P114. Acellular dermal matrix versus latissimus dorsi breast reconstruction: An investigation of the costs

S S59 P114. Acellular dermal matrix versus latissimus dorsi breast reconstruction: An investigation of the costs Kali Potiszil, Philip Drew, Iain Brown, Mohsen El-Gammal, Rachel English, Polly King, Sheikh Ahmad Royal Cornwall Hospital Trust, Truro, UK Introduction: The use of acellular dermal matrix (ADM) is now widespread in breast reconstruction. This is reflected by many centres now using implant with ADM as their primary reconstructive option, as opposed to the autologous LD flap. However, cost comparisons have not yet been made in a large UK population. Methods: A retrospective analysis was performed of 5 years of data from immediate breast reconstructions by 5 surgeons in a single institution. All unilateral implant with ADM reconstructions were compared with all cases of LD flap reconstruction. Surgical and patient characteristics were recorded with complications. Costs of initial surgery, follow up, revisional surgery and materials were calculated. Results: Implant & ADM n 1⁄4 105 LD n 1⁄4 78 p Age (mean) 53 50 No. of Complications (Clavien-Dindo Grade II and Above) 25 (22%) 19 (24%) No. of Revisions (median) 1 1 Cost of Initial Surgery 3580 5527 0.00001 Cost of In-Patient Stay 1148 1985 0.00001 Cost of Revision Surgery 1943 1401 0.14131 Total Cost 6741 9266 0.00001 LD reconstruction was shown to be more expensive to our hospital trust due to higher initial costs. Despite concerns of higher revision rates raising costs in implant and ADM reconstruction, this was not found to be the case in our cohort. Conclusion: Reconstruction with implant and ADM is replacing LD as the dominant method of breast reconstruction in the UK. Despite concerns regarding increased complication rates and need for revision, we have shown that for our hospital trust, ADM provides a cost effective alternative. http://dx.doi.org/10.1016/j.ejso.2015.03.152 P115. The cytokeratin-19 mRNA copy number from one step nucleic acid amplification (OSNA) analysis of sentinel lymph nodes can be used in multiple ways to predict further axillary lymph node metastasis in patients with invasive breast cancer Ibrahim Natalwala, Robert Kirby, Soni Soumian, Hammond Lisette, Mark Stephens, Sankaran Narayanan University Hospital North Midlands, Stoke on Trent, UK Introduction: In Sentinel lymph node biopsy, One-step nucleic acid amplification (OSNA) of cytokeratin-19 (CK-19) mRNA greater than 5000 indicates presence of macro-metastasis, usually necessitating axillary node clearance (ANC). The aim of this study was to calculate the optimal cut off Copy Number value for predicting additional non-sentinel lymph node metastasis (nSLNMets). Methods: 783 lymph nodes from 426 patients who underwent SLNB using the OSNA assay from February 2013 to October 2014 were analysed. Multivariate logistic regression analyses were used to test whether Total Tumour Load (TLTotal), Maximum Tumour Load (TLMax), and Mean Tumour Load (TLMean) were independent predictors of nSLNMets. Youden’s Index was used to calculate the optimal cut off copy number. Bootstrapping was implemented to calculate 95% confidence intervals of the new cut-off value. Results: 72 of the 426 patients had ANC and were included in the study. TLTotal (p 1⁄4 0.008), TLMax (p 1⁄4 0.009), and TLMean (p 1⁄4 0.014) were all independent predictors of nSLNMets. TLMean had the best cutoff of 19000 (15000e640000) with sensitivity 87.10%, specificity 65.85% PPV 65.9%, NPV 87.1%. In comparison, the standard cut off of 5000 had a sensitivity of 90.62%, specificity of 15.00% , PPV of 46.03% and NPV of 66.67% Conclusion: The CK-19 mRNA copy number can reliably be used to predict nSLNMets. In our centre a higher cut off value of 19 000 (TLMean) would prevent a significant number of unnecessary ANC in patients who have no further nSLNMets. Large multi-centre studies are required to calculate the optimal cut-off value. http://dx.doi.org/10.1016/j.ejso.2015.03.153 P116. Effects of trastuzumab treatment on the patterns of survival and metastasis in Her-2 positive breast cancers Andrew McGuire, Aoife Lowery, James Brown, Michael Kerin NUI Galway, Galway, Ireland Introduction: Accumulating evidence suggests that breast cancer subtype determines the timing, pattern and outcome of metastatic disease. The aim of this study was to assess the patterns of Her2 +ve breast cancer subtypes (Her2-over-expressing and Luminal B), with specific emphasis on relapse patterns prior to and following the introduction of trastuzumab treatment. Methods: Analysis of 469 patients with Her2-positive breast cancer treated at a tertiary referral unit from 1992e2014. Overall survival (OS), disease free survival (DFS) and patterns of relapse were compared between Luminal B and HER2 overexpressing subtypes before and after the introduction of trastuzumab. Results: 61.2% of tumours were Luminal B and 38.8% HER2-overexpressing. Luminal B cancers displayed a significant improvement in both OS & DFS at 2 and 5yrs, following introduction of trastuzumab. Conversely, HER2-overexpressing cases displayed improvement in DFS at both time points, however, there was no significant difference in OS at 5yrs (46.8% vs 42.4%). Patterns of metastasis were subtype dependent; Luminal B tumours had higher rates of bone relapse, (n 1⁄4 29, 11.1%), while Her2-overexpressing most commonly metastasised to the lung (n 1⁄4 13, 7.8%). Significantly, brain metastasis was >3 times more likely to occur in HER2-overexpressing cancers (1.9%LumB vs 7.2%Her2+). Following the introduction of trastuzumab treatment there was a dramatic reduction in distant metastasis rates in both subtypes, excluding brain which increased (3.7% vs 4.2%). Conclusions: Her2 positive breast cancer exhibit distinct patterns of distant recurrence according to molecular subtype. Insights into the preferences for different metastatic sites will provide exciting avenues for future research. http://dx.doi.org/10.1016/j.ejso.2015.03.154 P117. Clinical impact of PET-CTon patient management in metastatic breast cancer Mark Phillips, Kieran Horgan, Andrew Scarsbrook, Bhavani Rengabashyam Leeds Teaching Hospitals NHS Trust, Leeds, UK Introduction: To assess the impact of Fluorine-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) on the clinical management of primary and metastatic breast carcinoma. Methods: One hundred and sixty patients with metastatic breast carcinoma who underwent FDG PET-CT at a single large tertiary referral centre between January 2008 and August 2014 were retrospectively analysed.