Abstract P5-22-19: Nipple sparing mastectomy in unselect patients: Experience of an academic center in the south of Brazil

INTRODUCTION: Nipple sparing mastectomy (NSM) consists in the complete excision of the breast gland, mantaining the subcutaneous tissue, skin and nipple-areola complex (NAC). Recently, the NSM was developed as a therapeutic option not just for the patients that need risk-reducing surgery, but also for patients that have tumors not involving the NAC.

OBJECTIVES: Evaluate the overall survival, disease-free survival and local recurrence of the patients that underwent NSM. The only exclusion criteria for NSM was lesion at the NAC.

MATERIAL AND METHODS: Retrospective study that evaluate the number of cases of NSM performed between 2003 and 2015 in a private sector in the south of Brazil.

RESULTS: A total of 224 patients underwent NSM during the period of 2003-2015. The mean age was 47 years. From the total, 43 patients underwent risk-reducing NSM and 181 therapeutic NSM (64 unilateral and 117 bilateral). In those cases of bilateral procedures all of them underwent risk-reducing surgery on the contralateral breast (there were no bilateral cancers). Of this 181 cases, 108 (59%) have familiar history of breast cancer, considering first, second and third-degree relatives. Twenty six patients (14%) have history of previous breast cancer diagnosed. In this group of 181 patients with therapeutic NSM, 29 (16%) developed any unfavorable outcomes, 13 (7%) local recurrence, 4 (2%) ipsilateral node recurrence, 3 (1,6%) contralateral recurrence and 9 (5%) distant metastasis. None of the local recurrences occurred at the NAC, neither the cited unfavorable outcomes occurred in the risk-reducing setting. In a median follow-up of 47,7 months, the overall survival was 95% (8 deaths related to breast cancer) and the disease-free survival was 83,7%.

CONCLUSIONS: The overall survival rates of 95% at 47 months of follow-up is similar to the literature rates, that range from 93 to 97% in 5 years, depending on study's inclusion criterias. In our study, 14% of patients had previous breast cancer and 59% of patients treated for breast cancer by NSM had positive familiar history of breast cancer. This results in an unselected group of patients confirms the safety of this therapeutic method as an option for breast cancer patients.

Citation Format: Frasson A, Zerwes F, Souza A, Rossato N, Miranda I, Trindade V, Vollbrecht B, Santos M, Viegas J. Nipple sparing mastectomy in unselect patients: Experience of an academic center in the south of Brazil [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-19.

Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET)

BACKGROUND

The impact of adherence to clinical practice guidelines (CPGs) for loco-regional treatment (i.e. surgery and radiotherapy) and chemotherapy on local disease control and survival in sarcoma patients was investigated in a European study conducted in an Italian region (Veneto).

PATIENTS AND METHODS

The completeness of the adherence to the Italian CPGs for sarcomas treatment was assessed by comparing the patient's charts and the CPGs. Propensity score-adjusted multivariate survival analysis was used to assess the impact of CPGs adherence on patient clinical outcomes.

RESULTS

A total of 151 patients were included. Adherence to CPGs for loco-regional therapy and chemotherapy was observed in 106 out of 147 (70.2%) and 129 out of 139 (85.4%) patients, respectively. Non-adherence to CPGs for loco-regional treatment was independently associated with AJCC stage III disease [odds ratio (OR) 1.77, P = 0.011] and tumor-positive excision margin (OR 3.55, P = 0.003). Patients not treated according to the CPGs were at a higher risk of local recurrence [hazard ratio (HR) 5.4, P < 0.001] and had a shorter sarcoma-specific survival (HR 4.05, P < 0.001), independently of tumor stage.

CONCLUSIONS

Incomplete adherence to CPGs for loco-regional treatment of sarcomas was associated with worse prognosis in patients with non-metastatic tumors.

