Posters 2010

The Breast Journal Awards 2010

Utilization of Breast MRI in the Surgical Treatment of DCIS Luisa C. Kropcho, MD, Shawn Steen, MD, Alice Chung, MD, Myung-Shim Sim, MS, DrPH, Armando Giuliano, MD The John Wayne Cancer Institute Santa Monica, CA How Breast Cancer Mode of Presentation Affects Stage at Diagnosis: Are 40-50 Year Old Different? Sumy H. Chang, Kwadwo Boachie-Adjei, Laurie K. Kirstein, Tamara Fulop, Susan K. Boolbol Beth Israel Medical Center New York, NY Development of a Multidisciplinary Rapid Diagnostic Breast Clinic Bridgette Lord, Tulin Cil, David McCready, Naomi Miller Princess Margaret Hospital Toronto, Canada Utilization of Breast MRI in the Surgical Treatment of DCIS Luisa C. Kropcho, MD, Shawn Steen, MD, Alice Chung, MD, Myung-Shim Sim, MS, DrPH, Armando Giuliano, MD The John Wayne Cancer Institute, Santa Monica, CA Background Determination of the size and extent of disease by imaging in ductal carcinoma in situ (DCIS) is uncertain. The objective of this study was to examine the accuracy of MRI in size assessment of DCIS lesions and to determine if preoperative MRI affected rates of positive surgical margins. Methods Data was reviewed from a prospective database of 116 DCIS patients from 2002 to 2009. We identified 58 patients who had preoperative breast MRI and compared them to a control group of 58 DCIS patients who received treatment prior to 2006 when MRI was not routinely used. Size assessment by MRI was compared to pathologic size using Pearson correlation coefficients. Additionally, the 2 groups were compared with respect to surgical margin status using Chi-squared tests. Results The correlation between size of DCIS on MRI and pathologic size was highly significant (P=0.0275). MRI size measurement was most accurate in high grade DCIS compared to intermediate and low grade lesions, with p-values of <.0001, 0.0204, and 0.6809 respectively. There was no statistically significant difference between the two groups with regard to positive margin rate. Conclusion Preoperative MRI accurately predicts size of DCIS lesions, especially in high and intermediate grade tumors. Preoperative MRI did not affect margin status. We conclude that while preoperative MRI may guide surgical planning, it is not helpful in reducing the rate of positive margins following local excision.

34th Annual Symposium Page 2

How Breast Cancer Mode of Presentation Affects Stage at Diagnosis: Are 40-50 Year Old Different? Sumy H. Chang, Kwadwo Boachie-Adjei, Laurie K. Kirstein, Tamara Fulop, Susan K. Boolbol Beth Israel Medical Center, New York, NY Introduction Early stage breast cancer has a 98% 5-year survival rate. In 2009, the United States Preventive Services Task Force (USPSTF) released guidelines recommending biennial screening mammography for average risk women age 50 through 74. This is in contradiction to other published guidelines, which recommend screening mammograms start at 40. We reviewed our breast cancer database to examine whether mode and stage of presentation varied by age. Methods A prospective database was reviewed to stratify patients ages 40-49 (Group A) and 50-74 (Group B). Mode and stage of presentation were compared between the two groups. Results There were 2120 patients reviewed, with 628(30%) in Group A and 1492(70%) in Group B. There were equal numbers of patients who presented with early stage disease in both groups (62%). However, in Group A, when considering mode of presentation, women were 3.5 times more likely to have early stage disease if detected by mammogram rather than palpable mass(odds ratio) (CI: 2.5-4.9, p <0.0001)(Table 1). Likewise in Group B, women were 2.3 times more likely to have early stage disease if detected by mammogram rather than palpable mass(odds ratio) (CI: 1.8-2.86, p < 0.0001)(Table 2). Conclusion Our analysis demonstrates that whether under or over age 50, a woman is more likely to have early stage breast cancer when diagnosed by mammography rather than by palpation. Given the survival rate of early stage breast cancer, this argues against recent USPSTF recommendations. Further studies are needed to examine the impact of these findings on treatment and survival.


Development of a Multidisciplinary Rapid Diagnostic Breast Clinic Bridgette Lord, Tulin Cil, David McCready, Naomi Miller Princess Margaret Hospital, Toronto, Canada In 2009, approximately 22,700 Canadian women were diagnosed with breast cancer (Canadian Cancer Society, 2009). Across Canada, considerable variation exists for patients from the time a breast abnormality is detected to the time of diagnosis. Many patients wait several weeks to receive a diagnosis leading to prolonged patient anxiety and a delay in treatment (Olivotto, 2001). At a large Canadian Cancer Center, the average wait time from referral to diagnosis was found to be 37 days. In an effort to improve the diagnostic process, a multidisciplinary, same-day, rapid diagnostic breast clinic was created. The goals of this clinic were two-fold: to expedite the diagnostic process for patients with suspicious breast abnormalities, and to provide a supportive environment for patients throughout the diagnostic process. To achieve a same-day diagnosis a rapid tissue processor was purchased allowing breast core biopsy specimens to be processed within a few hours. The morning of the clinic, patients undergo necessary breast imaging investigations and a biopsy if deemed appropriate. Patients meet with a surgeon later the same day to receive their pathology results. Data from the first two years of the clinic shows that the time from biopsy to diagnosis has decreased from several days to several hours, with over 90% of patients receiving a same-day diagnosis. Patient satisfaction was evaluated and patients rated their care as either very good or excellent. Creating multidisciplinary diagnostic clinics can help to ameliorate the diagnostic process for patients and to ensure optimal multidisciplinary breast care.


Poster Index Poster 1 "Aesthetic Oncology" Philip C. Bonanno, MD, Karen Arthur, MD , Anthony Cahan, MD , Sharon DeChiara, MD , David Palaia, MD , Michael Rosenberg, MD , Kathryn Spanknebel, MD The Breast Institute at Northern Westchester Hospital, Mount Kisco, New York Poster 2 49 Months Follow Up Results of GnRH Analogue Use in Premenopausal Breast Cancer Hee Jeong Kim, Sei Hyun Ahn Department of Breast Surgery, College of Medicine, Asan Medical Center, Seoul, South Korea Poster 3 An Audit of Mammography Results in a Private Service Setting Hanan S. Gewefel, Moustafa El Houssinie, PhD, Professor, Dept of Community Medicine Ain Shams University, Cairo, Egypt Poster 4 APBI Using IMRT is Safe and Effective in Selected Early Stage Breast Cancer Alan A. Lewin, Robert Derhagopian, Andre Abitol, D Jay Wieczorek, Kunal Saigal, Joseph E. Panoff, Cristiane Takita Baptist Hosptial of Miami, Department of Radiation Oncology, Miami, FL Poster 5 Association of Triple-Negative Breast Cancer with Extracapsular Extension of Axillary Lymph Node Metastasis: Prognostic Implications Sinisa Maksimovic General hospital Sveti Vracevi Bijeljina, Bijeljina, Yugoslavia Poster 6 Atypical Ductal / Lobular Hyperplasia on Core Biopsy; Do We Need Further Surgery? Abuzer Dirican, MD, Oya Andacoglu, MD, Amal Kanbour-Shakir, MD, Ronald Johnson, MD, Atilla Soran, MD, MPH Magee-Womens Hospital (MWH) University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA Poster 7 Racial Differences in the Surgical Management of Papillary Lesions Diagnosed by Core Needle Biopsy Amanda L. Kong, MD, Allegra Saving, MD, Shannon Rathke, MD, Zainab Basir, MD. Tina W.F. Yen, MD, MS Medical College of Wisconsin, Milwaukee, WI Poster 8 BRCA-negative male breast cancer: Importance of the family history.


D. Nicholas Wilson, Edward C. Saltzstein, Gary W. Shabacker, Fausto A. Rodriguez, Juan Herrada Texas Tech University Health Sciences Center, El Paso, TX Poster 9 Breast Cancer Knowledge in an Underserved Population 15 to 39 Years Old in Southern Brazil Maira Caleffi, Rodrigo Antonini Ribeiro, Julia Maria Parode Viegas-Butzke, Fernanda Della Giustina Baldisserotto, Juliana Picoral Manassero, Giovana Paggiarin Skonieski, Ademar José Bedin Júnior, Hospital Moinhos de Vento, Porto Alegre, Brazil Poster 10 Breast Cancer Trend and Characteristics Among Young Women in a Community-Based Hospital Gelen del Rosario, Kristine Krafick, Deepa Halaharvi, Brenda Sickle-Santenello Columbus, Ohio Poster 11 Clinical experience from Fulvestrant use in patients with metastatic breast cancer in korea Ku bo kyoung, Ash SH, Son BH, Kim HJ, Koh BS, Jang MA Asan Medical Center, Seoul, South Korea Poster 12 Clinical Outcome of Patients with Sentinel Lymph Node Micrometastases Marissa Howard-McNatt, John Stewart, MD, Perry Shen, MD, Edward Levine, MD, Marissa Howard-McNatt, MD Wake Forest University Baptist Medical Center, Winston-Salem, NC Poster 13 Comparision of Excisional Biopsies Performed by Wire Guide Localization or ROLL (Radionuclide Occult Lesion Localization) in Nonpalpable Breast Lesions: A Prospective Randomized Trial Ahmet Korkut Belli, Kagan Karabulut, Ali Cercel, Fatih Aydogan, Ahmet Korkut Belli, Halit Yilmaz, Gul Esen Cerrahpasa Medical School & Hospital, Istanbul, Turkey Poster 14 Tuberculous Mastitis: A case report from an urban community hospital Jennifer E. Joh, MD, Anitha Srinivasan, MD, MPH, Marc K. Wallack, MD Metropolitan Hospital Center, Jacksonville, FL Poster 15 Criteria of Oncoplastic Approach of Local Advanced Breast Cancer after Neoadjuvant Chemotherapy A G Zucca Matthes, Haikel RL, Uemura G, Vieira RAC, Fregnani CMS, Folgueira Maak Hospital de Cancer de Barretos, Barretos, Brazil Poster 16 Death from Breast Cancer Occurs Predominantly in Women Not Participating in Mammographic Screening


Matthew Webb, Matthew L Webb, Blake Cady, James S Michaelson, Raymond A Jean, Daniel Kopans, Barbara Smith Massachusetts General Hospital, Boston, MA Poster 17 Treatment of Post-Partum Breast Abscesses in the Era of Methicillin Resistant Staphylococcus aureus (MRSA): Time to Take a New Look at the Standard of Care Melissa C Hulvat, MD, Jacqueline Jeruss, MD, PhD, Amanda E. Bass-Zubek, MD Bass Breast Center, Kalispell Regional Medical Center, Kalispell, MT Poster 18 Diagnostic Accuracy of the Fine Needle Aspiration Cytology (FNA) and Core Needle Biopsy (CNB) as a Diagnostic Method for Breast Lesions Patrícia P Frankel, Viviane Ferreira Esteves, Luiz Claudio Santos Thuler, Roberto José da Silva Vieira Instituto Fernandes Figueira-IFF / Fundação Oswaldo Cruz-FIOCRUZ and Instituto Nacional de Câncer-INCA / Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, Brazil Poster 19 Differences Between Radiographically and Clinically Detected Breast Cancers Mandy Greenberg, MD, Alison Estabrook, MD, Sharon Rosenbaum Smith, MD, Paul Tartter, MD, Kwadwo Boachie-Adjei, St. Luke's-Roosevelt/Beth Israel, Stamford, CT Poster 20 Does Micropapillary Breast Cancer Have a Unique Radiologic Pattern? Amber A. Guth, MD, Cecilia Mercado, MD, Amber A. Guth, MD, Linda Moy, MD, Jiyong Lee, MD, Hildegarde Toth, MD, Joan Cangiarella, MD NYU Clinical Cancer Center, New York, NY Poster 21 Effect of Deep Tissue Approximation on Post-Operative Complications Toni M Green, DO, Melissa M. Stobbs, Judy C. Boughey, MD, Alyssa D. Throckmorton, MD, Tanya L. Hoskin, Sarah Y. Boostrom, MD, Andrea C. Holifield, CNP, Amy C. Degnim, MD Mayo Clinic, Rochester, MN Poster 22 Evidence-Based Recommendations for Breast Reconstruction Juan Carlos Zambrano, Lorena Patarroyo, Luis Eduardo Nieto Bogota, Colombia Poster 23 Health-Related and Psychosocial Quality-of-Life in Breast Cancer Survivors Influenced by Age and Extent of Disease


Terence Sio, Difu Wu, Mary Politi, Maureen Chung Alpert Medical School of Brown University, Providence, RI Poster 24 Tissue Loss Associated With Intraoperative Frozen Section Evaluation of Sentinel Nodes Does Not Cause Underdiagnosis of Isolated Tumour Cells Robert Tasevski, Alexander Mathieson, Adriana Fonseca-Gonzalez, Bruce Youngson, David R. McCready University of Toronto, Toronto, Canada Poster 25 Idiopathic Granulomatous Mastitis Maria Augusta Rodi Carvalho Barros, Paulo Roberto De Alcantara Filho, Marina Rodi Carvalho Barros, Renato Carvalho Barros Ecomax, Sao Paulo, Brazil Poster 26 Women Inspiring, Serving and Educating (WISE) Project for Underserved Women - Early Results of an Educational Intervention Program Rakhshanda Layeequr Rahman, MD, Sybil Crawford, Nancy Rudolph, Marjorie Jenkins, Mark Arredondo, MD Texas Tech University Health Sciences Center, Amarillo, TX Poster 27 Improvements in Critical Dosimetric Endpoints Using the Contura® Multi-Lumen Balloon (MLB) Breast Brachytherapy Catheter to Deliver Accelerated Partial Breast Irradiation: Preliminary Dosimetric Findings of a Phase IV Trial Natasha Behrmann, Frank A. Vicini, MD, Dorin A. Todor, PhD, Thomas B. Julian, MD, Maureen R. Lyden, MS, Assistant Researcher Lake Forest, CA Poster 28 Primary Angiosarcoma of the Breast Paulo Roberto De Alcantara Filho, Maria Augusta Rodi Carvalho Barros, Jose Luiz Barbosa Bevilacqua, Alfredo Carlos Simoes Dornelas De Barros, Vera Lucia Nunes Aguillar Hospital Sirio Libanes, Sao Paulo, Brazil Poster 29 Influence of Age on Treatment Choices in a Cross-Sectional Study of Breast Cancer Survivors Difu Wu, Terence Sio, Mary Politi, Maureen Chung Alpert Medical School of Brown University, Providence, RI Poster 30 Innovative Nursing Roles of the Breast Health Center (BHC) Bonnie Edsall RN, BSN, CBCN, CBPN-C, Christina Egan RN, CBCN Good Samaritan Hospital Medical Center, West Islip, NY


Poster 31 Intraoperative Radiotherapy with the IntraBeam System Jonathan F. Head, PhD, Robert L. Elliott, MD, PhD Elliott-Elliott-Head Breast Cancer Research and Treatment Center, Baton Rouge, LA Poster 32 Lobular Involution, mammographic density and Risk of Breast Cancer Karthik Ghosh MD, MS, Celine Vachon PhD, V.S. Pankratz PhD, Rob Vierkant, Kathleen Brandt, MD, Carol Reynolds, Lynn C. Hartmann MD Mayo Clinic, Rochester, MN Poster 33 Macromastia in Adolescence: a Prospective Look at the Physical and Psychological Impact Erika R. McCarty, BA, Michelle Webb, BS, Heather Rosen, MD, Chao-Yu Guo, PhD, Brian Labow, MD Children's Hospital Boston Harvard Medical School, Boston, MA Poster 34 Utility of the 21 Gene Recurrence Score (RS) and Mitotic Index for Treatment Recommendations in ER+ Breast Cancer J. Stanley Smith, MD, Rena Kass, MD, Gordon L Kauffman, MD, Harold A Harvey, MD, Alan Lipton, MD, Leah Cream, MD, Bing Han, MD Breast Disease Team Leader Penn State Hershey Cancer Institute, Hershey, PA Poster 35 Magnetic Resonance Imaging and Molecular Breast Imaging in the work up of Mammary Fibromatosis Julie K. Brodt, MS, CNP, Deborah J Rhodes, MD, Katrina N Glazebrook, MD,, Carrie Hruska, PhD, Michael O’Connor, PhD, Judy C Boughey, MD Mayo Clinic, Rochester, MN Poster 36 Mammography in Young Women: A Population-Based Study Anees Chagpar, Sarah Mizuguchi, Lane Roland University of Louisville, Louisville, KY Poster 37 Micrometastatic Breast Cancer and Oncotype DX Score: Is There a Relationship? Talia K. Ben-Jacob MD, M. Lisa Attebery DO, Anne Steffney RN Cooper University Hospital, Camden, NJ Poster 38 Molecular Breast Imaging - An Additional Screening Tool for Women with Dense Breasts


