Metastatic disease to the breast from extra mammary sites is uncommon and has an incidence of 0.5 to 3%. It is important to make an accurate diagnosis as this has an impact on the therapeutic planning and management. Clinically, it can be difficult to differentiate between primary breast cancer and a metastatic disease. An incorrect diagnosis can lead to unnecessary surgical interventions. Immunohistochemistry has a significant role in identifying the primary origin of tumor and has to be considered in the presence of unusual cytologic patterns. We report three cases of metastatic disease to breast from primary lung tumors. The cases demonstrate the difficulties encountered in the diagnosis and the impact on the management of these patients.

Sokal index was developed in the pre-imatinib era to predict and prognosticate the outcome of Chronic myeloid leukemia (CML) patients. In the Imatinib era, a new scoring system called EUTOS scoring system has been validated as a predictive marker in CML. The scores have shown variable correlation with complete cytogenetic response (CCyR) and major molecular response (MMR). To assess the performance of Sokal score and EUTOS score as a predictive marker for CCyR and MMR for newly diagnosed CML-CP patients treated with TKIs. 273 patients with newly diagnosed CML were included in the study. They were treated with upfront imatinib. They were followed up for a median period of 3 years. Cytogenetic and Molecular response to the treatment were monitored regularly. Out of 273 patients, 174 patients (63 %) were having low EUTOS score and 99 (37 %) were having high EUTOS score. Patients with low, intermediate and high sokal scores were 237 (86.8 %), 28 (10.3 %) and 8 (2.9 %) respectively. 122 patients with low EUTOS score achieved CCyR within 18 months compared to 42 patients with high EUTOS score (p = 0.000).113 patients with low EUTOS score achieved MMR in 18 months compared to 33 patients with high EUTOS score (p = 0.000). 148, 14, 2 patients with low, intermediate and high Sokal score respectively have achieved CCyR in 18 months (p = 0.054). 133, 11, 2 patients with low intermediate and high sokal score respectively have achieved MMR in 18 months.(p = 0.06). EUTOS is better than Sokal score in predicting the outcome of patients of CML treated with imatinib.

11043 Aim: To analyze the efficacy, tolerability, toxicity profile, quality of life, survival rates and pharmaco-economics of TAC vs. FAC in women with ER/PR positive breast cancer and >4 involved lymph nodes. Methods: 100 patients with >4 node-positive breast cancer were randomly assigned to receive either 6 cycles of taxane-based (TAC) or anthracycline-based (FAC) adjuvant chemotherapy. All the patients received adjuvant radiotherapy and hormonal therapy after completion of chemotherapy. The primary end point was to assess disease-free survival (2 years), toxicity profile, QOL and to analyze the pharmaco-economics of both therapies. All patients completed EORTC QLQ 30, BR 23 questionnaire before randomization and before every cycle of chemotherapy. Pharmaco-economic feasibility was determined using cost of drugs, duration of hospital stay, laboratory investigations, management of complications and loss of wages. Treatment: The treatment (dose in mg/m2) was as follows: TAC: docetaxel 75, doxorubicin 50, cyclophosphamide 500; CAF: 5 flourouracil 500, doxorubicin 50, cyclophosphamide 500. Results: The patient demographics and primary tumor characteristics were comparable in both the arms. Taxane- based regimen was associated with decreased global QOL and physical function. The cost of TAC regimen was 25 times more than FAC regimen. Conclusion: Although TAC regimen had longer DFS as compared to FAC, it was associated with a higher incidence of side effects and increased duration of hospital stay. Further, high cost precludes its wide-spread use, and FAC regimen still continues to be the first choice treatment of high-risk node and receptor-positive breast cancer in a third world country like India. [Table: see text] No significant financial relationships to disclose.

BackgroundCTGB is widely used to sample lung masses. One of the important complications is pneumothorax which could potentially lead to a prolonged hospital stay. The aim of the study was to examine the prevalence and potential predictors associated with pneumothorax following GTGB.MethodsWe retrospectively reviewed CTGB data over a two year period (August 2014 to July 2016) for all patients who underwent CTGB. The data collected included age, sex, co-morbidities, smoking history, spirometry, performance status, presence of emphysema, thickness, depth of the needle, size of the lesion and lobe of the lesion.Results227 patients underwent CTGB with an overall diagnostic yield of 93.8% (213/227). The incidence of pneumothorax was 61/227 (26.9%). Of the patients with pneumothorax, 8/61 (13.1%) needed chest drain insertion with a median hospital stay of 4.5±2.1 days. There was no difference in diagnostic yield between both pneumothorax and the no pneumothorax group. Overall 89.2% (190/213) of the positive biopsies were malignant while 10.8% (23/213) were benign. There was no difference in the performance status, severity of airflow obstruction or lobe of the lesion between groups. Binary logistic regression analysis showed the size of the lesion as a determinant of developing pneumothorax (p=0.022). The risk of developing a pneumothorax was 27.1% for a lesion ≤10 mm and 18.7% for a lesion ≤20 mm.Abstract P40 Table 1No pneumothorax (n=166)Pneumothorax (n=61) Age (mean±SD)71.3±9.869.2±10.3FEV1% predicted69.5±22.371.5±22.8Smokers145 (87.3%)52 (85.2%)Emphysema on CT80 (48.2%)32 (52.5%)Needle depth (median±SEM) mm8±1.911±1.9Gauge of needle (median)1818ConclusionThe incidence of pneumothorax following CTGB was 26.9% but only 3.5% of all patients undergoing CTGB had a chest drain inserted for their pneumothorax. While CTGB is a safe procedure with a good diagnostic yield one needs to be watchful of the risk of pneumothorax. The size of the lesion correlated with the development of pneumothorax with a smaller size associated with a higher risk.