ABSTRACTS S65

indication of radiological margins. This study assessed the use of this tech-

nology in reducing re-excision rates.

Methods: 200 cases of WLE for palpable tumours were randomly

sampled from the hospital data bank: 100 cases from 2005e06 (pre-Faxi-

tron) and 100 from 2011e12 (Faxitron). Data were gathered on age,

tumour size, grade, closest excision margin, dimensions excised, intra-/

post-operative re-excision of margins and cavity biopsies. Data were ana-

lysed using SPSS Statistics 20

Results:

Median waiting time

(range)

5/2009e7/2009

147 patients

7/2012e10/2012

120 patients

P value

From referral date to

outpatient appointment

11(1e48) 9(2e34) 0.1386

From clinic review

to endoscopy

20.5(2e137) 12(1e48) <0.0001

From endoscopy to imaging

(Total imaging)

18(7e100) 17.5(6e110) 0.8552

Outpatient to CT 27(14e127) 27.5(14e73)

Pre-Faxitron Faxitron p Value

Age 59.5 (SD12.0) 61.5 (SD12.6) 0.293

Excision

volumes

364 cm3

(IQR 148e414)

205 cm3

(IQR 92e253)

<0.001

Tumour size 19.3 mm (SD10.3) 22.1 mm (SD11.2) 0.079

Closest margin 6.8 mm (SD5.9) 6.0 mm (SD3.7) 0.273

Secondary re-excision of margins fell from 35% to 17% (p[0.004). In-

traoperative re-excision of margins increased from 10% to 31%

(p<0.001) during Faxitron use, associated with reduced excision

volumes.

Conclusion: Intra-operative Faxitron use for palpable breast cancers

reduces the need for secondary re-excision of margins, improving cost

effectiveness and allowing earlier post-operative radiotherapy

http://dx.doi.org/10.1016/j.ejso.2013.07.191

Axillary management in operable breast cancers

Medhat Alaker, William Maxwell

Withybush Hospital, Wales Deanery, UK

Introduction: Axillary assessment is mandatory in staging Operable

Breast Cancers. The procedure of choice is Sentinel Node Biopsy (SNB)

which, if positive, will require the patient to have a second procedure

for Secondary Axillary Node Clearance (ANC), or to have axillary

radiotherapy.

Pre-operative diagnosis of axillary metastasis, by ultrasound-guided

Fine Needle Aspiration or Core biopsy, can avoid the patient going through

another operation, and proceed directly to a Primary ANC. The aim of this

study is to assess node positivity rates after SNB, Secondary ANC, and Pri-

mary ANC.

Methods: Notes of all patients admitted for axillary management over

a 2 year period have been assessed retrospectively.

Results: A total of 367 axillae have been assessed. 259 had Sentinel

Node Biopsies, of which 66 were positive for metastasis (25.4%). Of

the 65 who proceeded to Secondary ANC, 23 yielded further positive

nodes (35.4%). 36 patients had a Primary ANC, (N1 and patient/sur-

geon’s choice), which yielded a node positivity rate of 85.7%. Node pos-

itivity rates for Screen detected Breast cancers vs. Symptomatic Breast

cancers were 13.8% and 46% respectively, yielding a Relative Risk

of 3.33.

Conclusion: Primary ANC is practical and feasible; with a high node

positivity rate of 85.7%. Around 65% of patients who had Secondary ANC

after having a positive SNB are disease free, which raises the issue

regarding the feasibility of subjecting the patient to another operation

rather than receiving radiotherapy of the axilla.

http://dx.doi.org/10.1016/j.ejso.2013.07.192

2 week rapid access colorectal clinic audit

Veronika Pronisceva, Tariro Gandiya, Mohamed M. Ahmed, Iona

Livingstone, Kothandaraman Murali, Jacek Adamek, Peter Hanek,

Mark Watson, Andrew McIrvine, Rakesh Bhardwaj

Darrent Valley Hospital, Dartford, UK

Introduction: The 62 day target for colorectal cancer pathway initi-

ated a need for novel strategies and improvement in cancer service deliv-

ery. Usually, suspected cancer patients were reviewed in routine follow-up

clinics.

Aim: To see whether a dedicated 2 week wait rapid access clinic

improved waiting times for investigations and was able to deliver service

requirements.

Methods: Retrospective data collection using endosoft, PACS system,

patient notes.

Standard: NICE-CG27 referral guidelines for suspected cancer.