Dietlind L Wahner-Roedler, MD, Judy C Boughey, MD, Carrie B Hruska, PhD, Marilyn J Morton, DO, Deborah J Rhodes, MD Mayo Clinic, Rochester, MN Poster 39 MRI Vs. Mammography to Evaluate the Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Aron Kefela MD, Ruemu Birhiray MD, Syed Moazzem MD St. Vincent Hospital, Indianapolis, IN Poster 40 Why Patients Choose Prophylactic Mastectomy? Wafa Alkhayal, Costanza Cocilovo, MD, Elizabeth Feldman, MD, Ali Al-attar, MD, Scott L. Spear, MD, Shawna Willey, MD Georgetown University Hospital, Washington, DC Poster 41 Occult Breast Neoplasm in the Setting of Reduction Mammaplasty Kathryn Spanknebel, MD, Jane Petro, MD, Thomas Higgins, MD, Philip Bonanno, MD The Breast Institute, Northern Westchester Hospital, Mt. Kisco, NY, New York Medical College, Valhalla, NY Poster 42 Oncotype DX Surpasses Adjuvant! Online and Nottingham Prognostic Index as a Breast Cancer Prognostic Tool Angie R Larsen MD, Claudia E Lago-Toro, Andrea V Bario, Thomas G Frazier Bryn Mawr Comprehensive Breast Center, Bryn Mawr, PA Poster 43 Outcome of Patients with Metaplastic Cancer of the Breast Treated with Adjuvant Platinum and Taxane Based Chemotherapy: A Mayo Clinic Arizona Experience Prakash Thapaliya, MD, Donald Northfelt, MD, Barbara Pockaj, MD Mayo Clinic Arizona, Scottsdale, AZ Poster 44 Pathologic Complete Response of a Locally-Advanced Metaplastic Breast Cancer: A Case Report of a Novel Approach Using Neoadjuvant Weekly Paclitaxel and Concurrent Radiation Cristina M. Checka, MD, J.L. Speyer, MD, S.C. Formenti, MD, J.P. Levine, MD, E.P. Connolly, MD, P.G. Levine, MD, R.S. Berman, MD, D.M. Axelrod, MD NYU Langone Medical Center, New York, NY Poster 45 Patient Preference for Breast Exam Chaperone Cristina M. Checka, MD, Kristin Bright, PhD, Hildegarde Toth, MD, Jennifer Chun, MPH, Amber Guth, MD


NYU Langone Medical Center, New York, NY Poster 46 Positron Emission Tomography with FDG-Avid Siliconosis Mimicking Recurrent Tumor: A Case Report. Jessica Keto, MD, Jamie L Caughran, MD, Thomas Gribbin, MD Saint Mary's Healthcare/Lack's Cancer Center, GRMERC/MSU General Surgery Residency, Grand Rapids, MI Poster 47 Post-Operative Benign Calcifications Secondary To Floseal™ in Breast Surgery: A Case Report. Jessica L. Keto, MD, Jane E. Pettinga, MD Spectrum Health, GR/MERC General Surgery Residency, Grand Rapids, MI Poster 48 Magnetic Resonance Imaging (MR) Findings in Breast Adenoid Cystic Carcinoma Jessica L. Keto, MD, Jane E. Pettinga, MD, Marianne K. Melnik, MD, Tammy H. Kreuzer, MD Spectrum Health, GRMERC/MSU General Surgery Residency Grand Rapids, MI Poster 49 Prophylactic Intra-Aortic Balloon Pump Counterpulsation During Mastectomy: A Case Report Jessica L Keto, MD, Robert J Dean, MD, Robert Wolyn, MD, Marianne K Melnik, MD Michigan State University/Grand Rapids Medical Education and Research Center General Surgery Residency, Grand Rapids, MI Poster 50 Prevalence of Paresthesia, Fatigue, Edema and Pain After Treatment for Breast Cancer Ruffo Freitas-Junior, Geraldo Silva Queiroz, Ana Flavia Ribeiro Santos, Rubens Jose Pereira, Guilherme Luiz Hermogenes Pereira Araujo Jorge Hospital, Goias Anticancer Association, Goiania, Brazil Poster 51 Incidence and risk factors for winged scapula after axillary clearance for breast cancer Ruffo Freitas-Junior, Adriana de Sousa Mastrella, Régis Resende Paulinelli Federal University of Goias, Goiania, Brazil Poster 52 Axillary Clearance wthout Drainage for Breast Cancer Treatment: Randomized Clinical Trial Ruffo Freitas-Junior, Luiz Fernando Jube Ribeiro, Marise Amaral Rebouças Moreira, Geraldo Silva Queiroz, Rosemar Macedo Souza Rahal, Maria Virginia Thomazini, Regis Resende Paulinelli Mastology Research Network of Goias, Goiania, Brazil Poster 53 Prevalence of Breast Cancer in the City of Goiânia, Goiás, Brazil, between 1988 and 2002 Ruffo Freitas-Junior, Edesio Martins, Maria Paula Curado, Jose Carlos Oliveira


Rede Goiana de Pesquisa em Mastologia/Mastology Research Network of Goias, Goiania, Brazil Poster 54 Radioguided Occult Lesion Localization (ROLL) and Sentinel Node and Occult Lesion Localization (SNOLL) of Non-Palpable Breast Lesions Maurício Augusto Silva Magalhães Costa, Sergio Augusto Lopes de Souza, Flávia Paiva Proença Lobo Lopes, Bianca Gutfilen, Augusto Cesar Rocha, Sergio Romano, Lea Mirian Barbosa da Fonseca Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Poster 55 Re-evaluating Lobular Neoplasia and the Risk of Invasive and Intraductal Breast Cancers Bridget A. Oppong, Daniel Choi, Boris Sepesi, Kristin Skinner University of Rochester, Rochester, NY Poster 56 Results of Two Phase I Clinical Trials of the Mammalian Target of Rapamycin (mTOR) Inhibitor Everolimus in HER2-Overexpressing Metastatic Breast Cancer (MBC) With Prior Resistance to Trastuzumab: Combinations With Paclitaxel/Trastuzumab and Vinorelbine/Trastuzumab Sara Hurvitz, MD, Cristian Massacesi, MD Novartis Pharmaceuticals Corporation, Florham Park, NJ , UCLA Medical Center, Santa Monica, CA Poster 57 Role of BTG2 in the antioxidant response in breast cancer cells. Tejaswita M. Karve, Saijun Fan, Eliot M. Rosen Georgetown University, Washington DC Poster 58 Sentinel Lymph Node Biopsy (SLNB) is Feasible in Patients with Previous Mantle Radiation (MR) for Lymphoma Lydia Choi, Michelle Stempel, Monica Morrow, Alexandra Heerdt Memorial Sloan Kettering Cancer Center, New York, NY Poster 59 Tamoxifen and Anastrozole Neoadjuvant Treatment Correlates with Anthropometric And Biomarker Changes in Postmenopausal Women with Breast Cancer Karine Angélica Cintra, MD, André Mattar, Yong K Joo, Alexandre Mellito, Ângela Flávia Logullo Waitzberg, Fernando Soares, Luiz Henrique Gebrim Federal University Of São Paulo and Pérola Byington Hospital, São Paulo, Brazil Poster 60 The Accuracy of Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes over a 7-Year Period Brigid K. Killelea, Donald Lannin, MD, Eliza Tran, MD, Baiba Grube, MD Yale New Haven Breast Center, New Haven, CT


Poster 61 Touch-Imprint Cytology False-Negative Patients Opt for Non-Standard Management of the Axilla Eeke Thomée, Miss J. E. Rusby, Miss F.A. MacNeill, Dr. P. Osin The Royal Marsden Hospital, London, UK Poster 62 The Role of PET-CT in Personalizing Radiation Therapy for Breast Cancer Manjeet Chadha, MD, Alyssa Gillego, MD, Laurie Kirstein, MD, Sumy Chang, MD Susan K. Boolbol, MD, Louis B. Harrison, MD Beth Israel Medical Center, New York, NY Poster 63 Unusual presentation of Tubular carcinoma of the breast Fernando Collado-Mesa, MD, Sherry S. Thompson, MD, Stuart S. Kaplan, MD, Robert J. Popitti, Jr., MD, Katrina Rabinovich, MD, Adrian Legaspi, MD Mount Sinai Medical Center, Miami Beach, FL Poster 64 Solitary Neurofibroma of the Breast Fernando Collado-Mesa, MD, Sherry S. Thompson, MD, Stuart S. Kaplan, MD, Robert J. Popitti, Jr, MD, Katrina Rabinovich, MD Mount Sinai Medical Center, Miami Beach, FL Poster 65 Correlation of Large Core Vacuum Assisted Ultrasound Guided Biopsy Pathology Results a and Subsequent Surgical Pathology Janet Szabo, MD, Laurie Margolies, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Poster 66 Non-Breast Findings on MRI Examination of the Breast Laurie Margolies, MD, Janet Szabo, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Poster 67 Pre-Biopsy Worry Predicts Breast Biopsy Pain and Anxiety Laurie Margolies, MD, Stephanie Sohl, PhD, Julie Schnur, PhD, Guy Montgomery, PhD, Janet Szabo, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Poster 68 Upgrading of Low Grade Malignant and Potentially Malignant Lesions Obtained on Stereotactic Core Needle Biopsy Using an 8 Gauge Vacuum Assisted Biopsy System


George Hermann, MD, Laurie Margolies, MD, Janet Szabo, MD, C. Nagi, MD Mount Sinai School of Medicine, New York, NY Poster 69 Does Her2neu Expression Vary With Fixation Time? J.A. Ibarra, MD, L.W. Rogers, MD MemorialCare Breast Centers at Orange Coast, Fountain Valley, CA and Long Beach, Long Beach, CA


Poster Abstracts Poster 1 "Aesthetic Oncology" Philip C. Bonanno, MD, Karen Arthur, MD, Anthony Cahan, MD, Sharon DeChiara, MD, David Palaia, MD, Michael Rosenberg, MD, Kathryn Spanknebel, MD The Breast Institute at Northern Westchester Hospital, Mount Kisco, NY "Aesthetic Oncology" combines the principles of cancer surgery and aesthetic surgery, and is an integral component of breast cancer care at The Breast Institute at Northern Westchester Hospital This philosophy utilizes the specialized services of dedicated oncological breast surgeons and reconstructive plastic surgeons, who synchronize surgical treatment plans to design customized procedures for individual patients. These physicians strive to achieve optimal medical management of the cancer, while maintaining or enhancing aesthetic results for their patients' quality of life. The Breast Institute rates among the highest in breast preservation and primary reconstructive techniques for our patients. In addition, the physicians help coordinate proactive breast procedures in the management of patients who have the high-risk genetic predisposition to breast cancer. Our multidisciplinary Breast Program's team of professionals are dedicated to diagnosing, treating, and managing breast cancer, and includes experts in oncological breast surgery, reconstructive plastic surgery, medical oncology, radiation oncology, radiology, pathology, nuclear medicine, and nursing. This team approach to treating breast cancer provides patients with the continuum of services needed to confront the disease, as well as its physical, emotional and social side effects.


Poster 2 49 Months Follow Up Results of GnRH Analogue Use in Premenopausal Breast Cancer Hee Jeong Kim, Sei Hyun Ahn Department of Breast Surgery, College of Medicine, Asan Medical Center, Seoul, South Korea Background The objective of this study is to discuss our experience of gonadotropin-releasing hormone analog plus tamoxifen(GnRHa+T) or adriamycin and cyclophosphamide (AC) followed by tamoxifen(AC->T) in premenopausal women with hormone response, node negative breast cancer. Methods We retrospectively reviewed the records of 587 premenopausal women with hormone- responsive, node-negative breast cancer. Of these, 269 were treated with adriamycin and cyclophosphamide (AC) followed by tamoxifen (AC->T), and 318 were treated with gonadotropin-releasing hormone analog plus tamoxifen (GnRHa+T). Results At a median follow-up time of 49 months, 25 patients had relapsed and 6 patients had died. Of the 6 deaths, 3 were related to breast cancer. DFS and OS did not differ between the AC->T and GnRHa+T groups. There were no difference of time to recurrence and death between two groups. Type of recurrence did not differ between the two groups. GnRHa+T treatment had no effect on blood profile and did not cause the development of detrimental symptoms but decreased bone mineral density. Conclusion GnRHa +T treatment can be an alternative treatment option in pre-menopausal women with endocrine-responsive, node-negative, breast cancer patients.


Poster 3 An Audit of Mammography Results in a Private Service Setting Hanan S. Gewefel, Moustafa El Houssinie, PhD, Professor, Dept of Community Medicine Ain Shams University, Cairo, Egypt A database was set up in a private mammography and fetal imaging clinic (the WAFI Center) mainly for administrative purposes (keeping schedules and keeping mammography results and appointments and case follow-up). The database was therefore originally designed to include a limited amount of data on service clients. This purpose was later expanded to include mammography results, selected breast cancer risk factors, as well as clinical or pathology reports related to the breast cancer diagnosis where applicable. The present audit includes clinic service data from April 1, 2007 to March 31, 2009 despite the fact that the WAFI Center was operational before that date. Most clients attending the WAFI Clinic can be classified as affluent or well to do (from upper and upper middle class socio-economic strata) mainly due to the cost bracket of the service. In an attempt to include women form the lower socio-economic strata, Here, it should be noted that except for selected cases, the WAFI Clinic does not offer free or reduced cost BC screening services and therefore, its BC screening results should not be considered as applicable or to the general population or compared with population-based BC screening programs. The number of cases with complete information allowing for testing the predictive value of mammography results was found quite limited (n=505 out of the 3276 cases included in the service data). A further limitation was the need to wait for 12 months to elapse in order to confirm mammography results. Additionally, in cases where a surgical intervention was carried out subsequent to the mammography (needle biopsy, surgical biopsy, lumpectomy or mastectomy) thereby confirming positive mammography results, the pathology reports on these cases were not made available automatically to the WAFI center due to its nature, being separate from clinical settings where the said surgical procedures are carried out. A serious attempt was made, however, to obtain pathology reports whenever possible.


Poster 4 APBI Using IMRT is Safe and Effective in Selected Early Stage Breast Cancer Alan A. Lewin, Robert Derhagopian, Andre Abitol, D Jay Wieczorek, Kunal Saigal, Joseph E. Panoff, Cristiane Takita Baptist Hospital of Miami, Department of Radiation Oncology, Miami, FL Purpose Accelerated partial breast irradiation (APBI) is gaining popularity as an alternative adjuvant treatment modality in patients with early stage breast cancer. We report our results using Intensity Modulated Radiation Therapy (IMRT) APBI in selected stage I/II breast cancer patients after breast conserving surgery (BCS). Materials and Methods Thirty-six patients with stage I/II breast cancer elected to receive APBI using IMRT with respiratory gating following BCS in an IRB approved protocol. Patients were treated in the supine position on a breast board with both arms up. Varian RPM respiratory gating was used to track breast motion during both simulation and treatment. The clinical treatment volume (CTV) consisted of the lumpectomy cavity identified on the planning CT scan plus an additional 10-15 mm margin, not extending into the chestwall and at least 5mm from the skin. No additional margin was added to define the planning treatment volume (PTV) in the setting of respiratory gating. The CTV was treated twice daily, 3.8 Gy per fraction for 5 days, to a total dose of 38 Gy. Doses to the skin and chest wall were limited to 30 Gy. Acute and late toxicity was evaluated using the NCI-CTC AE v3 criteria. Cosmesis was assessed by the patient and treating physician using the Joint Center for RT four-point scale. Results Median follow up time was 44.8 months (1.9-71.5 months). Median age at diagnosis was 68 years (50-84). Median tumor size was 0.98 cm (.08-3). Thirty-four patients were pathologically staged as T1 and two as T2. ER was positive in 81%, PR positive in 61%, and Her-2 neu positive in 11% of patients. All patients underwent lumpectomy with negative surgical margins and SNLB was performed in 35/36 patients. All patients who underwent SLNB were node-negative. The median CTV treated was 65.3 cc (19-231 cc). The mean dose to the CTV was 38.96 Gy. The percentage of ipsilateral breast receiving greater than 19 Gy (V50%) was 27.3% (8.9-49.7). The percentage of ipsilateral lung receiving 30% of the dose (V30%) for the group was 1.97% (0-14). The percentage of the heart receiving 5% of the dose (V5%) in all patients with left-sided tumors was ! 6%. Acute toxicity was considered acceptable with 44% of patients experiencing grade I erythema and grade II in 6%; grade I hyperpigmentation occurred in 31% of patients, and grade II in 3%; grade I breast/chest wall tenderness occurred in 14% of patients. No grade III/IV acute toxicities were observed. The rate of late toxicities, including edema, fibrosis, telangiectasis, and residual hyperpigmentation, was within acceptable range. Grade I and II late toxicity, as edema, fibrosis and residual hyperpigmentation occurred in 14% and 11% of patients, respectively. Grade III telangiectasis was seen in 3% of patients. Overall cosmetic outcome was considered “excellent” or “good” by 94% of patients and 97% of physicians, respectively. Local control rate was 97%, with one patient experiencing a non-cancer related death.


Conclusion These results demonstrate that APBI can be safely and effectively administered using IMRT technique. In retrospective review, IMRT enabled the achievement of normal tissue dose constraints as outlined by RTOG 04-13, while providing high dose conformality for the CTV. Local control and cosmesis have remained excellent at our current median follow-up of 44.8 months, with acceptable rates of acute/late toxicities. Further prospective multi-institutional trials should be performed to evaluate IMRT in APBI.


Poster 5 Association of Triple-Negative Breast Cancer with Extracapsular Extension of Axillary Lymph Node Metastasis: Prognostic Implications Sinisa Maksimovic General hospital Sveti Vracevi Bijeljina, Bijeljina, Yugoslavia Objective Triple-negative breast cancers (TNBC) are defined by a lack of expression of estrogen, progesterone, and ERBB2 receptors. We compare the clinical features and prognosis of association of triple-negative breast cancer with extracapsular extension of axillary lymph node metastasis. Methods From January 2000 to December 2009, 591 breast cancer patients operated in General hospital “Sveti Vracevi” in Bijeljina. We selected 301 (50, 9%) patients with breast cancer who had metastases to axillary lymph nodes. Results Extracapsular extension (ECM) was found in 122 (40, 5%). Eighty-three patients (14%) were classified as TNBC. The patients were identified and divided into two groups: 22 patients with triple-negative breast cancer with extracapsular extension of axillary lymph node metastasis (TNBCECM) and 14 patients with triple-negative breast cancer without extracapsular extension of axillary lymph node metastasis (TNBCICM). With a median follow-up of 108 months factors with independent prognostic value for disease-free survival by multivariate analysis included TNBC with extracapsular extension (P < 0.005), pN category (P < 0.01), and presence of lymphovascular invasion (LVI; P < 0.005). An independent negative prognostic effect on overall survival was observed for TNBCECM (P < 0.05), pN category (P < 0.05), and presence of LVI (P < 0.005). Conclusion In patients TNBCECM prognosis was significantly worse compared with those who were TNBCICM. These findings have led to the conclusion that TNBC is associated with a more aggressive subtype of cancer.