Evaluation of mRNA markers for micrometastases detection by RT-PCR in lymph nodes (LN), peripheral blood (PB) and bone marrow (BM) of breast cancer patients (pts)

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Background: Previous RT-PCR study showed that hMAM and CEA mRNA could be detected in 95% and 78% breast carcinomas, respectively. Analyzed in normal LN, these two markers were the only ones not expressed, compared to other mRNA markers which could be detected in a variable number of cases (Marchetti 2001). We evaluate the expression of CEA and hMAM mRNA in breast cancer pts in order to investigate if the identification of these transcripts could be correlated to in the LN, PB and BM. Methods: Tumor, normal gland, LN and PB were obtained from 49 breast cancer pts who have been referred to surgery during the period of Jun/2000 to Jan/2004.BM could be obtained from 21 of these cases. Before the manipulation of the tumor, 5 mL of PB was collected and 5 mL of BM was aspirated from the iliac crest. First level axillary LN were sectioned in two. One of the halves was immediately frozen in liquid nitrogen. CEA and hMAM transcripts have been analysed by RT-PCR. Results: Tumors were positive for CEA in 38 (77.6%) cases and LN were positive in 15 cases (36.7%). 6/49 pts expressed CEA in normal breast (12.2%). Five of these, tumor also expressed CEA. Two pts (4.1%) showed CEA expression in PB and in BM. One patient expressed CEA in BM but not in PB. All pts that showed expression in PB, BM and LN, also showed transcript of CEA in tumor. hMAM transcripts were found in 39 (79.6%) normal gland tissue and in 41 of tumor samples (85.7%). LN were positive to hMAM in 12 cases (24.5%). 5 of these (10.2%) were also positive in PB and BM samples. The pts showing hMAM expression in PB, BM and LN also showed its expression in neoplasic tissue. Analyzing both markers, two pts showed the expression of CEA and hMAM in the PB and BM samples. In 21 of the 49 cases the comparison of hMAM and CEA was possible to be performed in all tissues. CEA and hMAM expression associated to larger number of LN affected. Conclusions: CEA and hMAM transcripts can be detected in majority of breast cancer tissue. Specificity of hMAM seems to be higher than CEA, which can be detected in more than 10% of non-tumor breast tissue. Synchronicity of CEA or hMAM expression in the tumor and in extra-mammary sites was high, suggesting that these markers may provide an interesting strategy for follow-up micrometastatic disease.

No significant financial relationships to disclose.

SOPRoxi

In Italy, postvention models specifically designed for people surviving the suicide of a loved one are very scarce. The SOPRoxi project was developed to respond to this particular lack. By involving different professional and nonprofessional figures (GPs, mental health professionals, social workers, volunteers, etc), the SOPRoxi project aims to remove the stigma associated with this condition and to offer adequate, multifaceted help to survivors.

Paraneoplastic neurological disorders in breast cancer

Paraneoplastic syndromes are the rarest neurological complications in patients with cancer. The neurological paraneoplastic syndromes that are mainly associated with breast cancer are subacute cerebellar degeneration, paraneoplastic retinopathy, opsoclonus-myoclonus syndrome, lower motor neuron diseases and Stiff-man syndrome. The aim of this paper is to briefly outline these paraneoplastic neurological syndromes and consider their relation to breast carcinoma.

Optimised nuclear medicine method for tumour marking and sentinel node detection in occult primary breast lesions

The aim of this study was to evaluate the feasibility of sentinel node (SN) biopsy in occult breast lesions with different radiopharmaceuticals and to establish the optimal lymphoscintigraphic method to detect both occult lesions and SNs (SNOLL: sentinel node and occult lesion localisation). Two hundred and twenty-seven consecutive patients suspected to have clinically occult breast carcinoma were enrolled in the study. In addition to the radioguided occult lesion localisation (ROLL) procedure, using macroaggregates of technetium-99m labelled human serum albumin (MAA) injected directly into the lesion, lymphoscintigraphy was performed with nanocolloids (NC) injected in a peritumoral (group I) or a subdermal site (group II). In group III, a sole injection of NC was done into the lesion in order to perform both ROLL and SNOLL. Overall, axillary SNs were identified in 205 of the 227 patients (90.3%). In 12/62 (19.4%) patients of group I and 9/79 (11.4%) patients of group III, radioactive nodes were not visualised, whereas SNs were successfully localised in 85 of 86 patients of group II ( P<0.001). Pathological findings revealed breast carcinoma in 148/227 patients (65.2%) and benign lesions in 79 (34.8%). A total of 131 axillary SNs were removed in 118 patients with breast carcinoma; intraoperative examination of the SNs revealed metastatic involvement in 16 out of 96 cases of invasive carcinoma (16.7%). It is concluded that the combination of the ROLL procedure with direct injection of MAA into the lesion and lymphoscintigraphy performed with subdermal injection of radiocolloids represents the method of choice for accurate localisation of both non-palpable lesions and SNs.