Audit: May 2009 e July 2009, 147 patients. Data showed evidence of

poor performance in time management for some cancer patients.

Implementation:

� Dedicated rapid access clinic with 2 week referrals

� Created endoscopy slots with dedicated times and dates

� Forward radiology planning

Re-audit: July 2012 e October 2012, 120 patients.

Results:

Outcome:

� No significant reduction in time between GP ref to OPC

� No significant reduction in waiting time from endoscopy to staging

investigations

� Significant reduction in waiting time from OPC to endoscopy

� Protecting the 2 week pathway has rationalised cancer care and enabled

more patients to be treated within nationally agreed target protocols.

� Further improvements required.

http://dx.doi.org/10.1016/j.ejso.2013.07.193

An uncommon calvarial osteosarcoma: Case report & literature

review

Andrew Alalade1, Ute Pohl2, Seb Bavetta1

1 Department of Neurosurgery, Essex Centre for Neurological Sciences,

Queens Hospital, Romford, Essex, UK2Department of Cellular Pathology, Queens Hospital, Romford, Essex, UK

Introduction: Parosteal osteosarcomas are low-grade variants of oste-

osarcoma and rarely occur in the head and neck region. As noted in liter-

ature, their typical localisation is the distal femur. Even though clinical and

radiographic features are informative, definitive diagnosis requires histopa-

thology, supported by genetic studies.

Methods: Case report and literature review.

Results: We report a case of a calvarial parosteal osteosarcoma that

required wide local excision and acrylic cranioplasty. She presented with

a gradually increasing left-sided scalp swelling over about 7 years, and a

2-month history of progressive headache. Examination revealed an obese

lady with a hard left fronto-parietal scalp swelling of approximately 8 x

5 x 2 cm3. Imaging studies demonstrated a large calcified lesion anterior

to the outer table of the left frontal lobe and extending antero-laterally,

S66 ABSTRACTS

with no demonstrable skull table invasion. The patient’s management plan

was determined in consultation with the Specialist Sarcoma Service. So

far, there has been no radiological evidence of a recurrence 23 months after

surgery. Literature review and case reports were identified by a compre-

hensive search of MEDLINE.

Conclusions: This case report illustrates the importance of a multidisci-

plinary approach in treating rare tumours.With optimal treatment, the tumour

has a good prognosis; however incomplete excision can result in local recur-

rence. Metastatic spread may even occur if the tumour has dedifferentiated.

Chemotherapy and radiotherapy are not advocated in the treatment of

parosteal osteosarcoma. Extended follow-up is essential, as metastasis can

present even more than 10 years after presentation.

http://dx.doi.org/10.1016/j.ejso.2013.07.194

Do young women (£40 years) with breast cancer have more aggressive

invasive cancer compared with older women?

John Mathew, Carla Hope, Yasmin Wahedna

Royal Derby Hospital, Derby, UK

Aim: The aim was to assess the predictive and prognostic factors in

young women (� 40 years) with breast cancer and compare with older

age group with symptomatic breast cancer. We also analysed the long

term outcome in young women with symptomatic breast cancer.

Method: Retrospective review of breast cancer patients (� 40 years)

undergoing breast surgery between January 2006 to February 2011 (group

1). We compared the pathology data of young patients with same number

of consecutive symptomatic breast cancer patients > 40 years who were

operated between January 2012 to August 2012 (group 2). Data was ana-

lysed using SPSS 19 and p value of <0.05 was considered significant.

Results: There were 94 patients in each group. Median age was 36

years and 65 years in group 1 and 2 respectively. Median tumour size

was 22 mm and 23 mm in group 1 and 2 respectively. Significantly

more patients in group 1 had grade 3 cancers compared to group 2 (60%

versus 45%; P¼0.04). Significantly more patients in group 1 had triple

negative disease (25% versus 10%; P¼0.002). There were no significant

differences between the groups with regard to lymph node status.

After a median follow-up of 41 months (6e83), eight patients (9%)

developed local recurrence and 12 patients (13%) had distant metastases

in group 1. Eighty eight percent were alive at the end of follow up.

