An analysis of a nationwide survey of current trend in breast reconstruction
Authors: Debasish Debnath, Kamaljeet S. Samra, Lauren A.M. Mitchell, Lorna Cook, Amy Burger, Isabella Karat, Ian J. Laidlaw, Raouf Daoud
Journal: International Journal of Surgery (2013)

Abstracts / International Journal of Surgery 11 (2013) 589e685 604s / International Journal of Surgery 11 (2013) 589e685 604 0219: A CLOSED LOOP AUDIT TO ANALYSE AND IMPROVE COMMUNICATION WITHIN THE BREAST CANCER MULTIDISCIPLINARY TEAM SophieMarett, ThomasMicic, Chris Gateley. Royal Gwent Hospital, Cardiff, UK. Background: Communication within any multidisciplinary team is critical to ensure best patient care. ‘Best Practice Diagnostic Guidelines for Patients presenting with Breast Symptoms' (1) state that ‘there should be clear and rapid communication between breast imaging and the breast clinic'. This continuing audit analyses and improves communication between breast clinicians and radiologists, through the use of palpation scores (ranging from 11⁄4normal to 51⁄4malignant) on radiology request forms. Methods: The breast ultrasound radiology request forms over a 3 week period were analysed as to whether palpation scores as per guidelines were included. At initial audit presentation, the communication of breast score guidelines on request forms was advocated and a new specific radiology request form introduced. Re-audit was carried out prospectively. Results: 87 patients required an USS over 3 weeks. 21.8% (n1⁄419/87) had guideline-standard appropriate information. A prospective re-audit demonstrated an initial improvement to 76%. An additional prospective reaudit, after the implementation of a new radiology request form, demonstrated a further improvement to 92%. Conclusions: Communication in the MDT is paramount to ensure the best care for cancer patients. The changes we have implemented, although simple, have proven to be effective and can be easily extrapolated to other similar clinical scenarios. 0292: AN ANALYSIS OF A NATIONWIDE SURVEY OF CURRENT TREND IN BREAST RECONSTRUCTION Debasish Debnath, Kamaljeet S. Samra, Lauren A.M. Mitchell, Lorna Cook, Amy Burger, Isabella Karat, Ian J. Laidlaw, Raouf Daoud. Frimley Park Hospital, Frimley, UK. Aims: We aimed to assess whether recent wider use of acellular dermal matrix (ADM)-based breast reconstruction affected other methods of breast reconstruction. Methods: An email-based survey, using surveymonkey.com , was performed of all members of the Association of Breast Surgeons. Results:Out of 438 members, 36 replied. 31 performed reconstruction, 29 of whomwere breast surgeons.16 surgeons worked in tertiary centres,15 were based in district general hospitals. Occurrences of different methods performed during last year were compared with those of the preceding year. There was a significant fall in use of free flap (14.03%, p<0.00000001) and Latissimus Dorsi flap (18.5%; p<0.00000001), and a rise of implant-only (19.91%; p1⁄40.00002), ADM (69%; p1⁄40.000006) and other breast reconstruction methods (such as fat transfer) (279.16%; p1⁄40.09). Commonest complications encountered in ADM-based reconstructions were 1 to 2 cases of allergy (n1⁄44), significant bleeding (n1⁄42), infection (n1⁄413) and explantation (n1⁄414). ADM of porcine origin was used mostly (n1⁄419). Funding (never1⁄46; sometimes1⁄45) and faith related issues (never1⁄414; sometimes1⁄41) in using ADMwere limited. Conclusions: Admittedly a small response, although not so unexpected in email-based surveys, confirmed the trend of change in different methods used in breast reconstruction. This has implications on training, organisation and need for further research. 0316: NEOADJUVANT SYSTEMIC THERAPY FOR ER+ BREAST CANCER: IS IT SAFE TO ASSESS THERAPY RESPONSES BASED ON IMMUNOHISTOCHEMICAL ASSESSMENT OF MOLECULAR SUB-TYPING? Tasadooq Hussain, Kartikaye Grover, Tapan Mahapatra, Penelope McManus, Amandeep Dhadda, Peter Kneeshaw. Castle Hill Hospital, Hull, UK. Background: Hormonal status determined on immunohistochemistry is considered as a surrogate of breast molecular subtypes. Neoadjuvant therapy responses for the the luminal molecular subtype is determined on IHC recognised ER+surrogates. With recent studies reporting discordance between IHC and gene expressionprofilingmolecular taxonomies, assessment of therapy responses based on IHC surrogates may be questioned. Aim: The aim of this study was to assess pCR & clinical response rates to anthracycline-taxane neoadjuvant chemotherapy based on immunohistochemical assessment of breast molecular subtypes. Material and Methods: A retrospective analysis was performed of the clinical and pathological data for 58 patients treated with Epirubicin Cyclophosphamide-Docetaxel between January 2009 to December 2011. Statistically significant correlations between pCR rates and molecular subtypes were determined using chi-square test. Results: A statistically significant correlation with pCR (P1⁄40.03) and partial clinical response (P1⁄40.04) was found with luminal-A and erbB2 subtypes. An overall pCR rate of 9.6% was observed across all molecular subtypes. An overall partial clinical response rate based on histological subtype was 64% but considerably low in invasive lobular cancers. Conclusions: Our study showed pCR and partial clinical response rates were significantly associated with luminal and erbB2 subtypes. A good concordance rate was observed between IHC surrogates (ER+) of luminal molecular subtype with regards to pCR rates. 0317: AUDITING COMPLIANCE WITH NICE CLINICAL GUIDELINE: QUALITY STANDARD FOR BREAST CANCER (AUG 2011) AT SALFORD ROYAL FOUNDATION TRUST (SRFT) Stacey Picart. Salford Royal Foundation Trust, Manchester, UK. Aims: To improve the care of patients with breast cancer. To determine whether the Breast unit at Salford Royal Foundation Trust is compliant with the most recent NICE Quality Standard for breast cancer care guidance. Methods: Breast Unit practice was compared against the NICE Clinical Guideline: Quality standard for breast cancer (Aug 2011) for those patients diagnosed with breast cancer at SRFT between September 2011 and December 2011. Standard 1 was not included as it applies to primary care institutions. Standard 10 was also excluded as not enough time had elapsed between when the guidelines were published and when the audit was carried out to determine whether mammography recommendations were followed. Data was collected using the electronic patient records system (iSoft). Results: The trust achieved 100% compliance in 6 out of 10 key areas. Areas identified for improvement included improving documentation about reconstruction discussions, giving patients written care plans and documenting discussions about adjuvant therapy. Conclusions: It was concluded that it may be beneficial to have an electronic proforma that can be started at the time of a patient's diagnosis and continually updated at each clinic or inpatient visit to ensure that all aspects of the guidance are covered. 0318: COMPARATIVE PROTEOMIC APPROACH FOR THE IDENTIFICATION OF PUTATIVE BIOMARKERS OF NEOADJUVANT CHEMOTHERAPY RESISTANCE IN LUMINAL A BREAST MOLECULAR SUBTYPE Tasadooq Hussain , Lucy Scaife , Victoria Hodgkinson, Vijay Agarwal , Tapan Mahapatra , Penelope McManus , Peter Kneeshaw, Mike Lind , Lynn Cawkwell . Castle Hill Hospital, Hull, UK; University of Hull-HYMS,