Poster 6 Atypical Ductal / Lobular Hyperplasia on Core Biopsy; Do We Need Further Surgery? Abuzer Dirican1, Amal Kanbour-Shakir, M.D2, Oya Andacoglu1, Ronald Johnson1, Atilla Soran1 1Surgical Oncology Department Breast Surgery Unit, 2Department of Pathology, Magee-Womens Hospital (MWH) University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA Background Percutaneous core needle biopsy (CNB) is considered to be the standard technique for histological diagnosis of breast lesions. There is an increase in the number of atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) diagnosis on CNB as a consequence of the advances in breast screening programs and biopsy techniques. There is a debate in the literature whether the patients diagnosed with ADH and ALH on CNB should undergo surgical excision. Many studies confirmed the co-existing cancer between 10-40% of ADH and ALH cases upon surgical excision. Up to date, no strong predictive factor has been established to distinguish ADH or ALH cases diagnosed on CNB requiring surgical excision to reveal adjunct malignancy. We aim to identify if the factors evaluated in this study can predict the presence of adjunct malignancy in patients diagnosed with ADH and ALH on CNB. Methods We reviewed 479 patients’ medical records who were diagnosed with ADH and/or ALH upon stereotactic, MRI or ultrasound-guided CNB performed for suspicious lesions in the breast in 2007-2008. All patients underwent follow-up surgical excision and are grouped depending on their surgical excision results as cancer (ductal carcinoma in situ [DCIS] or invasive ductal/lobular carcinoma [IDC/ILC]) or non-cancerous group. The number of CNB samples (1-4 vs more than 4), core biopsy needle gauge (9-11, >11), patients’ age (!50, >50 year), presence of additional proliferative diseases on CNB such as sclerosing adenosis, radial scar, or papilloma and presence of calcification on mammography were evaluated for all groups. Variables are compared within non-cancerous and cancer groups. Results A total of 347 (72.5%) patients were diagnosed with ADH only, 96 (20%) patients had ALH only and 36 (7.5%) cases had both ALH and ADH on CNB. Fifty five (11.5%) out of all cases were found to have adjunct malignancy upon surgical excision (41 cases [74.5%] DCIS only, 14 cases [25.4%] invasive cancer with and without DCIS). Three hundred (62.6%) patients were older than 50 years old. Forty (72%) of cancer patients were older than 50 years of age whereas 15 (27%) cases were younger than 50 years of age (p>0.05). Among 125 cases who had additional proliferative lesion on CNB, 9 patients (16% of cancer cases) were upgraded to malignancy. The remaining 46 cancer patients (83%) had no additional proliferative lesion. Forty three cancer patients (78%) had calcification on CNB while 12 (21.8%) cancer patients did not and this was also insignificant (p>0.05). The type of CNB or number of CNB samples were also found statistically insignificant within the groups (p>0.05).


Conclusion Since 11.5% of ALH and ADH patients are upgraded to cancer after surgical excision, and no variables evaluated in this study are found significant within the groups; patients diagnosed with ADH and/or ALH on CNB should undergo surgical excision. Other variables such as lesion size, imaging features, patient characteristics and potential biomarkers should be studied in larger patient populations to identify ALH and ADH patients who do not require excision but close follow-up and chemoprevention.


Poster 7 Racial Differences in the Surgical Management of Papillary Lesions Diagnosed by Core Needle Biopsy Amanda L. Kong, MD, Allegra Saving, MD, Shannon Rathke, MD, Zainab Basir, MD. Tina W.F. Yen, MD, MS Medical College of Wisconsin, Milwaukee, WI Introduction The surgical management of papillary lesions diagnosed by core needle biopsy (CNB) remains controversial with limited data on racial differences. The objective of this study was to determine if there are racial differences in malignancy rates on surgical excision of papillary lesions diagnosed by CNB. Methods A retrospective chart review was performed on 122 patients with papillary lesions diagnosed by CNB who underwent surgical excision over a ten year period. Patients were divided by race into two categories: White (including 2 Hispanic and 1 Asian patient) and African American. Results Of the 122 patients, 75 (62%) were White and 47 (38%) were African American. The overall malignancy rate was 7.4%. There was no difference in malignancy rates between both groups (p=0.70). There were also no differences in other clinical, pathologic and radiologic characteristics which were examined (Table1). Of the 9 cases upstaged to malignancy on surgical excision, 3/5 of the White group and 1/4 of the African American group demonstrated atypia on CNB. Concurrent malignancy was present in 10/75 (13%) at the time of their papilloma diagnosis (6 contralateral, 4 ipsilateral) in the White group and 3/47 (6%) (2 contralateral, 1 ipsilateral) in the African American group. Conclusion There are no racial differences in malignancy rates on surgical excision of papillary lesions diagnosed by CNB. However, in non-African American patients there may be higher rates of atypia in upstaged papillary lesions as well as increased rates of concurrent malignancy in both the contralateral and ipsilateral breast.


Poster 8 BRCA-negative male breast cancer: Importance of the family history D. Nicholas Wilson, Edward C. Saltzstein, Gary W. Shabacker, Fausto A. Rodriguez, Juan Herrada Texas Tech University Health Sciences Center, El Paso, TX Background Male breast cancer (MBC) is an unusual disease accounting for less than 1% of breast cancer in the United States. Age and obesity appear to be associated with its prevalence, as well as family history of breast cancer, particularly in men who had a first degree relative with breast cancer. Inherited mutations in the BRCA gene increase the risk of MBC, but a different set of genes may be also involved. Methods Case report Results A 72 year old obese male presented with a slow growing 3 x 4 cm left breast mass. An ultrasound-guided fine needle biopsy revealed the presence of malignant cells. Pathological examination after a left modified radical mastectomy showed a 4 x 3.5 cm invasive ductal carcinoma. Additional studies showed the tumor was estrogen receptor positive, progesterone receptor negative, and with no evidence of Her-2 gene amplification. Although he had 2 sisters diagnosed with breast cancer, the patient’s BRCA-1 and BRCA-2 sequencing exhibited no mutations. Conclusion This case report illustrates the importance of family history as a risk factor for MBC, and that genes other than BRCA may be involved in predisposition to MBC.


Poster 9 Breast Cancer Knowledge in an Underserved Population 15 to 39 Years Old in Southern Brazil Maira Caleffi, Rodrigo Antonini Ribeiro, Julia Maria Parode Viegas-Butzke, Fernanda Della Giustina Baldisserotto, Juliana Picoral Manassero, Giovana Paggiarin Skonieski, Ademar José Bedin Júnior Hospital Moinhos de Vento, Porto Alegre, Brazil Background Population education regarding breast cancer (BC) is an important step in effective implementation of preventive measures towards BC-related death reduction. Objective To evaluate BC knowledge in an underserved population of women 15-39 years. Methods: Between 2004-2006, 3,000 women from Porto Alegre (southern Brazil) were seen in basic healthcare units (BHUs), in order to educate them for the importance of BC early diagnosis, recommending annual visits for clinical breast exams (CBE). In the current project, 1/3 of those women were invited to be seen by breast surgeons in the project’s central facility, where they were examined and submitted to a 10-items questionnaire evaluating BC knowledge before and after an educational session. Questions involved common misbelieves about BC, risk factors and genetic inheritance, treatment misconceptions and importance of clinical breast examination (CBE). Results Only 147 women attended. Mean age was 31±6 years; 65% were submitted at least once to CBE in the previous 3 years. The median number of correct answers in the questionnaire applied before the talk was 4 (IQR: 3-5). Only 30% of women were aware that chemotherapy is not always necessary in BC treatment. The median rose to 10 (IQR: 9 – 10) after the educational session (p<0.01). Discussion The fact that few women attended depicts the lack of concern in breast health care. The low knowledge shown in the before questionnaire is especially worrisome since women who attended are probably more concerned about breast health than the general population. The physician’s role in education is cornerstone.


Poster 10 Breast Cancer Trend and Characteristics Among Young Women in a Community-Based Hospital Gelen del Rosario, Kristine Krafick, Deepa Halaharvi, Brenda Sickle-Santenello Columbus, Ohio Objectives This study aims to evaluate the trend of breast cancer diagnosed among young women in a community-based hospital with a dedicated breast health center and a dedicated breast surgeon. Method A retrospective chart review was undertaken of young women (age < 50) with biopsy proven invasive and/or intraductal breast cancer reported to our tumor registry from 2003-2008 (N=497). The Chi-square test was employed to evaluate differences in the rate of breast cancer in this age group. A univariate analysis was performed comparing histology, grade, race, and ER/PR status among women in three age groups (< 30, 31-40, and 41-49). Results There was a statistically significant increase in the incidence of breast cancer in this group of women over the study period . When broken down into age subgroups, the incidence of breast cancer among women aged 31-40 increased but there was no increase in breast cancer incidence among women ages 21-30 or 41-49 years old. In our sample of young breast cancer patients there was trend of higher incidence of invasive versus in situ cancer, although this was not significant. Conclusion Typically, young women with breast cancer represent 42% of all breast cancer diagnoses (SEER, age-adjusted incidence, 2000-2006). In our practice, the total number of young women diagnosed with breast cancer is higher, up to 54%. We believe that early detection and treatment provided by dedicated breast health centers improves breast cancer care and attracts younger patients. Our comprehensive multi-disciplinary breast center provides effective surveillance and selective screening that has a significant impact in the breast care of this patient population. This may translate into favorable outcomes in this group of young breast cancer patients.


Poster 11 Clinical Experience from Fulvestrant Use in Patients with Metastatic Breast Cancer in Korea Ku bo kyoung, Ash SH, Son BH, Kim HJ, Koh BS, Jang MA Asan Medical Center, Seoul, South Korea Background Endocrine therapy is important metastatic breast cancer of hormone receptor-positive. Fulvestrant can be treated by hormone therapy failed in two or more in post-menopausal with advance breast cancer after breast surgery. Method We reported our experience of Fulvestrant by 3rd-line or 4rd-line endocrine therapy for postmenopausal women with metastatic breast cancer. We retrospectively studied 17 postmenopausal women with hormone-responsive metastatic breast cancer. 76.5% received Flv as 3rd-line treatment, 23.5% 4rd-line. 71% received adjuvant chemotherapy. All patents received fulvestrant 250 mg every 28day intramuscular injection. Our study was performed from April 2007 to April 2009. Responses of the patients was evaluated based on the Response Evaluation Criteria In Soid Tumors(RECIST). Results In our study 88.2% patients had ER and PR positivity, HER-2 positivity was 33.3%. 23.5% patients had a stable disease(SD) > 24 week and 11.7% had Partial Response(PR). Average time from first diagnosis of breast cancer to Fulvestrant (FASLODEX) was 6years 7months and Average time from metastatic disease to Fulvestrant (FASLODEX) was 3years 1 month. Flv was disease progress 14 patients including 41.1% patients had a Progressive disease (PD). Conclusion Fulvestrant is well-tolerated and few side effects. Object response rate(OB:12.5%) low, but effective in some patients with non-visceral. Fulvestrant 250 mg/month is Activity and the value of fulvestrant were retained in metastatic patients who were hormone responsive.


Poster 12 Clinical Outcome of Patients with Sentinel Lymph Node Micrometastases Marissa Howard-McNatt, John Stewart, MD, Perry Shen, MD, Edward Levine, MD, Marissa Howard-McNatt, MD Wake Forest University Baptist Medical Center, Winston-Salem, NC Introduction It is known that axillary lymph node status is the most important predictor of prognosis. Sentinel lymph node (SLN) biopsy has not only been proven to be accurate in staging the patient’s axilla, but it has also increased the rate at which micrometastases are identified. The clinical significance, treatment, and outcomes of patients with micrometastases have been the subject of debate. We therefore sought to delineate the clinical outcomes in patients with micrometastases identified in SLN biopsies. Methods A retrospective chart review of patients treated in our medical center between 2000 and 2006 identified patients with micrometastases in their SLN biopsies. Clinicopathologic data included tumor characteristics, treatments, as well as overall and recurrence- free survival were recorded. Results A total of 421 patients had positive axillary lymph nodes for metastases from 2000-2007. There were thirty-two patients with micrometastases. The median patient age was 55 years. The majority of tumors were ER+ (84%) and Stage 2 (94%). LVI was found in half of the tumors with Grade 2 disease seen in 47% (Grade 1 {28%}, Grade 3 {25%}. 59% of patients underwent breast conservation therapy, and 66% of the patients underwent an axillary dissection. Only 44% of the patients received chemotherapy while 96% had hormonal therapy. There were 3 recurrences and only one death (3%) at a median follow-up of 68 months. Conclusion Micrometastases in SLN biopsies are not associated with a higher risk of local or distant failure. The majority of tumors have favorable characteristics that are treated with local control and hormonal therapy. Prospective evaluations of the use of chemotherapy and complete axillary dissection are warranted in this cohort of patients.


Poster 13 Comparision of Excisional Biopsies Performed by Wire Guide Localization or ROLL (Radionuclide Occult Lesion Localization) in Nonpalpable Breast Lesions: A Prospective Randomized Trial Ahmet Korkut Belli, Kagan Karabulut, Ali Cercel, Fatih Aydogan, Ahmet Korkut Belli, Halit Yilmaz, Gul Esen Cerrahpasa Medical School & Hospital, Istanbul, Turkey Purpose Nonpalpable breast lesions have been increasing owing to the fact that awareness of women for breast cancer and increased screening with mammography. The standart and most used procedure in order to localize nonpalpable lesions is wire guide localization. Recently a new technique was alternatively developed for localizing these lesions, called ROLL (Radionuclide occult lesion localization). This study was designed so as to compare excisional biopsies, performed by either wire guide lozalization or ROLL. Material and Method Between April 2006 and September 2007 60 consecutive patients with nonpalpable breast lesion were enrolled to the study after the approvement of ethical committee. Patients were randomized into wire localization group and ROLL group. A scale was made in order to measure the comfortability of the technique for both surgeon and patient, in the range of 1-10 points. Duration of surgery, volume of pathology specimen and comfortability scores were evaluated. Results For wire guide localization and ROLL mean duration of operation was 42 ± 18,12 and 34,5 ± 15,04 minutes; mean volume of pathology specimen was 205,47 mm3 and 159,151mm3 (p=0,388); mean comfortability score for patients was 5,76 and 5,46 (p=0,17); mean comfortability score for the surgeon was 6,06 and 5,0 (p=0,01) respectively. Conclusion We have found ROLL as a comfortable and feasible technique for surgeons to excise nonpalpable breast lesions. When considering disadvantages of wire guide localization like difficult to place in dense breast, getting out of target, pneumothorax and migration of wire, surgeons can use ROLL reliably.


Poster 14 Tuberculous Mastitis: A Case Report from an Urban Community Hospital Jennifer E. Joh, MD, Anitha Srinivasan, MD, MPH, Marc K. Wallack, MD Metropolitan Hospital Center, Jacksonville, FL Tuberculous mastitis is a rare disease that can mimic either malignancy or pyogenic abscess of the breast. In the United States, the last reported case of tuberculous mastitis was in 1985. We report a case of primary tuberculous mastitis seen at our urban community hospital. Our patient did not have any previous history of tuberculosis and presented with clinical signs of pyogenic breast abscess. Moreover, she had associated radiographic imaging suggestive of malignancy. Her diagnosis was eventually made when acid-fast bacilli were seen on a core-needle biopsy of her breast lesion. In countries where pulmonary tuberculosis is endemic, tuberculosis of the breast is not uncommon. Given the greater number of foreign-born patients now seen in our hospitals, we should consider tuberculous mastitis in our differential diagnosis with patients who present with non-healing breast abscesses or inflammatory breast masses in order to avoid a delay in diagnosis and treatment.


Poster 15 Criteria of Oncoplastic Approach of Local Advanced Breast Cancer after Neoadjuvant Chemotherapy A G Zucca Matthes, Haikel RL, Uemura G, Vieira RAC, Fregnani CMS, Folgueira Maak Hospital de Cancer de Barretos, Barretos, Brazil It is considered that the neoadjuvant chemotherapy (NC) offers several advantages in the treatment of local advanced breast carcinoma (LABC), such as the possibility of conservative surgical treatment. Yet the literature is scarce and controversial and this study seeks to clarify criteria that indicate an oncoplastic treatment after neoadjuvant therapy. This was a prospective, nonrandomized, cross-sectional study. From 2008 to 2009, we evaluated 79 female patients, those with LABC, included in a research protocol for specific treatment NC at HOSPITAL DE CANCER BARRETOS. We evaluated the variables related to breast imaging studies, measures tumor (dermatography) and the distance between the tumor and the skin, which were related by correlation analysis, with the gold standard values of the pathological anatomy. An analysis with descriptive purpose of evaluating the different points between the measures was also made. We evaluated 79 patients, excluded from the protocol 40 (50.6%), 16 remain under treatment and 23 completed chemotherapy and underwent surgery. The average size of tumors was 8.4cm (4-17). The clinical response showed a complete response, partial, stable disease and progression in 8.7%, 60.9%, 13.0% and 17.4% of patients. In clinical and radiological complete response was observed, observing a partial response, stable disease and progression in 65.2%, 21.7% and 13.0% of patients. Held 13% of skin-sparing mastectomy, 17.4% of quadrantectomy with glandular remodeling, 4.3% were contralateral breast lift, but were made radical mastectomy 39.1% and 30.4% modified radical mastectomy. The pattern of pathological response was different, occurring macro-fragmentation of single and multiple tumor, with or without carcinoma in situ. The pathological findings showed a wide range of possibilities. Furthermore they corroborate the need for resection of the tumor area defined before chemotherapy. Most of the remaining findings showed lesions often not palpated or hidden methods of image. The oncoplastic technical approach, as well as skin-sparing mastectomy with immediate reconstruction strategy allows a wide and safe resection, including always the previous tumor area.


