632 ABSTRACTS

P075. Introduction of OSNA (One-Step Nucleic acid Amplification) in

the intra-operative assessment of the sentinel node (SLN): The clinical

impact

Biswajit Ray, Lynda Wyld, Stanley Kohlhardt, Malcolm Reed, Vidya

Chandran

Department of Breast Surgery, Royal Hallamshire Hospital, Sheffield, UK

Introduction: Whole node OSNA was introduced at our centre for

intra-operative assessment of SLNs in December 2012. The aim of this

study was to assess its impact on management of the axilla in clinically

& radiologically node negative breast cancer.

Methods: All patients with micro- or macrometastases in the SLN un-

derwent axillary clearance (ANC). Comparison was made between 2

groups: Group A; A cohort of 322 consecutive patients treated before

OSNA was introduced (SLN biopsy, conventional histology and delayed

ANC) and Group B; A subsequent cohort of 248 consecutive patients

(SLN biopsy, intra-operative OSNA and immediate ANC). Detection rates

of micro- and macrometastases were compared and their impact assessed

in terms of ANC rates & additional nodal involvement.

Results: Patients in Group B had significantly higher positive SLNs

compared to Group A.

Histology

(Group A)

OSNA

(Group B)

P (Pearson

Chi-square)

Positive SLN 19.3%(75/322) 44.1%(109/248) <0.001

Macrometastases 82.6% 51.4% <0.001

Micrometastases 17.4% 48.6% <0.001

Further disease detection on ANC was significantly higher for SLN

macrometastases compared to SLN micrometastases (p<0.005 Pearson

Chi-square). Additional positive lymph nodes on ANC were found in

38.8% (Group A) & 48.1% (Group B) for SLN macrometastases and

16.7 % (Group A) & 9.4% (Group B) for SLN micrometastases respec-

tively. No patient in either group had >3 nodes or level 3 involvement

when ANC was undertaken for micrometastases.

Conclusions: ANC was performed more frequently following intro-

duction of OSNA due to increased detection of micrometastases. Axillary

clearance is no longer performed for SLN micrometastases in the Unit.

http://dx.doi.org/10.1016/j.ejso.2014.02.075

P076. An initial review of a personalised survivorship follow-up

programme for patients with early breast cancer: One size does not

fit all

Julia Massey, Dinesh Thekkinkattil, Rakeeb Chowdhury, Kartikae

Grover, Tapan Mahapatra, Peter Kneeshaw, Penelope McManus

Hull and East Yorkshire Hospitals NHS Trust, Hull, East Yorkshire, UK

Introduction: The frequency of clinical follow-up of early stage breast

cancer patients varies between units. NICE and ABS Guidelines conclude

available evidence cannot indicate an ideal frequency suggesting one fixed

follow-up schedule might not meet all patients’ needs.

The aim of follow-up is early detection of recurrence however, recur-

rence is most commonly detected by patients presenting symptomatically

between visits. This supports ‘on-demand’ follow-up, reflecting National

Cancer Survivorship Initiative recommendations to move away from a

‘one size fits all’ approach.

In 2010, our unit changed from scheduled annual clinician review to an

on-demand ‘survivorship’ programme facilitated by the Breast Care

Nurses (BCN). A physician review and Holistic Needs Assessment are per-

formed before entry.

The aim of this initial review is to assess benefits of personalised

follow-up, particularly the number and timing of patient contacts and sub-

sequent clinic referrals.

Methods: Retrospective review of records from a random selection of

138 patients eligible to enter the survivorship programme between 11/2010

and 11/2012.

Results:

� 138 patients in survivorship programme for 11-35 months (126

completed more than 12 months)

� 73% contacted BCNs, 3% more than once

� Mean time of contact was 6 months (range 1-16 months)

� 23 unplanned clinic visits after contacting BCN, 4 radiology recalls, 2

symptomatic metastases referred via GP

� 156 routine clinic visits prevented by the new approach

Conclusion: Patients made contact at a variety of points. Overall, they

required fewer clinic reviews than previously. This on-demand approach

offers flexibility without increased clinic contacts.

http://dx.doi.org/10.1016/j.ejso.2014.02.076

P077. Role of NF-kB as a prognostic marker in breast cancer: A pilot

study in Indian patients

Diptendra K. Sarkar, Debarsi Jana, Suvro Ganguly1 Breast Service, IPGME&R, Kolkata, West Bengal, India2 Breast Cancer Research Unit, IPGMER, Kolkata, West Bengal, India

The nuclear factor kB (NFkB) is a superfamily of transcription factors.

Activation of NFkB signalling pathway leads to induction of target genes

that can inhibit apoptosis, dysregulates cell cycle, promotes cellular inva-

sion. It therefore, as a master regulator, contributes to tumorogenesis,

inflammation and metastasis. It is hypothesized that study of a single fac-

tor, instead of multiple proliferative genes, can prognosticate breast cancer

to same extent.

The aim of the study was to validate the use of NFkB as a prognostic

factor in clinical practice.

A prospective study was conducted at the comprehensive breast service

and Breast Cancer Research Unit, Institute of Post Graduate Medical Ed-

ucation and Research, Kolkata, India. The patients were divided into two

groups, first group (Group A) comprised of 57 patients with primary breast

cancer and second group (Group B) comprised of 54 patients of fibroade-

nomas. NFkB was measured in both groups by Western Blot technique us-

ing p65 protein of NFkB family. ER, PR and HER2 neu were measured by

immunohistochemistry methods.

NF-kB was expressed in 71.8% of breast cancer patients while none

of the Group B patients expressed it. NF-kB / p65 expression is signifi-

cantly associated with large tumour size (>5 cm.) (p-value 0.012), Grade

III tumours (p¼0.002), ER and PR negative tumours (p¼0.002 and 0.001

respectively) and HER2 neu positive tumours (p¼<0.001).Correlation is

poor with lymph node status (p0.393) and menopausal status

(p¼0.973).The results were correlated with NPI (higher NPI of more

than 5.4 was statistically significant with p¼0.002).

The study puts forward the fact that NF-kB is a valid prognostic

marker. Being a transcription factor, it controls multiple pathways and

thus has the potential to replace costly multigene prognostication models.

This can have a major impact in developing countries in prognosticating

breast cancer.

http://dx.doi.org/10.1016/j.ejso.2014.02.077

P078. The “postcode lottery” for the surgical correction of

gynaecomastia in NHS England

Roger Stevens, Samantha Stevens, Jennifer Rusby

The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK

Introduction: Despite Action On Plastic Surgery (AOPS) guidelines,

NHS funding for gynaecomastia surgery varies between Clinical