1 Strattice patient,

and skin flap necrosis resulting in salvage LD musculocutaneous flap (but

without removal of the implant/ADM) was seen in 1 Strattice patient.

There was no obvious difference in seroma or infection rate.

To date, we have found that using XCM and Strattice have produced

similar short term outcomes in immediate implant-based breast reconstruc-

tion, with little difference in handling properties and complications. In the

current economic climate of reducing expenditure, the significantly lower

price of XCM is a very attractive feature.

http://dx.doi.org/10.1016/j.ejso.2014.02.172

P174. An oncoplastic breast MDM: A review of practice

Caroline Richardson, Jason Lee, Paul Harris, Peter Barry, Gerald Gui,

Stuart James, Kelvin Ramsey, Nicky Roche, Jennifer Rusby, Adam

Searle, Fiona MacNeill

The Royal Marsden Hospital, London, UK