Poster 16 Death from Breast Cancer Occurs Predominantly in Women Not Participating in Mammographic Screening Matthew Webb, Matthew L Webb, Blake Cady, James S Michaelson, Raymond A Jean, Daniel Kopans, Barbara Smith Massachusetts General Hospital, Boston, MA Background Randomized population mammographic screening trials demonstrated statistically significant mortality reduction in screened women. However, in large general populations, it is unclear how screening impacts death from breast cancer. In a previous report, 75% of breast cancer deaths occurred in the small proportion of unscreened women. That conclusion needs confirmation. Methods 6,997 invasive breast cancer diagnoses occurred in a large hospital consortium between 1990 and 1999. Among all subsequent deaths through 2007, breast cancer deaths in Massachusetts women were documented by actual review of hospital and out-patient records. Regular screening was defined as two or more screening mammograms at intervals of two years or less in asymptomatic women. Results After 12.5 (8-17) years median follow-up, 461 deaths from breast cancer were confirmed. 72 deaths (15.6%) resulted from non-palpable screen detected cancers; 44 deaths (9.6%) resulted from palpable interval cancers, a total of 116 deaths (25.2%) were in regularly screened women. 322 deaths (69.9%) occurred in women who never had screening mammography, and 23 deaths (5%) occurred after one or more previous mammograms, none within two years of diagnosis. Thus 345 breast cancer deaths (74.8%) occurred in women not regularly screened. Conclusion The most effective method of avoiding death from breast cancer is for women to participate in regular screening mammography.


Poster 17 Treatment of Post-Partum Breast Abscesses in the Era of Methicillin Resistant Staphylococcus aureus (MRSA): Time to Take a New Look at the Standard of Care Melissa C Hulvat, MD, Jacqueline Jeruss, MD, PhD, Amanda E. Bass-Zubek, MD Bass Breast Center, Kalispell Regional Medical Center, Kalispell, MT Introduction Post Partum Mastitis (PPM) occurs in 1/3 of nursing women, 10% result in abscess formation, most from Staphylococcus aureus. Preferred management for breast abscesses changed in the early 1990s from operative incision and drainage to percutaneous drainage and treatment with antibiotics. However, the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) is increasing, and penicillin, the first-line antibiotic choice for PPM, has no activity against MRSA. Also, characteristics of a MRSA breast abscess may differ significantly from those caused by Methicillin Sensitive Staphylococcus aureus, necessitating a different approach to local treatment. Case A lactating 31 year-old six weeks post-partum, presented with erythema and pain in the left breast. Sonogram demonstrated mild skin thickening and edematous changes without abscess (Figure 1); she was prescribed Dicloxacillin. Her symptoms failed to resolve over a week, and repeat sonogram demonstrated an abscess (Figure 2). Aspiration was performed, and cultures returned as MRSA. Over her 7-day hospital course, she required Vancomycin and operative debridement of necrotic tissue twice to resolve this abscess (Figure 3). Discussion Community-acquired MRSA frequently expresses Panton-Valentine Leukocidin (PVL). PVL encodes a pore-forming cytotoxin that acts against leukocytes and erythrocytes, causing an intense inflammatory cascade and extensive tissue necrosis. This results in an abscess that is less amenable to percutaneous drainage. Early operative debridement may be necessary if percutaneous drainage fails to swiftly resolve an abscess caused by MRSA. A first-line antibiotic with activity against MRSA may be prudent for the treatment of PPM in hospitals with a high incidence of MRSA.


Poster 18 Diagnostic Accuracy of the Fine Needle Aspiration Cytology (FNA) and Core Needle Biopsy (CNB) as a Diagnostic Method for Breast Lesions Patrícia P Frankel, Viviane Ferreira Esteves, Luiz Claudio Santos Thuler, Roberto José da Silva Vieira Instituto Fernandes Figueira-IFF / Fundação Oswaldo Cruz-FIOCRUZ and Instituto Nacional de Câncer-INCA / Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, Brazil Objective To determinate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) and of core-needle biopsy (CNB) in diagnosing breast lumps and breast cancer. Methods This is a cross-sectional, retrospective and descriptive study based on medical records search. The FNAB and CNB were carried out simultaneous as the routine service of Mastology Fernandes Figueira Institute / Fiocruz. Both percutaneous procedures (FNAB and CNB) have been made in 233 patients from March of 2005 to February of 2007, in women aged 18 years old or more with change in the clinical and/or image examination of the breast. We calculated the sensitivity, specificity, positive and negative predictive values and the accuracy of FNAB and CNB, considering as the gold standard the surgical biopsy. Results The sensitivity, specificity, positive and negative predictive values and accuracy were higher in CNB than in FNAB, regardless of the size of the breast lesion. The diagnostic accuracy was 97.5% to CNB and 77.5% to FNAB. Conclusion The CNB was a diagnostic tool better than FNAB, with higher rates of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for palpable and not palpable breast lumps.


Poster 19 Differences Between Radiographically and Clinically Detected Breast Cancers Mandy Greenberg, MD, Alison Estabrook, MD, Sharon Rosenbaum Smith, MD, Paul Tartter, MD, Kwadwo Boachie-Adjei St. Luke's-Roosevelt/Beth Israel, Stamford, CT Purpose To compare radiographically and clinically detected breast cancers. Methods We performed a retrospective database review of patients with a diagnosis of breast cancer between 2001 and 2008. Patients were divided into two groups based upon presentation of their cancer, either radiographically (by mammography, ultrasound, or MRI) or based on clinical breast exam. Age, race, tumor type, pathological stage, and hormone status were evaluated. Statistical analyses were performed using odds ratios and confidence intervals. Results 2884 patients were included in the database review. Of those, 1823 (64%) patients presented with abnormal radiographic findings and 1040 (36%) presented with an abnormal clinical breast exam. Seventy-one percent were Caucasian and 13% were African American. Regarding age groups, in the 40-49 age group, 60% of the cancers were diagnosed radiographically. In the patients age 75 and older, 67% of the cancers were diagnosed radiographically. With regards to race, 67% of Caucasians were diagnosed radiographically compared to 60% of African Americans. Patients who had radiographically detected cancers presented at an earlier stage (Table 2). In addition, 69% percent of radiographically detected cancers were ER positive compared to 66% of clinically detected cancers. Conclusions Radiographically detected breast cancers present with more favorable characteristics including earlier stage and hormone receptor positivity. Moreover, breast cancer in patients between the ages of 40-49 and those over 75 were more likely to present radiographically than on clinical breast exam. Therefore screening mammograms need to be performed in women under age 50 as well as over 75 in order to diagnose breast cancer early.


Poster 20 Does Micropapillary Breast Cancer Have a Unique Radiologic Pattern? Amber A. Guth, MD, Cecilia Mercado, MD, Amber A. Guth, MD, Linda Moy, MD, Jiyong Lee, MD, Hildegarde Toth, MD, Joan Cangiarella, MD NYU Clinical Cancer Center, New York, NY Introduction Invasive micropapillary cancer (IMC) is a rare variant of breast cancer, with a high incidence of lymph node metastases. We present a series of 18 patients to better elucidate its presentation and radiologic features. Methods Retrospective review from our institution yielded 27 cases from 2005-2009. Nine patients for whom imaging was not available were excluded. Results 18 women (mean age 56.3 years) were identified, most without personal (83%) or family (61%) history of breast cancer. Seven of 11 were premenopausal. Most lesions (12/18, 67%) were identified on screening mammography; six had a palpable mass or thickening; one had a bloody nipple discharge. Mammography revealed a mass in 10 (56%), asymmetry in 5 (28%), calcifications only in 2 (11%), and a mass w/calcs in 1 (6%). Mean lesion size was 3.1 cm. (range: 0.6-18.5 cm). Ultrasound was available for 12 patients; 11 (irregular mass), 1(no lesion). 3/18 patients had a second adjacent tumor foci. Most tumors were moderately (56%) or poorly (28%) differentiated, ER(+) and HER2(-), had associated DCIS (72%), and lymphovascular invasion (61%). Nine of 18 had axillary node metastases. Conclusion While micropapillary breast cancers are aggressive tumors with a characteristic histologic appearance, they lack a unique radiologic appearance.


Poster 21 Effect of Deep Tissue Approximation on Post-Operative Complications Toni M Green, DO, Melissa M. Stobbs, Judy C. Boughey, MD, Alyssa D. Throckmorton, MD, Tanya L. Hoskin, Sarah Y. Boostrom, MD, Andrea C. Holifield, CNP, Amy C. Degnim, MD Mayo Clinic, Rochester, MN Background Breast parenchymal closure has been recommended to improve cosmetic outcome after wide local excision (WLE), but may also have beneficial effects on post-operative seroma and surgical site infection (SSI). We hypothesized that deep tissue approximation decreases seroma and SSI compared to superficial closure. Methods A retrospective review of patients undergoing WLE with or without axillary surgery from July 2004 - June 2006 was performed. Operative notes were reviewed on closure technique. Clinically significant seromas (those requiring intervention) and SSI’s were ascertained by medical record review. SSI was defined as purulent drainage, positive aseptic culture, wound opened by the clinician, or antibiotic-treated cellulitis within 30 days. Results Among 199 WLEs, 95% (190/199) were performed for breast cancer while the remaining 9 (5%) were for benign lesions. Ninety-nine (49.7%) cases underwent deep tissue approximation while 100 (50.3%) underwent superficial closure only. Deep tissue approximation was used by breast surgeons in 92 of 134 cases (68.7%) and by general surgeons in 7 of 65 cases (10.8%). Seromas occurred in 11 cases (5.5%); 8/100 (8%) with superficial closure versus 3/99 (3%) with deep closure (p=0.13). Odds ratio for seroma was 2.8 for superficial versus deep closure (95% CI: 0.7 to 10.8). Seven SSIs occurred; four with deep tissue approximation (4%) and three with superficial closure (3%) (p=0.72). Conclusion Deep tissue approximation did not reduce SSI, but appears to reduce seroma and warrants evaluation in a larger sample. In our series deep tissue approximation was more commonly used by breast surgeons.


Poster 22 Evidence-Based Recommendations for Breast Reconstruction Juan Carlos Zambrano, Lorena Patarroyo, Luis Eduardo Nieto Bogota, Colombia Breast reconstruction has demonstrated physical and psicological benefits in the patients, improving quality of life. Therefore the plastic surgeon must have tools to choose the moment and the best method of reconstruction in order to optimize the results and to diminish complications. There are multiple techniques of breast reconstruction, but in most cases the decision of the procedure dependes on the preferences of the surgeon without epidemiological criteria. This study consists of the design of evidence based recommendations for breast recosntruction. Every recommendation is the answer to a scientific question related to the process of selecccion of the breast reconstruction in a specific circumstance and for specific type of patirents. To generate the answer to every question, we carried out a systematic review of the scientific literature (search, selection, recovery, extraction of information, critical appraisal and elaboration of tables of evidence) with the institutional experience of the Plastic Surgery Unit at Hospital Universitario San Igacio, allowed us to establish a protocol of decisions based on the clinical and pathological characteristics of every patient, in order to choose a spcific technique and timing for breast reconstruction.


Poster 23 Health-Related and Psychosocial Quality-of-Life in Breast Cancer Survivors Influenced by Age and Extent of Disease Terence Sio, Difu Wu, Mary Politi, Maureen Chung Alpert Medical School of Brown University, Providence, RI Background Breast cancer patients are often presented with surgery and adjuvant treatment options that have different effects on quality of life and survival. When survival benefits are equivalent, understanding how different breast cancer treatments impact quality of life may improve patient treatment decisions. Methods A 62-question survey was mailed to female breast cancer patients diagnosed from 2004-2008 at our institution. The survey collected information on quality of life using EROTC-BR23 and BSI-18 modules and included questions concerning recurrence and death. Respondents were stratified for age (<50, 50-65, >65) and extent of disease. Results Of 1131 surveys sent, 516 were returned, and 418 were eligible (37%). Most respondents reported good quality of life with few cancer-related symptoms. Women over age 65 reported a higher quality of life with a better body image compared to women under age 50, despite lower reported sexual and physical functioning. Women with regional disease expressed more anxiety, depression, and somatization symptoms than women with breast cancer confined to the breast. Women older than age 50 with regional disease worried more about recurrence and dying from cancer. Conclusion Age and extent of disease influenced quality of life and psychosocial well-being in breast cancer survivors. Younger women were more likely to report lower quality of life and body image compared to older patients. Increased anxiety, depression and somatization symptoms were associated with more extensive disease. Discussion of treatment impact on quality of life may improve counseling of breast cancer patients.


Poster 24 Tissue Loss Associated With Intraoperative Frozen Section Evaluation of Sentinel Nodes Does Not Cause Underdiagnosis of Isolated Tumour Cells Robert Tasevski, Alexander Mathieson, Adriana Fonseca-Gonzalez, Bruce Youngson, David R. McCready University of Toronto, Toronto, Canada Introduction Tissue loss leading to an underdiagnosis of isolated tumour cells (ITCs) is often cited as a reason against routine intraoperative frozen section evaluation of sentinel lymph nodes (SLN). Our aim was to determine whether the incidence of ITCs in patients that had undergone intraoperative frozen section differed significantly from those that had not. Methods All patients undergoing a SLN biopsy for staging of newly diagnosed invasive breast cancer between 1st July 1998 and 31 December 2008 where identified from the prospective institutional breast cancer database. Data was collected on the final pathological diagnosis of the SLNs which were evaluated with a sentinel node protocol involving serial sectioning and immunohistochemistry, and whether the patient had undergone intraoperative lymph node evaluation with frozen section. Results During the study period a total of 1484 patients with invasive breast cancer underwent SLN biopsy. The final pathology was absence of nodal metastases in 957 (64.5%) patients, ITCs (<0.2mm) in 117 (7.9%), micrometastases (0.2-2.0mm) in 159 (10.7%) , and macrometastases (>2.0mm) in 251 (17.0%). Intraoperative frozen section evaluation of SLN was performed in 601/951 (63.2%) of node negative patients and 77/117 (65.8%) of patients with ITCs. There was no statistically significant difference in the incidence of ITCs in patients that had undergone intraoperative frozen section compared to those that had not (Chi square, p=0.579). Conclusion There is no evidence that loss of tissue associated with intraoperative frozen section leads to underdiagnosis of ITCs, and this reason should not deter intraoperative assessment of SLN.


Poster 25 Idiopathic Granulomatous Mastitis Maria Augusta Rodi Carvalho Barros, Paulo Roberto De Alcantara Filho, Marina Rodi Carvalho Barros, Renato Carvalho Barros Ecomax, Sao Paulo, Brazil The aim of this educational study is to describe and illustrate clinical, mammographic, sonographic and Magnetic Resonance findings in 2 cases of idiopathic granulomatous mastitis with complete documentation. The idiopathic granulomatous mastitis is a rare breast disease, and the differential diagnoses is usually with other types of granulomatous mastitis, including Tuberculosis, Wegner and Foreign body Reaction, also Sarcoidosis and Diabetes, as well as breast carcinoma, specially inflammatory carcinoma. It is also a socially relevant entity; once it’s cronical and physical aspects can cause serious damages in the patient’s personal life. So although it is a benign disease these aspects in the patient life makes it much worth to be studied.


Poster 26 Women Inspiring, Serving and Educating (WISE) Project for Underserved Women - Early Results of an Educational Intervention Program Rakhshanda Layeequr Rahman, MD, Sybil Crawford, Nancy Rudolph, Marjorie Jenkins, Mark Arredondo, MD Texas Tech University Health Sciences Center, Amarillo, TX Background The US “Healthy People 2010” program aims to attain a 70% breast cancer screening rate by 2010, regardless of race or social class such as minorities, the poor, the immigrants, and the uninsured. Innovative programs are needed to achieve this goal. Methods Amarillo has a multicultural, multiethnic and multilingual population. WISE program (funded by Komen Affiliate of Greater Amarillo) was designed after “Train the Trainer Model” to identify community enthusiasts through American Housing Foundation, and train them as educators for their peers on basics of breast health. Five training modules were created: (i)Risk reduction, (ii)Screening, (iii)Mastalgia, (iv)Lump and (v)Nipple Discharge. Demographic surveys were conducted and training was imparted on one module every two months. Materials were provided but women designed teaching strategies for peers. Four pre and post-training test questions were administered for each module. Results Ninety-five women completed the baseline survey [59(57%) non-whites; 28(29%) immigrants; 24(25%) rural setting; 47(49%) <high-school education; 53(55%)<$20,000/yr household income]. Five WISE women attended the training sessions and educated 16-29 peers in self-designed sessions. The mean/median difference in correct responses between pre and post-tests were 1.05/1 for risk reduction(p=0.0023); 0.62/1 for screening(p=0.0029); 1.45/2 for mastalgia(p=0.0015); 1.75/2 for lump(p=0.0021) and 0.1/0 for nipple discharge(p=0.7052). WISE women tended to have a higher percentage of correct responses, but the difference between WISE women and their peers before and after training were not statistically significant. Conclusion Preliminary data documents the significant impact of the WISE woman program on knowledge of the underserved community in Amarillo regarding breast health.


Poster 27 Improvements in Critical Dosimetric Endpoints Using the Contura® Multi-Lumen Balloon (MLB) Breast Brachytherapy Catheter to Deliver Accelerated Partial Breast Irradiation: Preliminary Dosimetric Findings of a Phase IV Trial Natasha Behrmann, Frank A. Vicini, MD, Dorin A. Todor, PhD, Thomas B. Julian, MD, Maureen R. Lyden, MS, Assistant Researcher Lake Forest, CA Objectives Dosimetric findings in patients treated with the Contura® Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) on a multi-institutional phase IV registry trial are presented. Method CT-based 3D planning with dose optimization was performed. For the trial, new ideal dosimetric goals included: (1) "95% of the prescribed dose (PD) covering "90% of the target volume (TV), (2) a maximum skin dose !125% of the PD, (3) maximum rib dose !145% of the PD, and (4) the V150 !50cc and V200 !10cc. The ability to concurrently achieve these dosimetric goals using the Contura® MLB was analyzed. Results 144 cases were available for review. Utilizing the MLB, all dosimetric criteria were met in 76% of cases. Evaluating dosimetric criteria individually, 92% and 89% of cases met skin and rib dose criteria, respectively. In 93%, ideal TV coverage goals were met and in 99%, dose homogeneity criteria (V150 and V200) were satisfied. When skin thickness was "5mm - <7mm, the median skin dose was limited to 120.1% of the PD and when <5mm, the median skin dose was 124.2%. When rib distance was <5mm, median rib dose was reduced to 136.5% of the PD. When skin thickness was <7mm and distance to rib was <5mm, median skin and rib doses were jointly limited to 120.6% and 142.1% of the PD, respectively. Conclusions The Contura® MLB catheter provided the means to achieving the imposed higher standard of dosimetric goals in the majority of clinical scenarios encountered.