Conclusion: Young women with breast cancer are associated with

some adverse prognostic factors (more patients with grade 3 and triple

negative disease) compared with older group.

http://dx.doi.org/10.1016/j.ejso.2013.07.195

mrEMVI status should be used in addition to pEMVI for treatment

decision making in rectal cancer to prevent under-reporting of

extramural venous invasion

Manish Chand1,2, Jemma Bhoday1,3, Rahul Bhome4, Ian Swift3,

Alex Mirnezami4, Paris Tekkis1,2, Gina Brown1,2

1 Royal Marsden Hospital, London, UK2 Imperial College, London, UK3Croydon University Hospital, London, UK4 Southampton University Hospital, Southampton, UK

Introduction: Extramural venous invasion (EMVI) is increasingly rec-

ognised as an important prognostic factor in rectal cancer. Traditional his-

topathological methods have been shown to be variable and lead to under-

reporting. MRI can accurately identify EMVI (mrEMVI), pre-operatively.

This study aimed to show that mrEMVI can be used as an adjunct to pa-

thology-detected EMVI (pEMVI).

Methods: Retrospective analysis of prospectively collected data was

conducted comparing MRI-detected and pathology-detected EMVI

following neoadjuvant chemotherapy in patients that had presented with

rectal cancer and evidence of mrEMVI on baseline staging. Correlation

was tested using Kappa agreement and comparison of 3-year DFS made

with Mantel-Cox log rank test. Multivariate analysis was performed using

a binary logistic regression model for disease recurrence.

Results: 211 patients were included. There was agreement between

MRI and pathology for detection of EMVI in 43.4% of cases (Kappa

0.29). There was no difference in 3-year DFS or recurrence rates between

the patients with mrEMVI or pEMVI (Mantel-Cox p>0.05) or between

mrEMVI-negative and pEMVI-negative tumours (p>0.05); however there

was significant difference in 3-year DFS and recurrence rates between

pEMVI positive and negative patients (p<0.05). mrEMVI and pEMVI pos-

itive status were the only significant radiological or pathological factors

associated with disease recurrence following CRT on multivariate analysis

with odds ratios of 1.97 and 2.39, respectively.

Conclusion: Pathologists may be under-reporting EMVI in rectal can-

cer. Whilst the importance of pathological identification must not be lost, it

may be prudent to consider features on MRI in addition to help guide ac-

curate staging.

http://dx.doi.org/10.1016/j.ejso.2013.07.196

Male breast cancer: Our 10 year experience

Natasha Jiwa, Hem Rai, Steven Goh

Breast Unit, Peterborough City Hospital, Peterborough, Cambridgeshire,

UK

Introduction: Male breast cancer (MBC) is rare and accounts for less

than 1% of breast cancers. Treatment guidelines for MBC are usually

extrapolated from data derived from female patients. We evaluated our

practice in this retrospective study.

Methods: All MBC treated in our unit between January 2003 and

December 2012 were included. Cancer registry, case-notes, radiological

and histopathological reports were used for data collection. Patient demo-

graphics, tumour characteristics, treatment and survival data were analysed.

Results: Seventeen patients were diagnosed with MBC during the10--

year period. One patient had simultaneous bilateral cancers. Median age at

diagnosis was 69 [41e77] years. Median follow-up was 27 [3e69]

months. The common presenting complaints were painless breast lump,

nipple changes and bleeding. There were 15 cases of invasive carcinoma,

2 DCIS and 1 case of encapsulated intracystic solid carcinoma.

Thirteen patients underwent mastectomies with curative intent. Four

patients had axillary nodal metastases, and 4 patients had axillary and

distant metastases. Three patients underwent neo-adjuvant chemotherapy

but passed away before surgery. Chemotherapy was given to 5 patients,

and 7 patients underwent radiotherapy. All invasive cancers were oestrogen

receptor positive, and 3 were HER2 receptor positive. One patient devel-

oped local chest wall recurrence. Twelve patients remained disease-free

but all 4 patients with Stage IV MBC have succumbed to their diseases.

One patient has died of medical morbidities.

Conclusions:MBC patients were older at diagnosis when compared with

female patients. Therapy regimes derived from treating female breast cancer

are effective, and survival ofMBC is comparablewithmatched female cohorts.

http://dx.doi.org/10.1016/j.ejso.2013.07.197

Re-excision of anterior margins for breast cancer is associated with a

low local recurrence rate

Layal El-Asir2, Faizan Jabbar2, George Boundouki1, Clive Griffith2,

James Harvey1,3

1 University Hospital of South Manchester, Manchester, UK2Royal Victoria Infirmary, Newcastle-u-Tyne, UK3University of Manchester, Manchester, UK

Background: Management of close margins following oncological

breast surgery is a controversial topic. There is little evidence to support