1128 ABSTRACTS

partial pathological response, equivalent to that seen following chemora-

diotherapy, was found following abdominoperineal resection. A second pa-

tient has demonstrated improved symptoms and an endoscopically

confirmed reduction in tumour volume following treatment.

Conclusions: Thus far, endoscopic electropermeabilisation with the En-

doVe has proven to be a safe, effective treatment for colorectal tumours.

P81. Mammagraphic follow up alone is adequate following treatment

of ductual carcinoma in situ (DCIS) of breast

D. Shrestha, M. Schneiders, M. Pittam, D. Ravichandran

Luton and Dunstable Hospital, Luton, UK

Introduction: DCIS is usually a mammographic diagnosis and con-

sists of approximately 20% of screen detected carcinomas in the UK. Ad-

equate local treatment involves either simple mastectomy or breast

conserving surgery (BCS) with radiotherapy. We studied whether it is nec-

essary to bring patients back for regular clinical examinations following

treatment or mammographic follow up (MGFU) alone is adequate.

Method:We reviewed patients whowere offeredmammographic follow

up after being treated for DCIS in one breast unit over a period of four years.

Results: One hundred and one patients were treated for DCIS between

2005 and 2008, 79 of these were screen detected. Sixty-nine patients had

BCS and 32 had mastectomy. Median follow-up was 57 months. Forty-

nine patients had MGFU only and others had some additional clinical fol-

low ups. During the follow up period there were 2 DCIS recurrences in the

treated breasts. One DCIS was diagnosed on the contralateral side after 12

months. Two invasive carcinomas were also found on the contralateral

sides, one after 4 years and the other after 1 year following the previous

treatment. Both recurrent DCIS and the new tumours on the contralateral

side were diagnosed on mammograms. All of these were not palpable clin-

ically except one patient with contralateral invasive carcinoma where there

was minor thickening only on clinical examination.

Conclusion: A policy of MGFU only with option of having open ac-

cess to clinics via the breast care nurses and GPs following DCIS treatment

would save cost and is safe.

P82. The value of discharge cytology and blood-staining in pathological

nipple discharge

Sala Abdalla

Guy’s Hospital, London, UK

Introduction: While nipple discharge is usually of benign aetiology,

cancer may be the underlying process in up to 20% of presentations.

The diagnostic value of discharge cytology and significance of presence

of blood remains a topic of interest. Our study sets out to review the dis-

tribution of histopathology and diagnostic application of blood staining

and duct cytology in pathological nipple discharge.

Methods:We performed a retrospective analysis of patients presenting

to our tertiary breast unit with pathological nipple discharge. The hospital’s

electronic medical records and breast cancer information systems were

used to identify our study cohort. Parameters evaluated included patient

demographics, radiological assessment, if discharge was blood-stained

and histological/cytological analysis.

Results: Out of 123 patients, intraductal papilloma was the leading di-

agnosis (n¼62) followed by duct ectasia (n¼34). Carcinoma in-situ and in-

vasive carcinoma occurred in 9 cases. Seventy-one patients presented with

blood-stained nipple discharge of which 41 had a diagnosis of intraductal

papilloma, 17 had duct ectasia, and seven cases were due to carcinoma.

Two cases of cancer were negative for blood. Cytology alone was not di-

agnostic of carcinoma, but identified intra-ductal papilloma in 3 cases.

Conclusion: This study supports the generally accepted view that duct

cytology has very poor sensitivity for detecting breast cancer and is there-

fore of very limited diagnostic value. It confirms that intra-ductal papil-

loma is the leading cause of pathological nipple discharge and one that

supersedes carcinoma as the commonest lesion to generate blood-stained

nipple discharge. Furthermore, blood stained negative discharge was also

associated with breast cancer.

P83. An audit and survey of ductal carcinoma in situ upgrading to

invasive cancer and axillary staging

Jasdeep Gahir, Johanna Gaiottino, Antony Pittathankal

King George Hospital, Breast Unit, Redbridge, Barking and Havering NHS

Trust, Ilford, London, UK

Introduction: Ductal carcinoma in situ (DCIS) of the breast is the

most common form of non-invasive breast cancer. It is primarily treated

by surgery with or without adjuvant radiotherapy. NICE guidelines

(2012) state axillary staging in patients undergoing a mastectomy for

DCIS. The aim of this audit and survey was to assess local incidence of

DCIS upgrading to invasive cancer and current practice of axillary staging

in DCIS in the UK.

Method: Breast cancer histological data was collected and analysed

over a 2 year period (2009-2010) of patients undergoing surgical treatment.

An inclusion criterion was pure DCIS core biopsies. An online question-

naire was send to ABS members. Respondents were asked about routine

axillary procedure in DCIS.

Results: Seventy cases were identified with pure DCIS on core biop-

sies. Upgrade rate of DCIS to invasive carcinoma was 26 (35.9%). Size

of DCIS in the specimen did not correlate with a higher conversion rate

but high grade DCIS on core biopsy corresponded to the grade III invasive

tumour at surgery. Of the >400 surgeons, 72 responded. SLN or axillary

sampling was performed by breast surgeons in 76.1% if carrying out mas-

tectomy for DCIS, 67.2% if microinvasive disease was present, 38.8% if

a palpable mass was present, and 28.4% if undertaking oncoplastic

procedures.

Conclusion: Our up staging percentage was slightly higher than the

national average, but for patients with high risk, DCIS axillary staging sur-

gery should be offered. Survey response was poor, but it showed non con-

formity and variation among breast surgeons in the UK.

P84. Operative treatment of primary cranial vault lymphoma. Less is

more?

Edward Dyson, Mathew Guilfoyle, Ramez Kirollos

Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Introduction: The cranial vault is a rare, but increasingly reported site

of non-Hodgkin’s lymphoma. 41 cases have been reported so far, although

27 of these were in the past 12 years. Treatment and survival have been

variable. Given the apparent increasing incidence of this condition, it is im-

portant to establish the most effective treatment modality.

Methods: We present a case of primary cranial vault lymphoma

(PCVL) and a literature review. Our search revealed several treatment mo-

dalities. We discuss the advantages of our approach versus the others

reported.

Results: A total of 42 cases of PCVL were identified. A biopsy was

performed in 22 cases and total resection in 19 cases. One case was con-

firmed at autopsy. The predominant histological subtype was diffuse large

B-cell lymphoma (DLBCL). To our knowledge, ours is the first case of

a mixed DLBCL and follicular lymphoma subtype. Treatment was either

operative (with or without adjuvant chemo-/radiotherapy) or non-operative

(biopsy followed by chemo- and/or radiotherapy). Our case is also unique

in that it is the only one where a combination of surgery and chemotherapy

alone were used.

Conclusions: Length and nature of follow-up ranged from 5 months to

6 years, making an analysis of the treatment modalities used difficult. Our

modality was unique and our disease-free follow-up one of the longest (41

months). It may represent an effective strategy of biopsy/resection of the

extracranial component (with minimal associated morbidity) and subse-

quent primary oncological treatment of the intracranial component. Further

prospective research is required.