Poster 28 Primary Angiosarcoma of the Breast Paulo Roberto De Alcantara Filho, Maria Augusta Rodi Carvalho Barros, Jose Luiz Barbosa Bevilacqua, Alfredo Carlos Simoes Dornelas De Barros, Vera Lucia Nunes Aguillar Hospital Sirio Libanes, Sao Paulo, Brazil Angiosarcoma of the breast is a rare tumor, accounting for less than 8% of breast sarcomas. They are classified as primary, which is a rarity, or secondary, mainly several years after breast conserving approach with radiation therapy was the choice when tumor was diagnosed. We reported 3 cases in our institution between march 2008 to december 2009, and all of them were reviewed in our database, with clinical, radiological and therapeutic aspects fully described as well as follow up of the patients. The women ranged in age from 33 to 41 years (mean, 37). All presented with a rapidly growing palpable mass. All were evaluated with mammograms, breast ultrasound and mri. Mammographic findings were similar with a non calcified solitary mass in all 3 cases. An ill defined solitary mass in ultrasound and a low t1 weighted with a higher signal intensity in t2 weighted in mri, respectevely. Core needle biopsy guided by ultrasound was performed in 2 patients and 1 incision biopsy in another. All women had high grade lesions (type 3), followed confirmed by the same laboratory in paraffin and immunohistochemistry. Total mastectomy was performed in all patients, but 2 had axillary lymph node dissection (levels i,ii). All patients who had axillary lymph node dissection had negative lymph nodes at pathologic evaluation. None radiotherapy. All received anthracycline - ifosfamide schemes. All women are still alive after a median follow up of 12.3 months.


Poster 29 Influence of Age on Treatment Choices in a Cross-Sectional Study of Breast Cancer Survivors Difu Wu, Terence Sio, Mary Politi, Maureen Chung Alpert Medical School of Brown University, Providence, RI Background Breast cancer patients are presented with various surgical and adjuvant treatment options at initial diagnosis. This study examined the effect of patient age on treatment decisions and the factors that most influenced treatment choices. Methods A 62-question survey evaluating breast cancer treatment was sent to breast cancer patients diagnosed from 2004-2008 at our institution, excluding those that were deceased or male. Regret associated with treatment received was measured using the standardized 5-item Decision Regret Scale. Patients were divided into three age groups (<50, 50-65, >65) and treatment differences amongst groups analyzed using chi-square. Results Of 1131 surveys sent, 516 were returned, and 418 were eligible. Women under age 50 with disease localized to the breast were more likely to choose mastectomy over breast conservation, compared to older women (p=0.007). Women under age 50 were also more likely to receive chemotherapy for both local (p=0.005) and regional disease (p=0.018). Age did not influence the likelihood of receiving adjuvant endocrine therapy or radiotherapy. Doctor’s recommendation (82.8%), desire for longevity (72.5%), and family or significant others (59.1%) were factors most often cited as influencing treatment decisions. Most respondents (87.9%) had little or no regret regarding their treatment choices. Conclusion Age influenced treatment choice in breast cancer patients. Women under 50 were more likely to choose mastectomy as compared to their older counterparts. Older breast cancer patients more were more likely to receive treatments that maximized quality of life, while younger women more often received treatments that maximized survival.


Poster 30 Innovative Nursing Roles of the Breast Health Center (BHC) Bonnie Edsall RN, BSN, CBCN, CBPN-C, Christina Egan RN, CBCN Good Samaritan Hospital Medical Center, West Islip, NY Good Samaritan Hospital Medical Center is a 437 bed non-for- profit Magnet designated community hospital. Education and support are the main focus of the innovative nursing roles of the BHC at any entry into the system. The Breast Health Center’s philosophy recognizes the patient and family unit, and extends education and support to family and friends through access to support groups, community lectures, child-life specialist and numerous partnerships with the community. Our mission is to educate, support and provide patient-focused, compassionate, seamless care to breast patients and their families. The nurses navigate our patients in the BHC and The Mammography Suite providing education and support during the diagnostic phase. The same nurses accompany patients to the operating room, provide post-operative education, navigate the patient throughout treatment, facilitate support groups and provide community education. This has created overlapping and interwoven services addressing the needs of all women and men concerning breast health and breast disease. The uniqueness of our center stems from the focus on psychosocial support, education, and close communication with the interdisciplinary breast leadership team members from the moment of diagnosis, throughout treatment and into survivorship and/or end of life. The patient and family with the nurse navigator serve as the center of our model of care; thus the one constant for the patient is the nurse. 2009 STATS: Patient satisfaction: 98.52% Mammography and Breast Diagnostic procedures: 32,173. Newly Diagnosed Surgical and/or Metastatic Breast Cancer patients attended: 405


Poster 31 Intraoperative Radiotherapy with the IntraBeam System Jonathan F. Head, PhD, Robert L. Elliott, MD, PhD Elliott-Elliott-Head Breast Cancer Research and Treatment Center, Baton Rouge, LA Background Failure after breast conserving surgery (BCS) and total breast irradiation usually occurs at the site of the original tumor. This is a report on our experience with accelerated partial breast irradiation (APBI) to determine if APBI delivered directly to the tumor bed is feasible and will provide adequate local control. Method Patients greater than age 50 with core biopsy confirmed invasive ductal carcinoma were enrolled. They had preoperative ultrasound defining margins of less than 3.5 cm. Intraoperative ultrasound was also performed in an effort to ensure good surgical margins. After excision of the tumor, intraoperative radiotherapy (IORT) with the IntraBeam system was delivered to the tumor bed. Results The procedure has been performed in 65 patients. Sixty patients had IORT during the original surgery, while 5 patients had the procedure after re-exploration of the segmental mastectomy site. Because of the final pathology (surgical margins, tumor biology and nodal status), 3 patients later had total mastectomy and 11 received total breast irradiation. When total breast irradiation was done, the IORT served as the radiation boost. The cosmetic results have been good to excellent, and there have been no serious surgical or radiation complications. To date, there have been no local failures. Conclusions IORT with the IntraBeam system is feasible, user friendly and versatile with few complications, good cosmetic results and great patient acceptance. It is practical and excellent for breast IORT in the community setting.


Poster 32 Lobular Involution, Mammographic Density and Risk of Breast Cancer Karthik Ghosh MD, MS, Celine Vachon PhD, V.S. Pankratz PhD, Rob Vierkant, Kathleen Brandt, MD, Carol Reynolds, Lynn C. Hartmann MD Mayo Clinic, Rochester, MN Background Mammographic Density (MD) is a strong risk factor for breast cancer. With increasing age, lobular involution increases while MD decreases. However, it is unclear whether involution and MD represent independent breast cancer risk factors. We examined breast cancer risk associated with lobular involution and MD in women with benign breast disease (BBD) to determine whether they are independently associated with breast cancer risk. Methods The Mayo BBD cohort is composed of 9376 women ages 18 to 85 with benign excisional breast biopsy between January 1, 1967 and December 31, 1991. We studied a sub-cohort of women diagnosed with BBD between 1985 and 1991 with a mammogram within 6 months of the BBD diagnosis. Breast cancer outcomes were determined through the Mayo medical records and a study-specific questionnaire. Lobular involution extent was assessed in background tissue; classified as ‘none’, ‘partial’ or ‘complete’. MD was classified as Wolfe’s parenchymal pattern (PP) as N1/ fatty; P1; P2; and DY/ homogenously dense. Hazard ratios and confidence intervals were calculated using Cox regression analyses. Results 2666 women in the Mayo BBD cohort formed the study cohort; 172 (6.5%) women developed breast cancer after 13 years follow up. Mean age 54.6 years. After adjustment for PP and other confounders, women with no or partial involution had elevated risk compared to women with complete involution (HR 2.62 [95% CI 1.39, 4.94] for no involution and 1.61 [95% CI 1.03, 2.53] for partial involution; complete involution- reference group; p for trend 0.003). Moreover, women with dense breasts were at greater risk compared to women with nondense breasts (HR 1.67 [95% CI 1.0, 2.73] for DY pattern, 1.96 [95% CI 1.2 – 3.21] for P2, 1.23 [95% CI 0.67, 2.26] for P1; N1- reference group; p for trend 0.02). Conclusion Lobular involution and MD are both independent risk factors for breast cancer.


Poster 33 Macromastia in Adolescence: a Prospective Look at the Physical and Psychological Impact Erika R. McCarty, BA, Michelle Webb, BS, Heather Rosen, MD, Chao-Yu Guo, PhD, Brian Labow, MD Children's Hospital Boston Harvard Medical School, Boston, MA Macromastia is common in adolescents and has significant consequences. As adolescence is a period of rapid development, controversy surrounds the treatment of macromastia in teens. No research has explored the consequences of macromastia for adolescents using validated measures. We hypothesized that adolescent girls with macromastia would have more disordered eating, less self-esteem, and lower health-related quality of life than previously studied adolescent populations, as measured by the Eating Attitudes Test 26 (EAT 26), Rosenberg Self-Esteem Scale (RSES), and Short Form 36 (SF 36), respectively, and that they would have significant physical symptoms related to macromastia, as measured by the Breast-Related Symptoms Questionnaire (BRSQ). To test these hypotheses, adolescent girls ages 12 to 20 (mean±SD, 17.1±1.7 years) diagnosed with macromastia (n=28) completed these measures and the results were compared with published norms. Compared with norms, adolescent girls with macromastia did not demonstrate increased disordered eating (p>0.05). Participants had less severe breast symptoms than published values in adult women with macromastia and higher measured self-esteem than published values in teens (p<0.05). Girls with macromastia scored lower on the physical functioning, role physical, bodily pain, general health, and social functioning scales of the SF 36 than teen norms (p<0.05). These data indicate that adolescent girls with macromastia experience decreased quality of life due to physical symptoms. Comparisons of breast symptoms with those of women with macromastia suggest that the physical consequences only worsen over time and that early intervention may be beneficial.


Poster 34 Utility of the 21 Gene Recurrence Score (RS) and Mitotic Index for Treatment Recommendations in ER+ Breast Cancer J. Stanley Smith, MD, Rena Kass, MD, Gordon L Kauffman, MD, Harold A Harvey, MD, Alan Lipton, MD, Leah Cream, MD, Bing Han, MD Breast Disease Team Leader Penn State Hershey Cancer Institute, Hershey, PA Background The 21 gene recurrence score (RS) prognosticates 10 year recurrence risk of tamoxifen-treated ER+ Breast Cancer. RS predicts benefit from endocrine or chemo/endocrine therapy. Several reports used RS to direct treatment versus 2005 NCCN Guidelines. Objectives 1. Report the largest single institution experience to date using RS to recommend treatment. 2. Compare RS with Mitotic Index Methods RS were prospectively obtained on FFPET from ER+, Her-2 neg, node negative breast cancers from 7/1/2005 to 12/31/2009. Since July of 2007, selected patients with N0itc or Nmic disease and selected patients for neoadjuvant therapy where chemotherapy eligibility was questionable were included. Results 210 RS from 203 patients. 24 patients enrolled in TailoRX, but 4 excluded, leaving 183 patients where RS could have influenced therapy. 6 patients refused chemotherapy. Of the remaining 177 patients, 100 (56%) changed therapy based on RS compared to recommendations from 2005 NCCN Guidelines: 90 from chemotherapy to endocrine alone and 10 from endocrine to chemo/endocrine. 7 patients had bilateral breast cancer (only 3 had similar bilateral RS). 9 pts. had LN+ disease: ITC in 2, micromets in 7. 5/9 were treated with endocrine alone. 6 pts. had RS on cores prior to neoadjuvant therapy. 5 endocrine treatment and 1 chemotherapy. SBR Grade 3 (19) RS ranged 14-78. Mitotic Index 1 (147) RS ranged 0-43. Mitotic Index 2 (23) RS ranged 0-59. Mitotic Index 3 (7) RS ranged 12-78. Conclusion Although higher grade and mitotic index tend to be associated with higher RS; RS, by itself, better predicts prognosis and chemotherapy benefit for ER+, Her-2 neg, N0 or Nmic+ breast cancer and is a more reproducible and validated test.


Poster 35 Magnetic Resonance Imaging and Molecular Breast Imaging in the work up of Mammary Fibromatosis Julie K. Brodt, MS, CNP, Deborah J Rhodes, MD, Katrina N Glazebrook, MD,, Carrie Hruska, PhD, Michael O’Connor, PhD, Judy C Boughey, MD Mayo Clinic, Rochester, MN Background Mammary fibromatosis is a rare benign, nonmetastasizing stromal breast tumor, which usually presents as a palpable, spiculated, and locally invasive mass. Molecular breast imaging (MBI) is a novel functional breast imaging technique that uses dedicated, small-field-of-view gamma cameras to detect technetium-99m (99mTc) sestamibi uptake in breast tumors. There are few reports of magnetic resonance imaging (MRI) features and no reported cases of MBI in fibromatosis. Methods A 65 year old female presented with a palpable mass in the right breast, with no prior history of breast disease. Examination revealed a 3 cm mass in the lateral right breast not affixed to the chest wall or skin. Results Mammogram identified an irregular spiculated 2.3cm mass. Ultrasound revealed a hypoechoic worrisome solid irregular mass measuring 2.5cm highly suggestive for malignancy. MRI revealed a 2.5cm irregular spiculated mass. The mass showed high signal intensity on T2 images and persistent enhancement kinetics. MBI showed intense focal activity in a 2.4cm mass the upper outer quadrant. Biopsy revealed mammary fibromatosis. Surgical excision revealed 3.6cm fibromatosis resected with 1cm margins. Conclusion We present a case with images of MRI and MBI in mammary fibromatosis. Mammary fibromatosis mimics breast carcinoma on MRI and MBI demonstrating uptake of gadolinium and 99mTc sestamibi respectively. These imaging modalities may be helpful to evaluate extent of disease prior to surgical resection.


Poster 36 Mammography in Young Women: A Population-Based Study Anees Chagpar, Sarah Mizuguchi, Lane Roland University of Louisville, Louisville, KY Introduction Data are limited regarding utility of mammography in women !40. The purpose of this study was to define the use of screening in this population. Methods Data from the 2005 National Health Interview Survey were queried to define the use, and factors associated with, mammography in women !40. Results Of the 3337 women !40 surveyed, 1040 (31.6%) reported having had a mammogram; 2620 (81.3%) reported having had a clinical breast exam. The two modalities were highly correlated; 883 patients had both (p<0.001). 671 (66.5%) had their first mammogram in their thirties; the remainder earlier. 742 (70.7%) women reported that their most recent mammogram was part of a routine exam; 241 (23.4%) women stated that this was done for a problem. 113 women (11.5%) reported a family history and 12 women (1.3%) reported a personal history of breast cancer. Family and personal history were correlated with a younger age of first mammogram (p=0.042 and p=0.027, respectively), but neither was associated with the indication for the test. Of 16 women who had heard of genetic testing, 10 (55.3%) underwent testing; these women were no more likely to have earlier mammograms or to have these done as part of a routine examination. Conclusion Despite the limited data regarding the utility of mammography in women !40, nearly a third of these women have had a mammogram, the majority for screening rather than to work-up a problem. Family and personal history influence the age of initiation of screening mammography in these women.


Poster 37 Micrometastatic Breast Cancer and Oncotype DX Score: Is There a Relationship? Talia K. Ben-Jacob MD, M. Lisa Attebery DO, Anne Steffney RN Cooper University Hospital, Camden, NJ Introduction Oncotype DX is a clinically validated test that examines breast tumor tissue at the molecular level in order to predict the likelihood of tumor recurrence. It is used to tailor treatment in patients newly diagnosed with breast cancer. Currently, the significance of the finding of micrometastatic disease in sentinel lymph node biopsy in patients with invasive breast cancer is unknown with treatment options ranging from observation to chemotherapy and radiation. We contend that if our pilot study determines a significant correlation between Oncotype DX and the finding of micrometastatic disease, we can then perhaps tailor treatment accordingly in the future. Methods All persons diagnosed with breast cancer who were treated at Cooper from 1995-present and were tested for Oncotype DX were included in the study. The pathology report of each subject was evaluated for a diagnosis of micrometastatic disease. A Pearson Chi Square test and Pearson Correlation test were then performed to determine if a correlation between the variables existed. Results There was no association found between micrometastatic breast cancer in general with Onctype DX score (CC: 0.022, Pvalue=0.8274). There was also no significant difference between the Oncotype DX score and ranges for those that were positive or negative for micrometastatic breast cancer. (p=0.557) Conclusion No significant correlation between Oncotype DX score and micrometastatic disease could be determined. However, the study sample was extremely small and we therefore recommend collaborating with other cancer centers to determine if a correlation does exist.


Poster 38 Molecular Breast Imaging - An Additional Screening Tool for Women with Dense Breasts Dietlind L Wahner-Roedler, MD, Judy C Boughey, MD, Carrie B Hruska, PhD, Marilyn J Morton, DO, Deborah J Rhodes, MD Mayo Clinic, Rochester, MN Case A 45 year old woman presented for her annual breast exam. Family history: postmenopausal breast cancer in mother and maternal aunt. Breast exam: normal; screening digital mammogram: heterogenously dense breasts (D3), nothing for malignancy. Based on her risk profile the patient was invited to participate in our Molecular Breast Imaging (MBI) screening study. MBI revealed a 9 x 9 x 13 mm area of uptake in the left breast; a left diagnostic mammogram showed a subtle, focal asymmetric density; sonography revealed a 6 x 7 x 7 mm heterogeneously hypoechoic, color flow Doppler negative lesion, and MRI identified a 17 x 10 mm irregularly marginated mass. Biopsy revealed invasive lobular cancer. Mastectomy with sentinel node biopsy revealed an infiltrating lobular carcinoma, 5.1 x 2.2 x 1.6 cm with negative sentinel lymph nodes. Discussion: This case illustrates that mammography with a reported sensitivity of 40%-70% in dense breasts can even miss large lesions. MRI is expensive and has a high false positive rate. MBI is a new nuclear medicine technique that utilizes semiconductor-based gamma cameras in a mammographic configuration, and has a high sensitivity for the detection of small tumors. Studies done at our institution revealed a sensitivity of 69% for cancers !5 mm, 91% for cancers 6 to 10 mm, and 97% for cancers >10 mm. Conclusion MBI is a novel way of providing high-resolution functional images of the breast and is complementary to existing techniques such as mammography in high risk patients with dense breasts.


Poster 39 MRI Vs. Mammography to Evaluate the Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Aron Kefela MD, Ruemu Birhiray MD, Syed Moazzem MD St. Vincent Hospital, Indianapolis, IN Background Neoadjuvant chemotherapy is now being used widely to treat locally advanced breast cancer for reasons such as breast tissue conservation, and improved tumor resectability, early treatment of micro-metastasis, and enhanced chemotherapeutic drug delivery with tumor vascularity. In addition to the above tumor response to the chemotherapeutic agents can be measured more reliably, thus assisting in improving and selecting more effective chemotherapeutic drugs. The aim of our study is to compare the accuracy of MRI vs. mammography in this setting. Method Imaging and pathological report from 52 patients enrolled in phase-II IRB approved prospective study. 32 patients received 4 drugs regimen that comprised docetaxel, capecitibine, doxorubicin, and cyclophosphomide. While 20 more received bavcizumab in addition to the above. Result MRI had 18 (34.6%) with no disease, 24 (46.2%) with residual disease, and 10 (19.2%) missing report vs. mammography had 20 (38.5%) with no disease, 28 (53.8%) with residual disease, and 4 (7.7%) missing report. When cross tabulated to pathological report MRI had sensitivity of 72.4% vs. 78.7% of mammography, specificity of 77% vs. 86% of mammography and negative predictive value of 55% vs. 65% of mammography. The slightly better percentages for mammography are attributed the higher number of missing MRI reports. Conclusion We have concluded that mammography might be as good as MRI in the evaluation of responsiveness to neoadjuvant chemotherapy in locally advanced breast cancer. Mammography is also cost effective and less cumbersome option. However a larger study will be necessary to reach a more firm conclusion.


Poster 40 Why Patients Choose Prophylactic Mastectomy? Wafa Alkhayal, Costanza Cocilovo, MD, Elizabeth Feldman, MD, Ali Al-attar, MD, Scott L. Spear, MD, Shawna Willey, MD Georgetown University Hospital, Washington, DC Background The reason patients choose prophylactic mastectomy has become the subject of much debate following reports of increasing prophylactic and therapeutic mastectomy rates in the United States. We explored the motivation of patients undergoing prophylactic mastectomy (PM). Methods One hundred thirty two patients who had 156 PM were retrospectively reviewed from a prospectively enrolled IRB-approved risk-reduction registry of patients at Georgetown University Hospital from January 2008 to November 2009. Patient demographics, breast cancer history, genetic testing, final histology results, cancer staging, and reasons for undergoing PM were recorded. Results The mean age of patients undergoing PM was 46 years (range 28-78 years). Over 80% of patients were Caucasian, and 13.6% were African American. Over half of the patients had a family history of breast cancer. Fifty patients (37.9%) underwent pre-operative genetic testing; 24 (18.2%) were BRCA-1/2 gene mutation carriers, and 5 patients (3.8%) had variations of uncertain significance. One hundred seventeen patients (88.6%) had immediate reconstruction. The patients were divided into 3 groups: Group A consisted of 32 patients without a current diagnosis of breast cancer, Group B which consisted of 85 patients with a new diagnosis of unilateral breast cancer, and Group C consisting of 15 patients with breast cancer recurrence. Group A: Twenty-four of the patients had bilateral prophylactic mastectomy and 8 patients (previous history of ipsilateral mastectomy for breast cancer) had delayed contralateral prophylactic mastectomy. The reasons for electing for PM in Group A were: genetic testing results (50%), family history (21.9%), diagnosis of atypia (12.5%), anxiety about future cancers (9.4%) and physician suggestion (6.2%). In groups B and C: One hundred patients (75.7%) had a current diagnosis of breast cancer. Twenty-four patients were Stage 0 and 70 patients had Stage I or II breast cancer. Group B: The reasons for electing for contralateral prophylactic mastectomy (CPM) in Group B were: anxiety about future breast cancer (57.7%), genetic testing results (14.1%), physician suggestion (9.4%), family history (7%), MRI findings (7%), young age (2.4%), diagnosis of atypia (1.2%), and history of radiation (1.2%). Group C: Recurrence (86.6%) was the main reason for pursuing CPM followed by MRI findings and genetic testing results equally (6.7%). Conclusion Genetic testing results, anxiety about future cancers, and breast cancer recurrence were the most commonly cited reasons for patients electing for prophylactic mastectomy.



Poster 41 Occult Breast Neoplasm in the Setting of Reduction Mammaplasty Kathryn Spanknebel, MD, Jane Petro, MD, Thomas Higgins, MD, Philip Bonanno, MD The Breast Institute, Northern Westchester Hospital, Mt. Kisco, New York Medical College, Valhalla, NY Background Reduction mammaplasty (RM) is a common procedure performed on women in the U.S. for which clear standards regarding pathologic assessment, patient selection and screening do not exist. This study aims to 1]determine the incidence of occult breast neoplasm in RM specimens in women undergoing elective and symmetrizing procedures, and 2]describe factors associated with neoplasm detection. Methods The Institute’s operative log was reviewed for consecutive patients undergoing RM(n=603) over a 7.5-year period(Jan 2002-June 2009). Those with available pathology reports were selected for further study(n=578). Descriptive statistics were used to characterize patient-, pathologic- and procedure-related factors associated with occult neoplasm detection. Results Occult breast cancer occurred in 1.2% of patients undergoing elective(n=6) or unilateral symmetry(n=1) procedures. High-risk and benign lesions were incidentally discovered in 9.5%(n=55) and 89.3%(n=516) of patients, respectively. Of 416 patients with available clinical data, 89% constituted elective RM for symptomatic macromastia/ptosis while 11% involved symmetry RM in the setting of breast cancer. Occult malignancy and high-risk lesion detection was associated with older patients(63 and 48 vs.41 years, respectively) and smaller specimen volumes(390 and 419 vs.524 grams, respectively), p<0.05. Furthermore, the type of lesion detected correlated with the clinical setting in which RM occurred (elective vs.symmetry). Elective RM had the highest ratio of benign lesions detected(1.5:1) whereas symmetry RM had the highest ratios of high-risk neoplasm(4:1) and occult cancer(1.3:1) detection. Conclusion Data from this single-center, community-based series suggests occult neoplasm detection in approximately 11% of patients undergoing RM procedures. Improved standards for specimen-handling and patient selection are warranted.


Poster 42 Oncotype DX Surpasses Adjuvant! Online and Nottingham Prognostic Index as a Breast Cancer Prognostic Tool Angie R Larsen MD, Claudia E Lago-Toro, Andrea V Bario, Thomas G Frazier Bryn Mawr Comprehensive Breast Center, Bryn Mawr, PA Introduction Breast cancer prognostic tools provide relapse estimates which guide decisions regarding adjuvant chemotherapy. The goal of our study was to compare risk estimates derived from Oncotype DX, Adjuvant! Online and NPI. Methods Adjuvant! and NPI scores were calculated for 139 cancer patients who had an Oncotype DX at our institution from 2004 to 2009. Results Of 139 patients, 3 had bilateral cancers resulting in 142 cancers.134 cancers were node-negative and 8 were node-positive. 75/142(53%) cancers were low risk on Oncotype DX, including 7/8 (88%) node-positive cancers. 67/142(47%) cancers were either intermediate or high risk. 73/142(51%) were Adjuvant! low risk, while 69/142(49%) were intermediate or high risk. With NPI, 104/142(73%) cancers were low risk versus 38/142(27%) intermediate or high risk. Of 75 low risk Oncotype DX cancers, only 38(51%) had a low score on Adjuvant! while 58(77%) were low on NPI. Of 73 Adjuvant! low risk cancers, only 38(52%) were low on Oncotype DX. Of 16 patients with high recurrence score on Oncotype DX, 4(25%) were high on Adjuvant! and none were high on NPI. 11 cancers were Her2/neu positive by IHC or FISH. 1 had low Oncotype DX score, 4 were intermediate and 6 were high. Conclusion Adjuvant! correlates poorly with Oncotype DX risk estimates. NPI offers better concordance with Oncotype DX than Adjuvant! Recommendations for chemotherapy based on Adjuvant! or NPI may lead to over or undertreatment of select patients. Oncotype DX should be the gold standard when making decisions regarding adjuvant chemotherapy.


Poster 43 Outcome of Patients with Metaplastic Cancer of the Breast Treated with Adjuvant Platinum and Taxane Based Chemotherapy: A Mayo Clinic Arizona Experience Prakash Thapaliya, MD, Donald Northfelt, MD, Barbara Pockaj, MD Mayo Clinic Arizona, Scottsdale, AZ Background Metaplastic Cancer of the Breast (MBC) is a rare entity characterized by the co-existence of ductal carcinoma along with areas of epithelial and/or mesenchymal elements. Previous studies have reported conflicting evidence on the prognosis and treatment of this disease. Currently there is no standardized approach to adjuvant treatment of MBC.These tumors are generally triple negative and have been found to be basal-like with defects in BRCA1 pathway. Platinum based treatment has been shown to be more effective in such cancers. Methods Based on this rationale, we instituted an empiric approach to adjuvant chemotherapy for MBC with the combination of Carboplatin and a Taxane. We collected data on six patients with MBC using Mayo Clinic Medical records from June 2006 to July 2008.Information on patient demographics, hormone receptor and Her-2 status, TNM stage, local therapy and adjuvant chemotherapy was obtained retrospectively. Results All six patients are disease free at a median follow up of 13 months (mean 19 months).The mean number of chemotherapy cycles delivered was 5 and the toxicity was very manageable. Conclusion This study shows that the combination of a Taxane and Platinum is a very reasonable adjuvant chemotherapy option in patients with Metaplastic Breast cancer. More work is needed to develop new drugs targeted to the molecular pathway that drives the carcinogenesis in this distinct group of cancer patients. We propose that this chemotherapy might be the backbone on which molecularly targeted agents can be added to improve the outcome of patients with metaplastic breast cancer (MBC).


Poster 44 Pathologic Complete Response of a Locally-Advanced Metaplastic Breast Cancer: A Case Report of a Novel Approach Using Neoadjuvant Weekly Paclitaxel and Concurrent Radiation Cristina M. Checka, MD, J.L. Speyer, MD, S.C. Formenti, MD, J.P. Levine, MD, E.P. Connolly, MD, P.G. Levine, MD, R.S. Berman, MD, D.M. Axelrod, MD NYU Langone Medical Center, New York, NY A 58-year-old Syrian woman presented with a painless fungating 14-cm, ulcerated breast mass. She had no family history of cancer. A core biopsy showed poorly differentiated metaplastic carcinoma. A firm, mobile 1.5 cm left axillary lymph node was aspirated and the FNA revealed lymphocytes. The tumor was ER negative, PR positive, Her2/neu negative, and Ki-67 90%. PET/CT identified a 12 cm mass (SUV max 10.9) and no metastatic disease. MRI showed enlarged intercostal vessels and loss of the chest wall plane. Patient was treated with neoadjuvant therapy consisting of weekly paclitaxel 100 mg/m2 for six weeks and concurrent daily radiation (60 Gy at x Gy/fraction). She achieved an excellent clinical response with only a persistent 1.0 cm ulceration inferiorly. Repeat PET/CT demonstrated a 5 cm enhancing area (SUV max 2.5). She underwent a left modified radical mastectomy. An additional posterior margin was excised at the junction of the inferior pectoralis, lateral serratus anterior, and superior rectus muscles. A latissimus dorsi flap was used for closure. The patient achieved a pathologic complete response. Eighteen axillary lymph nodes were negative. The chest wall margin contained normal muscle tissue only. Post-operatively she received four cycles of adriamycin and cyclophosphamide. This case illustrates the novel use of weekly paclitaxel and daily radiation to achieve not only excellent local control of a fungating metaplastic tumor but also ultimately a pathologic complete response.


Poster 45 Patient Preference for Breast Exam Chaperone Cristina M. Checka, MD, Kristin Bright, PhD, Hildegarde Toth, MD, Jennifer Chun, MPH, Amber Guth, MD NYU Langone Medical Center, New York, NY Background Gawande addressed the intimacy of the physical exam and the cultural differences that govern patient and physician behaviors in different countries (NEJM 2005). There is variability in the use of chaperones for different components of the physical exam. Chaperones are more consistently used for pelvic examinations but less so for breast exams. Patient preferences and cultural disparities have not been previously defined. Purpose This study attempted to characterize patient preferences for a breast exam chaperone within a culturally diverse urban population. Methods Self-guided questionnaires in English, Spanish, Mandarin, and Arabic were distributed to 363 patients undergoing breast examinations at private and public teaching hospitals. Descriptives and chi-square tests were used for statistical analyses. Results The median age was 48 years (range 17-87) and a majority of the patients were Caucasian (61%). Most had a college education (47%). Of 363 patients, 130 (36%) did not prefer a chaperone, 120 (33%) had no preference, and 69 (19%) wished to be asked. Only 33 (9%) preferred a chaperone. The majority preferred a female examiner (52%). Chaperone preference was significantly associated with education (p=0.003), racial background (p=0.002), and language (p=0.0001). Conclusions The majority of our patients indicated that they did not prefer to have a chaperone during a breast examination. However, when asked about their preference for the gender of the examiner, most preferred a female practitioner. This may reflect a higher degree of comfort with a female examiner or may be a reflection of the length of relationship with the examiner. Further study of individual cultural groups is needed.


Poster 46 Positron Emission Tomography with FDG-Avid Siliconosis Mimicking Recurrent Tumor: A Case Report. Jessica Keto, MD, Jamie L Caughran, MD, Thomas Gribbin, MD Saint Mary's Healthcare/Lack's Cancer Center, GRMERC/MSU General Surgery Residency, Grand Rapids, MI We describe a patient with a history of locally recurrent invasive ductal carcinoma with combined latissimus flap- implant reconstruction presenting with locally re-recurrent disease and evidence of FDG-avid silicone reaction. Our patient is a 64 year-old female with a history of partial mastectomy and axillary lymph node dissection (ALND) followed by whole breast radiation for breast cancer. She developed a local recurrence fourteen years later treated with a completion mastectomy with latissimus dorsi flap and silicone implant reconstruction. Four years later she underwent an exicisional biopsy of a sub-centimeter skin nodule, pathology revealing re-recurrent adenocarcinoma. A breast magnetic resonance imaging study (MRI) identified three areas concerning for local recurrence in her reconstructed breast: two superficial nodules and one deep nodule adjacent to the implant capsule. All three areas were FDG-avid on PET scan. The patient underwent a repeat mastectomy with takedown of the reconstruction and partial resection of the pectoralis major muscle. Final pathology revealed no remaining adenocarcinoma, but silicone material with foreign body reaction the deep lesion and one superficial lesion. No evidence of implant rupture existed on imaging or at surgery. A literature supports the ability of PET to differentiate benign inflammation from carcinoma. However our findings suggest foreign body reaction to silicone and benign inflammatory processes should be included in the differential diagnosis when evaluating a patient for recurrent disease in the setting of breast cancer.


Poster 47 Post-Operative Benign Calcifications Secondary To Floseal™ in Breast Surgery: A Case Report. Jessica L. Keto, MD, Jane E. Pettinga, MD Spectrum Health, GR/MERC General Surgery Residency, Grand Rapids, MI A number of hemostatic products are available for intraoperative use to decrease bleeding complications. Recently the use of hemostatic agents has also been proposed to decrease postoperative seromas and associated complications in breast surgery. We present a case of a patient undergoing an excisional biopsy in which FlosealTM Matrix Hemostatic Sealant (Floseal) was used. Two weeks postoperatively on follow-up mammogram the patient developed extensive new microcalcifications in the area of the previous excision. A published series of seven patients by Henkel et al had the same findings of extensive new microcalcifications in the area of Floseal use during lumpectomies. As microcalcifications are often used as a sign of new or recurrent cancer in breast imaging, we propose Floseal should not be used in breast surgery as benign microcalcifications secondary to Floseal will make follow-up for recurrent breast cancer extremely difficult.


Poster 48 Magnetic Resonance Imaging (MR) Findings in Breast Adenoid Cystic Carcinoma Jessica L. Keto, MD, Jane E. Pettinga, MD, Marianne K. Melnik, MD, Tammy H. Kreuzer, MD Spectrum Health, GRMERC/MSU General Surgery Residency, Grand Rapids, MI Adenoid cystic carcinoma (ACC) of the breast is a rare tumor, accounting for 0.1% of all breast cancers, with and overall favorable prognosis. Mastectomy was originally the standard treatment however breast conserving surgery has been increasingly utilized. Recently, reports of a high incidence of margin involvement during breast conserving surgery (BCS) have been reported. This may be related to extensive microscopic invasion despite having a well circumscribed tumor often noted on gross pathology. Preoperative imaging evaluation including breast magnetic resonance imaging (MR) has been suggested when considering BCS. In addition, increased local recurrence has also been described in the setting of wide resection alone. We describe two cases of breast ACC in which preoperative MR findings accurately predicted extent of disease and review the literature regarding BCS and adjunctive radiation therapy.


Poster 49 Prophylactic Intra-Aortic Balloon Pump Counterpulsation During Mastectomy: A Case Report Jessica L Keto, MD, Robert J Dean, MD, Robert Wolyn, MD, Marianne K Melnik, MD Michigan State University/Grand Rapids Medical Education and Research Center General Surgery Residency, Grand Rapids, MI Background Intra-aortic balloon pump counterpulsation (IABP) has been used to reduce cardiac morbidity and mortality in emergent and elective non-cardiac surgical procedures. We describe the first reported mastectomy utilizing an IABP. Case Report Our patient was a 38 year old female initially diagnosed with post-partum idiopathic dilated cardiomyopathy. Two months after diagnosis she developed a mass in her left breast. Imaging and biopsy revealed a 2.3cm retroareolar invasive ductal carcinoma. A multidisciplinary oncology and cardiology conference evaluated treatment options. It was concluded her best option for long-term cardiac survival was transplantation. To allow for transplant eligibility she required complete breast cancer treatment. A mastectomy with axillary staging was recommended with IABP cardiac support due to her decompensated heart failure. An IABP was placed on the day of surgery. She underwent a left mastectomy with sentinel node biopsy and subsequent completion axillary node dissection with 1:1 augmentation via IABP. Post-operatively she was maintained on 1:3 augmention for 24 hours, with the balloon pump subsequently removed. She was discharged on post-operative day two with no signs of cardiac morbidity. Pathology revealed a 2.4cm invasive ductal carcinoma and 3 positive nodes (Stage IIB). She is completing chemotherapy treatment with stable cardiac function. Conclusion We report the first case describing the prophylactic use of an IABP for a patient undergoing a mastectomy. IABP is viable option for cardiac support in high risk cardiac patients undergoing noncardiac surgery. And, cardiac transplantation is also described in patients with histories of malignancies, including breast cancer.


Poster 50 Prevalence of Paresthesia, Fatigue, Edema and Pain After Treatment for Breast Cancer Ruffo Freitas-Junior, Geraldo Silva Queiroz, Ana Flavia Ribeiro Santos, Rubens Jose Pereira, Guilherme Luiz Hermogenes Pereira Araujo Jorge Hospital, Goias Anticancer Association, Goiania, Brazil Objective To investigate the prevalence of chronic symptoms among patients who underwent breast cancer treatment, and to determine the factors that might be related to these symptoms. Material and Methods A questionnaire was applied to 87 patients undergoing breast cancer follow-up. It evaluated the length of time since treatment, therapeutic procedure (type of surgery, chemotherapy, radiotherapy and/or endocrine therapy), use of analgesic medication, location and intensity of pain and presence of paresthesia, fatigue and upper-limb edema. Results The patients’ mean age was 54.46 years; the mean interval between locoregional treatment and the interview was 52.95 months. The prevalence of paresthesia symptoms was 65.5%; fatigue, 49.4%; edema, 31%; and pain, 31%. From multivariate analysis, we observed that fatigue was influenced by mastectomy (OR = 2.680; 95% CI = 1.127-6.373), radiotherapy (OR = 3.028; 95% CI = 1.142-8.030) and chemotherapy (OR = 5.271; 95% CI = 1.067-26.034), and was lower among patients who underwent endocrine therapy (OR = 0.407; 95% CI = 0.171-0.967). Paresthesia, edema and pain were not influenced by any of the therapeutic type. Conclusion There was high prevalence of complaints among the patients who had undergone breast cancer treatment. Fatigue was the only symptom influenced by the different treatments


Poster 51 Incidence and risk factors for winged scapula after axillary clearance for breast cancer Ruffo Freitas-Junior, Adriana de Sousa Mastrella, Régis Resende Paulinelli Federal University of Goias, Goiania, Brazil The incidence of winged scapula following axillary clearance for breast cancer treatment presents great variability. Such variations may arise from the methodology used to evaluate this complication. Objective To evaluate the incidence of winged scapula following surgical breast cancer treatment and its evolution over time, and to correlate factors that might influence its incidence. Methods This was a cohort study that included 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld’s maneuver and by measuring scapular symmetry. The incidence of winged scapula was calculated at the time of removing the stitches, and 30 days and six months after the surgery. Results At the preoperative assessment, none of the patients presented winged scapula, while 16 patients (28.1%) presented this complication after the operation. The incidence of winged scapula decreased over time (p < 0.01). The factors associated with winged scapula were: age less than 50 years (OR = 3.81; 95% CI: 1.11-13.09), clinical stage I and II (OR = 7.73; 95% CI: 1.55-38.56) and not undergoing neoadjuvant chemotherapy (OR = 4.69; 95% CI 1.12-21.16). The other factors evaluated (including surgical type, number of lymph nodes resected, number of lymph nodes involved and body mass index were not associated with a risk of winged scapula. Conclusion This study revealed low incidence of winged scapula. Its incidence declined over time. Furthermore, young women at an initial stage who had not undergone neoadjuvant chemotherapy presented greater incidence of winged scapula.


Poster 52 Axillary Clearance wthout Drainage for Breast Cancer Treatment: Randomized Clinical Trial Ruffo Freitas-Junior, Luiz Fernando Jube Ribeiro, Marise Amaral Rebouças Moreira, Geraldo Silva Queiroz, Rosemar Macedo Souza Rahal, Maria Virginia Thomazini, Regis Resende Paulinelli Mastology Research Network of Goias, Goiania, Brazil Introduction Drainage following axillary lymphadenectomy reduces the number of evacuating punctures for seroma. Nonetheless, it causes discomfort and anxiety for patients. Objective To evaluate the possibility of not draining the axilla following axillary lymphadenectomy for breast cancer patients. Methods: This randomized study included 240 breast cancer patients who underwent axillary lymphadenectomy as part of the breast conservation treatment. They were divided between two groups: with or without drainage of the operative bed. Results The patients’ demographic characteristics were similar in the two groups. Regarding complications, there were two cases (2.4%) of dehiscence in the group with drainage, while there were 13 cases (13.5%) in the group without drainage (p = 0.007, OR = 3.70, 95% CI = 1.31 – 13.59). The infection, necrosis and hematoma rates were similar between the two groups. The median aspirated volume was 0.00 ml (0.00 – 270.00) in the drained group and 522.50 ml (130.00 – 1148.75) (p < 0.001) in the group without drainage. The median number of aspirations performed as part of the breast conservation treatment was 0.5 (0.0 – 4.0) and 5.0 (3.0 – 7.0), for the groups with and without drainage, respectively (p < 0.001). The volume of serous fluid was similar in the two groups. Conclusion It is feasible to perform lymphadenectomy without axillary drainage, since the safety rate (total number of complications) was similar in the two groups studied; however a greater numbers of evacuating punctures and occurrences of dehiscence of the operative wound might be expected.


Poster 53 Prevalence of Breast Cancer in the City of Goiânia, Goiás, Brazil, between 1988 and 2002 Ruffo Freitas-Junior, Edesio Martins, Maria Paula Curado, Jose Carlos Oliveira Rede Goiana de Pesquisa em Mastologia/Mastology Research Network of Goias, Goiania, Brazil Objective To analyze the annual prevalence of breast cancer in Goiânia over a 15-year period. Method This was a cross-sectional study on women with breast cancer diagnosed in Goiânia, Goiás, Brazil, from 1988 to 2002. The 15-year period was stratified into three five-year periods, for comparison purposes, as follows: 1988 to 1992, 1993 to 1997 and 1998 to 2002. The prevalence rate was defined as the number of existing cases plus the number of new cases in a given period, divided by the population over the same period and multiplied by 100,000. To exclude deaths, the mortality database was used. The official census was used as the denominator for rate calculations. Results The coefficient of breast cancer prevalence in Goiânia was 22.87/100,000 women in 1988 and 220.22/100,000 women in 2002, with an increase of approximately 197.35/100,000. The analyses for the five-year periods showed that in the first period, the rate was 19.39/100,000 and that it was 44.79/100,000 in the last period. For the fifteen years analyzed, the prevalence rate for breast cancer was 127.24/100,000 women. The annual percentage change was 27.07 (p<0.001; 95% CI: 20.79–33.67) from 1988 to 1992 and 9.38 (p<0.001; 95% CI: 8.52–10.25) from 1992 to 2002. Conclusion There was an increase in the breast cancer prevalence rate in the city of Goiânia between 1988 and 2002, possibly related to the improvement in the screening and treatment of breast cancer.


Poster 54 Radioguided Occult Lesion Localization (ROLL) and Sentinel Node and Occult Lesion Localization (SNOLL) of Non-Palpable Breast Lesions Maurício Augusto Silva Magalhães Costa, Sergio Augusto Lopes de Souza, Flávia Paiva Proença Lobo Lopes, Bianca Gutfilen, Augusto Cesar Rocha, Sergio Romano, Lea Mirian Barbosa da Fonseca Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil The use of radiopharmaceuticals in the detection of occult lesions is well-known as a useful method. Radioguided occult lesion localization (ROLL) enables malignant or probably malignant non-palpable breast lesions to be located; biopsy of the sentinel node can also be performed using the sentinel node and occult lesion localization (SNOLL). The aim of this study is to show our experience with ROLL and SNOLL. Method: 134 suspicious non-palpable breast lesions requiring diagnostic excision were submitted to ROLL (n=106) or SNOLL (n=28). The radiopharmaceuticals used to ROLL and SNOLL were respectively 99mTc-MAA and 99mTc-Phytate. 17 out of 106 patients submitted to ROLL also had its sentinel node assessed after a second injection (periareolar) of 99mTc-dextran. Injections were made in a minimum period of 1h and a maximum period of 12h before surgery. The radiopharmaceutical was injected into the non-palpable lesion under mammography, resonance or ultrasound guidance. In addition, 0.5 mL of air were administered to confirm the position of the radiotracer. Results: All lesions were correctly located. The histological diagnosis obtained in patients submitted to ROLL were: 28 invasive ductal carcinomas (26%),43 hyperplasias (41%), 3 lipomas (3%) and 32 fibroadenomas (30%). In patients who underwent SNOLL final diagnosis were: 19 invasive ductal carcinomas (68%), 5 hyperplasias (18%) and 3 fibroadenomas (14%). The sentinel node was detected in all cases (n=28). Conclusion: Although we didn’t compare our patients with wire technique its disadvantages are known. The use of radioguided surgery led us to precisely localization of the lesions and no need of reoperation.


Poster 55 Re-evaluating Lobular Neoplasia and the Risk of Invasive and Intraductal Breast Cancers Bridget A. Oppong, Daniel Choi, Boris Sepesi, Kristin Skinner University of Rochester, Rochester, NY Background Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) represent a spectrum of breast disease referred to as “lobular neoplasia”. Although lobular neoplasia occurs relatively infrequently, it is associated with increased breast cancer risk. The reported risk of invasive cancer or ductal carcinoma in situ (DCIS) undetected on a core biopsy showing lobular neoplasia but evident upon excisional biopsy has varied from 0% to 43%. When ALH or LCIS is diagnosed on core biopsy recommendations for treatment vary from observation to surgical excision to rule out sampling error that could miss some invasive carcinomas. While radical surgical treatment has fallen out of favor, there is still a lack of consensus on what the most appropriate management of patients diagnosed with atypical lobular hyperplasia should be. Methods Review of 58 women from 2001 to 2006 who underwent core biopsy for a suspicious breast mass or abnormal finding on screening mammogram with a diagnosis of atypical lobular hyperplasia or lobular carcinoma in situ. 41 of 58 with completed data analyzed to determine the number of patients found to have an invasive cancer and factors associated with surgical excision. Standard methods for contingency tables, t tests, and chi square analysis used for statistical analysis. Results 37/41 (90%) of the patients underwent surgical excision after a core needle biopsy diagnosis of lobular neoplasia. 2/41 (4.9%) with malignancy post-op. Having a breast mass on initial presentation was associated with surgical excision (P-value <.05). Conclusions Lobular neoplasia is a rare entity for which surgical excision is still practiced in our community. The current practices should be reconsidered given that lobular neoplasia represents an elevated risk of breast cancer without an associated concurrent malignancy. Due to surgeon anxiety about missing cancer, surgery is often recommended in place of close observation, seemingly more so in women presenting with a mass.


Poster 56 Results of Two Phase I Clinical Trials of the Mammalian Target of Rapamycin (mTOR) Inhibitor Everolimus in HER2-Overexpressing Metastatic Breast Cancer (MBC) With Prior Resistance to Trastuzumab: Combinations With Paclitaxel/Trastuzumab and Vinorelbine/Trastuzumab Sara Hurvitz, MD, Cristian Massacesi, MD Novartis Pharmaceuticals Corporation, Florham Park, NJ, UCLA Medical Center, Santa Monica, CA Background The oral mTOR inhibitor everolimus is being investigated for the treatment of breast cancer, with promising activity in preclinical and phase I/II clinical trials. In 2 phase Ib, multicenter studies, once-daily or once-weekly everolimus was combined with weekly paclitaxel/trastuzumab or vinorelbine/trastuzumab for trastuzumab-resistant HER2-overexpressing MBC. Methods Each study (paclitaxel/trastuzumab [N=33]; vinorelbine/trastuzumab [N=50]) had daily and weekly everolimus cohorts, escalating according to a Bayesian design, with starting dose levels of 5 mg/day and 20 mg/week. Concurrent chemotherapy consisted of weekly paclitaxel 80 mg/m2 (3 weeks, 1-week rest) or vinorelbine 25 mg/m2 (2 weeks, 1-week rest), with weekly trastuzumab given at 2 mg/kg. Results With everolimus/paclitaxel/trastuzumab in combination, the reported dose-limiting toxicities (DLTs) were febrile neutropenia (5 mg/day), oral mucositis (10 mg/day), and confusion (30 mg/weekly). With the combination of vinorelbine/trastuzumab and everolimus 5 mg/day, the observed DLTs included grade (G) 3/4 neutropenia and febrile neutropenia, G2/3 stomatitis, and G3 fatigue; with everolimus 30-mg/week, DLTs were G3/4 neutropenia and G3 anorexia. In both trials, the most commonly observed toxicities were neutropenia and stomatitis. Everolimus 10 mg/day and 5 mg/day have been selected for the combination with paclitaxel/trastuzumab and vinorelbine/trastuzumab, respectively. Long-term disease control was observed in both studies, with clinical benefit rate (CR + PR + SD "6 months) of 74% for everolimus/paclitaxel/trastuzumab and 45% for everolimus/vinorelbine/trastuzumab. Conclusion Everolimus in combination with paclitaxel/trastuzumab or vinorelbine/trastuzumab is feasible and shows promising antitumor activity in MBC patients with prior resistance to trastuzumab. Phase III trials evaluating these combinations in MBC are ongoing.


Poster 57 Role of BTG2 in the antioxidant response in breast cancer cells. Tejaswita M. Karve, Saijun Fan, Eliot M. Rosen Georgetown University, Washington DC This study shows a cytoprotective role of B-cell translocation gene 2, BTG2, in breast carcinoma cell (MCF7 and T47D) in response to oxidative stress, partly by upregulation of antioxidant response. We specifically propose that BTG2 enhances the repair of oxidative damage to DNA that in effect would be predicted to decrease the gene mutations. Our previous work indicates BRCA1 protects cells against oxidative stress partly by stimulating the expression of antioxidant enzymes (e.g., catalase) and by shifting the cellular redox balance. A new study suggests BRCA1 can stimulate the repair of 8-oxoguanine DNA lesions. Here, we focus on evaluating the role of BTG2, if any, as an intermediary for the cytoprotective role of BRCA1. Specifically, the interdependence of the BRCA1 effects on antioxidant gene expression, cellular redox state, and repair of oxidized DNA upon the endogenous BTG2 and the ability of wtBTG2 to restore these effects in the BRCA1-deficient mammary epithelial cells; by investigating the structural basis BRCA1/BTG2. We found that wtBTG2 protects against oxidative stress in breast tumor cells. Additionally, antioxidant enzymes as well as their enzyme activity, i.e. catalase, superoxide dismutase 1 & 2 and glutathione peroxidases were upregulated by wtBTG2. Additionally, wtBTG2 can protect BRCA1-deficient mammary epithelial cells from oxidative stress. Our studies may establish a role of BTG2 as a cytoprotective protein against oxidative DNA damage. It may also identify BTG2 as a potential molecular target for breast cancer therapeutics. Ultimately, BTG2 may also serve as a marker for the efficacy of tumor preventive agents.


Poster 58 Sentinel Lymph Node Biopsy (SLNB) is Feasible in Patients with Previous Mantle Radiation (MR) for Lymphoma Lydia Choi, Michelle Stempel, Monica Morrow, Alexandra Heerdt Memorial Sloan Kettering Cancer Center, New York, NY Introduction Prior radiation to the breast is considered a relative contraindication to the use of SLNB. However, as lymphoma survival rates improve, increasing numbers of breast cancer cases related to prior MR are likely to be diagnosed. This study was undertaken to determine whether SLNB is feasible in this population. Methods A retrospective analysis of a prospective database of all sentinel lymph node (SLN) procedures at our institution was done. All patients between 1997 and 2007 undergoing SLNB were evaluated and cases in which there was prior MR were compared to those without prior MR. Results 36 patients with breast cancer who had prior MR were identified and compared with the remaining 7536 patients who had no previous radiation exposure. Patients post- MR were significantly younger than the control group (49 vs. 56, p<0.05) but there was no significant difference in mean tumor size between the two populations (1.3 cm in radiated vs 1.5cm in control group, p=NS). At least one SLN was identified in 35/36 (97.2%) patients who had prior radiation exposure. Non-identification was not significantly different in the control population (2.0%). When lymphoscintigraphy and blue dye were both used, MR and control populations were found to have comparable numbers of either blue, hot or both blue and hot nodes. Of patients with prior radiation, 8 had positive SLN and another 4 had confirmatory axillary dissections despite negative SLNB. Total number of nodes recovered on axillary dissection were similar between MR(13) and control(16) groups. 1/12 (8.3%) patients in the MR population had a false negative SLN as compared to 167/2385 (7%) in the non-irradiated population. Of patients who did not undergo a full axillary dissection because of a negative SLNB, 1/24 had a regional recurrence at 5 months and then had axillary dissection. All other patients had no evidence of axillary recurrence at median follow up of 48 months. Conclusions Prior MR did not hinder the ability to detect a SLN in our experience. Because both the false negative rate and the regional recurrence rate are low, it is acceptable to offer SLNB to this population of patients.


Poster 59 Tamoxifen and Anastrozole Neoadjuvant Treatment Correlates with Anthropometric And Biomarker Changes in Postmenopausal Women with Breast Cancer Karine Angélica Cintra, MD, André Mattar, Yong K Joo, Alexandre Mellito, Ângela Flávia Logullo Waitzberg, Fernando Soares, Luiz Henrique Gebrim Federal University Of São Paulo and Pérola Byington Hospital, São Paulo, Brazil Epidemiological studies have associated high values of anthropometric variables including body mass index, waist circumference, hip circumference and waist-to-hip ratio (BMI, WC, HC and WHR) with an increased risk and mortality in breast cancers expressing hormone receptors. The impact of nutritional status on the molecular response to endocrine therapy has yet to be described. BMI, WC, HP, WHR were assessed in patients with invasive ductal carcinoma (IDC) prior to tamoxifen and anastrozole neoadjuvant treatment and a possible correlation with estrogen receptor (ER), progesterone receptor ( PgR) and Ki-67 was analyzed. Fifty-seven patients with palpable ER-positive IDC were randomized into three neoadjuvant treatment groups for twenty-one days: Anastrozole, Placebo and Tamoxifen. Biomarkers status was obtained comparing single immunohistochemical evaluation using Allred´s method. Statistical analysis was performed using the SPSS software . ER and PgR rates decreased in the anastrozole group after treatment (p<0.05) .The anastrozole and tamoxifen groups showed lower Ki-67 status after treatment. In the anastrozole subgroup, PgR positivity decreased significantly in women with greater waist and hip circumferences (p<0.05), and tended to associate with BMI (p=0.09). There was no correlation of BMI, WC, HC and WHR in the tamoxifen and placebo subgroups with the biomarkers analyzed. Anthropometric measurements did not correlate with ER and Ki-67 status in the tamoxifen and anastrozole treatment groups. Conclusion In conclusion, greater WC and HC were associated with lower rates of PgR expression after neoadjuvant anastrozole treatment. There was no correlation between anthropometric measurements and Ki-67 status after primary endocrine treatment with tamoxifen and anastrozole.


Poster 60 The Accuracy of Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes Over a 7-Year Period Brigid K. Killelea, Donald Lannin, MD, Eliza Tran, MD, Baiba Grube, MD Yale New Haven Breast Center, New Haven, CT Introduction The status of the axillary lymph nodes is an important factor in determining prognosis and treatment for breast cancer patients. Over the past two decades, sentinel lymph node biopsy (SLNB) has been accepted as the standard of care for the evaluation of the axilla among patients with stage I and II disease. Although the clinical significance of micrometastases and isolated tumor cells is controversial, they are not entirely uncommon; intraoperative false negative rates of up to 35% have been reported in the literature. Objective The objective of this study was to determine the false negative rate of introperatively reported sentinel lymph nodes at a single academic institution over a 7-year period. We also sought to identify how many nodes were found to contain either ITCs or micromets on final pathologic diagnosis. Methods A retrospective review of all patients who underwent SLNB between July, 2002 and September, 2009 was performed. Patients who had preoperative neoadjuvant chemotherapy and those who had SLNB performed at an outside institution were excluded. Results from intraoperative frozen section (FS) were then compared with the final pathologic diagnosis, as reported on permanent section. We considered only those patients who had micrometastases (.2mm- 2mm) on final pathology as false negatives, since those with isolated tumor cells (ITCs) were still considered clinically node-negative. Results Over the 7-year period, there were 881 sentinel lymph node biopsies performed on our study population. Of these, 19 (2.7%) initially reported as negative on FS were later found to contain metastases and 29 (4%) were found to have ITCs on the final pathologic report. Conclusion Although sentinel lymph node biopsy is highly accurate, we observed a low false negative rate of 2.7%. In the cases of false negative FS, sentinel node metastases were discovered on final pathologic diagnosis. Intraoperative frozen section analysis of the sentinel node resulted in definitive axillary surgery in more than 97% of women.


Poster 61 Touch-Imprint Cytology False-Negative Patients Opt for Non-Standard Management of the Axilla Eeke Thomée, Miss J. E. Rusby, Miss F.A. MacNeill, Dr. P. Osin The Royal Marsden Hospital, London, UK Aims Touch imprint cytology (TIC) maximises the benefits of sentinel lymph node biopsy (SLNB) by allowing completion axillary lymph node dissection (ALND) during the same operation if the SLN is cancer positive. The aim of this study was to • Establish sensitivity of TIC in patients with benign nodes on preoperative ultrasound • Compare TIC sensitivity and specificity for macro- and micrometastases • Examine decision-making regarding further axillary treatment after a false-negative TIC Methods Electronic records of consecutive patients with invasive breast cancer undergoing SLNB with TIC between May 2006 and September 2009 were analysed. Pre-operative assessment was performed with axillary ultrasound and FNAC if indicated. Results of TIC were compared with final histology. Results 829 sentinel nodes were submitted for TIC in 367 cases. 84 cases (23%) were node positive. TIC had a sensitivity and specificity of 51% and 100% with overall accuracy of 89%. TIC sensitivity for macrometastases and micrometastases was 69% and 8% respectively. 43 cases were tumour positive on TIC, of which 40 had macrometastases; all underwent immediate completion ALND. 41 node-positive cases were not identified by TIC. 23 (56%) had micrometastatic disease. 33 (80%) underwent delayed completion ALND. Of the 8 remaining, 4 underwent adjuvant chemotherapy and 2 received axillary radiotherapy. Conclusion Intra-operative SLN assessment with TIC has only moderate sensitivity after pre-operative selection with axillary ultrasound (+/- FNAC). A high proportion of patients with false negative TIC results have micrometastases rather than macrometastases and this appears to affect their decisions regarding further axillary treatment.


Poster 62 The Role of PET-CT in Personalizing Radiation Therapy for Breast Cancer Manjeet Chadha, MD, Alyssa Gillego, MD, Laurie Kirstein, MD, Sumy Chang, MD Susan K. Boolbol, MD, Louis B. Harrison, MD Beth Israel Medical Center, New York, NY Purpose Elective radiation therapy to the internal mammary lymph node (IMN) is controversial. The status of the IMN on PET-CT may be used to better tailor the radiation therapy target volume. The objective of the study was to determine the added value of PET-CT in radiation treatment planning for breast cancer. Methods For this study, only the pre-operative PET-CT data from a single facility was reviewed. PET-CT for breast cancer pathologic stage IIb to IIIb was selected for purposes of this study. Among the 63 PET-CT studies performed, 35 patients met the stage criteria and have completed surgical management. Clinical characteristics, pathologic information, imaging findings, and radiation planning recommendations were correlated. Results Among the 35 patients, the median number of positive axillary lymph nodes was 3 (range 1-20). Nine patients had 5 or more positive axillary lymph nodes. Routinely, for this lymph node burden the IMN field would be added to the radiation therapy plan. However, the pre-op PET-CT was negative for IMN disease in all 9 patients. In 1 patient with 3/17 axillary nodes positive for disease, routinely an IMN radiation field would not be planned. However, the PET-CT showed IMN metastases. Overall, PET-CT information influenced the radiation therapy field in 10/35 (29%) patients. Conclusion In approximately one third of the patients PET-CT can potentially influence the radiation target volume. Among patients presenting with loco-regionally advanced stage of disease PET-CT information might be helpful in personalizing the radiation therapy plan by treating areas of known risk while minimizing toxicity.


Poster 63 Unusual Presentation of Tubular Carcinoma of the Breast Fernando Collado-Mesa, MD, Sherry S. Thompson, MD, Stuart S. Kaplan, MD, Robert J. Popitti, Jr., MD, Katrina Rabinovich, MD, Adrian Legaspi, MD Mount Sinai Medical Center, Miami Beach, FL Infiltrating Tubular carcinoma of the breast is a sub-type of breast cancer with a more favorable prognosis. These cancers can present with a variety of clinical and imaging findings, and usually have imaging findings indistinguishable from other types of infiltrating breast carcinomas. They are also sometimes associated with adjacent benign radial scars. The case described here is an example of an unusual presentation of Tubular Carcinoma. The patient, who had not seen a physician in 30 years, presented with a friable, exophytic palpable mass in the inner aspect of the left breast, thought at first to possibly represent a skin malignancy. The clinical, mammographic, sonographic, and pathologic features of this case are described.


Poster 64 Solitary Neurofibroma of the Breast Fernando Collado-Mesa, MD, Sherry S. Thompson, MD, Stuart S. Kaplan, MD, Robert J. Popitti, Jr, MD, Katrina Rabinovich, MD Mount Sinai Medical Center, Miami Beach, FL Solitary neurofibromas of the breast are extremely rare. Only four cases have been reported in women and two in men. This excludes neurofibromas in the presence of neurofibromatosis, which is considered a separate disease process. This case report illustrates a rare case of a solitary neurofibroma of the breast in a 61 year old woman. Mammographic, sonographic and pathologic/histologic features of this particular case are presented. A brief review of the medical literature on this topic is also included.


Poster 65 Correlation of Large Core Vacuum Assisted Ultrasound Guided Biopsy Pathology Results a and Subsequent Surgical Pathology Laurie Margolies, MD, Janet Szabo, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Purpose Image guided breast biopsy is an often used alternative to surgery. This study’s purpose was to determine if there was underestimation of disease by ultrasound guided large gauge core vacuum assisted biopsy when compared with surgical pathology when the ultrasound biopsy yielded high-risk lesions or DCIS. Methods Consecutive patients with diagnosis of papilloma, ADH, LCIS, radial scar and DCIS obtained with 12 gauge vacuum assisted ultrasound guided biopsy were identified. Findings From 3/08 through 12/09 53 lesions yielding dcis or high risk pathologic diagnoses were identified. Of these 24 cases had no surgical results available. The remaining 29 lesions included 6 radial scars, 4 radial scars with ADH, 1 radial scar with DCIS, 8 papilloma, 5 papilloma with ADH, 1 papilloma with DCIS, 1 papilloma with LCIS, 1 ADH and 2 DCIS. No malignancy was identified in the uncomplicated papilloma and radial scar. 20% (1 of 5) of the papilloma with ADH, 1 papilloma with LCIS and 75% (3 of 4) of the radial scar with ADH were upgraded to DCIS on surgical specimen. The 2 cases of DCIS and 1 papilloma with DCIS were upgraded to infiltrating carcinoma. Conclusion Our experience suggests that large core needle biopsy may prove to be sufficient when the diagnosis is uncomplicated papilloma. However, all complicated and other high-risk lesions should go on to surgical excision due to underestimation of malignancy despite the large gauge vacuum technique.


Poster 66 Non-Breast Findings on MRI Examination of the Breast Laurie Margolies, MD, Janet Szabo, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Purpose To highlight the value and necessity of evaluating the chest, abdomen, and skeleton when viewing an MRI examination of the breasts. Breast MRI examinations typically begin with a localizer sequence in the axial, sagital and coronal planes which includes portions of the chest and abdomen in addition to the breasts. The field of view for diagnostic axial images often includes portions of the chest and abdomen. Careful inspection of these images is essential to identify unsuspected pathology that should be included in the breast MRI report. An atlas of non-breast findings on localizer images and on diagnostic breast MRI images is shown to highlight the benefit of and necessity of looking at all imaged areas. Examples of incidental non-breast findings shown include liver masses, renal masses, right sided aortic arch, lung disease, intramammary lymph nodes, thyroid masses and osseous pathology. Benign and malignant pathology including hepatic cysts, hepatic metastatic disease and osseous metastatic disease examples are included. The incidental findings are not only important to detect for medical-legal purposes, but have impacted patient care and staging. The breast MRI report should include all imaged portions of the body and if an abnormality is seen, a suggestion for additional evaluation. Direct communication of an unsuspected finding may also be beneficial.


Poster 67 Pre-Biopsy Worry Predicts Breast Biopsy Pain and Anxiety Laurie Margolies, MD, Stephanie Sohl, PhD, Julie Schnur, PhD, Guy Montgomery, PhD, Janet Szabo, MD, George Hermann, MD Mount Sinai School of Medicine, New York, NY Background Anticipatory worry can lead to greater pain following surgery. Breast biopsy procedures are often associated with worry and anxiety, which may similarly influence patients’ experiences. Hypothesis Pre-biopsy worry predicts breast biopsy pain and anxiety Methods Forty-three women were recruited to the study. The mean age was 45.2 years, 45.2% were married, and 61.9% were college graduates. The sampled population was diverse (62.8% White; 20.9% Black; 4.7% Asian; 11.6% other; ethnically, 20.9% were Hispanic). Fifty-seven percent had sonogram-guided biopsy and 43% had stereotactic-guided biopsy. Visual analogue scales (VASs) were used to assess worry (“How worried are you about what the doctor may find?”) prior to image-guided biopsy. Pain (At its worst, during the procedure, how much pain did you feel”) and anxiety (“At its worst, during the procedure, how anxious did you feel”) were assessed with VASs following biopsy. Results Worry about results predicted pain (t=2.06, p< .05, total model R2 = 0.22) and anxiety (t=3.10, p< .01, total model R2 = 0.43) during the procedure. Age, marital status, race ethnicity, and type of procedure did not affect results (all ps > .05). No demographic factors influenced worry (all ps > .10). Conclusion Patients’ worry about prognosis significantly correlates with pain and anxiety during image guided breast biopsies, accounting for 22% and 43% of the variance in these outcomes. This suggests that patient worry reduction may be an important clinical target for improving patient breast biopsy experiences. Future research may test interventions for reducing worry prior to breast biopsy.


Poster 68 Upgrading of Low Grade Malignant and Potentially Malignant Lesions Obtained on Stereotactic Core Needle Biopsy Using an 8 Gauge Vacuum Assisted Biopsy System George Hermann, MD, Laurie Margolies, MD, Janet Szabo, MD, C. Nagi, MD Mount Sinai School of Medicine, New York, NY Purpose To Correlate the pathologic diagnosis obtained on Stereotactic Core Needle Biopsy (SCNB) with the diagnosis following surgical excision to determine if SCNB with an 8G needle is as accurate as surgical biopsy when low grade malignant and high risk lesions are diagnosed. Method Between 9/2007, and 11/2009, 742 patients underwent SCNB using an 8 gauge needle. One hundred and fifty five lesions had a SCNB diagnosis of low grade DCIS, or potentially malignant lesions, necessitating surgical excision. Results The pathologic findings included: ADH, Radial Scar, intraductal papilloma, mucocele- like lesion, and low grade DCIS. The upgraded cases at the final surgical pathology were:DCIS in 33% cases of ADH, DCIS in 29% cases of, intraductal papilloma, DCIS in 16% of radial scars and DCIS in 16% of the mucocele-like lesions. Infiltrating carnicoma was found in 28% who had a diagnosis of DCIS on SCNB. Conclusion Our results indicate that while the incidence of upgrading in final surgical specimen is usually low grade malignancy, surgical excision is still warranted when SCNB shows potentially malignant lesions. It is noteworthy that the larger amount of tissue obtained with an 8 gauge needle may decrease the time of the procedure, but has no significant effect on the need for surgical excision of high risk lesions or DCIS.


Poster 69 Does Her2neu Expression Vary With Fixation Time? J.A. Ibarra, MD, L.W. Rogers, MD MemorialCare Breast Centers at Orange Coast, Fountain Valley, CA and Long Beach, Long Beach, CA Background It is said that Her2neu expression by IHC varies with the time of fixation in neutral buffered formalin. However, there are no published data validating this claim. The published guidelines (ASCO/CAP guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007;131:18-43) from ASCO and CAP recommend that the tissue fixation window should be between 6 and 48 hrs in order to reliably perform IHC for Her2neu. In many pathology practices this guideline can present logistic problems, particularly with cases received on Thursday and Friday. Design The goal of this pilot study is to examine 10 cases. Punch biopsy samples (3 mm) from tumors removed as part of patient's treatment were obtained immediately after receipt of the lumpectomy or mastectomy in the laboratory. These samples were immediately placed in 10% buffered formalin for 3 hrs, 48 hrs, 72 hrs, 96 hrs and 120 hrs. The tumors were large enough that the small samples removed did not compromise the analysis of the case. The study samples were not stained until the case was completed. After the fixation periods, each block was immediately processed. All cases, except for 5,7 and 10 were processed for 2:45 hrs in a Shandon Excelsior tissue processor. Case 5-48 hrs and case 10-3hrs were processed for 4 hrs in a Leica Peloris tissue processor. The remainder of cases 5, 7, and 10 were processed overnight for 11 hrs. All blocks were then batch stained with PATHWAY Her2neu Clone 4B5 rabbit monoclonal using Ventana Ultraview DAB detection kit in a Ventana Benchmark™ XT processor. All cases were invasive carcinomas known to be Her2neu overexpressers before inclusion in the study. Two pathologists reviewed every slide independently following ASCO/CAP guidelines. Results Ten cases of invasive breast carcinoma were analyzed. All blocks, regardless of whether they were fixed for 3, 48, 72, 96, or 120 hrs had strong and diffuse membranous staining with Her2neu. No significant staining difference was noted between the various fixation times. Conclusion Fixation times in 10% buffered formalin between 3 and 120 hrs do not affect Her2neu expression. Further studies are needed to confirm this finding. Acknowledgment This work was possible thanks to a grant from the Foundation at Orange Coast Memorial Medical Center.

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