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Introduction: Majority of women diagnosed with breast cancers (BC) have self-detected large tumors (mean tumor size >4 cm). There are number of myths and misconceptions regarding safety of breast conservation surgery (BCS), which, coupled with the fear of re-operation for infiltrated margins lead to poor acceptance of BCS by Indian BC patients. Practice of oncoplastic breast surgery (OBS), neo-adjuvant chemotherapy (NACT) and intra-op frozen section (FS) margins assessment have helped us achieve safe, single stage breast conservation even for patients with large tumors. In this retrospective study, we evaluated the OBS techniques used in patients undergoing primary or post-NACT BCS and compared the outcomes in terms of ipsilateral breast tumor recurrence (IBTR) and overall survival (OS) between patient groups that underwent OBS-BCS, non-OBS BCS and mastectomy. Methods: Retrieving data from a prospectively maintained database, all patients treated for stages I-III BC between 2009 & 2018 at a specialty breast surgery unit were reviewed. Patient demographics, TNM stage, pathology, OBS technique, margin re-excision, and outcomes in terms of IBTR and OS, were evaluated; and compared with non-OBS BCS and mastectomy patients. Results: Of 1884 (Median age 50 years, 59% post-menopausal, T3-18%, T4b-7%) who underwent curative breast surgery, 1424 (75%) underwent mastectomy. Rest 460 (24.4%) underwent BCS, of which 43% underwent OBS BCS. Fifty-two patients (26.6%) underwent post-NACT BCS, of which 27.5% had pathological complete response (pCR). OBS techniques used were volume displacement in 169 (86.4%) and volume replacement (mini LD/LD flap) in 29 (13.6%). The OBS techniques used constituted Level-1 OBS in 33% and level-2 OBS in 66%. Procedures performed included round block / modified Benelli-10.6%, batwing mastopexy- 6%, wise pattern reduction mammoplasty+contralateral symmetrization-4%, and other procedures-9.5% (medial mammoplasty, inverted T/vertical scar mastopexy, J or L mammoplasty, parallelogram excision, Z plasty). Intraop FS histology detected infiltrated margins in 11.6% of patients undergoing OBS-BCS, which were re-excised/ converted to mastectomy in the same sitting, thus avoiding a re-operation. In comparison, 17% patients who underwent non-OBS BCS had margin infiltration. Cosmetic outcomes and patient satisfaction were better in OBS BCS patients. Peri-op complications including partial nipple necrosis, skin necrosis, seroma, wound dehiscence and infection occurred in 17%. IBTR occurred in 4% of OBS-BCS patients, compared to 7% patients who underwent non-OBS BCS. Over 36 mo median follow-up, stagewise OS was similar in patient groups undergoing mastectomy, OBS BCS or non-OBS BCS. Conclusion: Employing OBS techniques has enabled us offer BCS for EBC and large or locally advanced BC. These techniques facilitate safe BCS of patients undergoing primary or post-NACT breast surgery, with relatively lower margin infiltration and local recurrence rates, comparable survival and higher patient satisfaction of their cosmetic outcomes, compared to patients undergoing mastectomy or conventional/ non-OBS BCS. Table: Types of oncoplastic procedures used in patients undergoing primary or post-NACT Oncoplastic breast surgical breast conservation surgeryNo.of patientsPercentageLevel I16181.3 %Level II(MiniLD/ LD/ Contralateral Symmetrisation)3718.6%Volume Displacement16985.3%Volume Replacement2913.6%Ipsilateral breast tumor recurrence84.02% Citation Format: Gaurav Agarwal, VC Ramya, Anjali Mishra, Gyan Chand, Sabaretnam Mayilvahanan, Vinita Agrawal, Narendra Krishnani, Namita Mohindra, Punita Lal. Oncoplastic breast conservation surgery for patients with large breast cancers undergoing primary or post-NACT breast conservation surgery is safe and effective [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-07.

Bladder cancer usually spreads via the lymphatic and hematogenous routes, the common sites of metastases of urinary bladder cancers being the regional lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland and intestines. Metastasis to non-regional lymph nodes especially cervical lymph nodes is extremely rare presentation. Metastasis to head and neck region is associated with poor prognosis and low survival rate. Here-in we report a case of cervical lymph node metastasis in patient with muscle invasive bladder cancer.

Introduction: Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically N0 axilla in breast cancer (BC) patients. The current gold standard technique for SLNB utilizes a radiopharmaceutical (R) and a blue dye (B) in combination (RB). However, in the developing countries, the limited availability and high costs of radiopharmaceutical and gamma probe are major barriers in performing SLNB. Fluorescein (F) is a commonly available, inexpensive and safe lymphophilic dye commonly used for retinal angiography. When injected, it is trapped selectively by lymphatics and rapidly transported to, and concentrated in the lymph nodes, which can be detected as bright fluorescent structures under blue light. Its use can obviate the need for radiopharmaceutical and gamma probe. In this comparative validation study, we used this novel dye and an inexpensive hand-held blue LED light as the method for SLNB, and assessed the SLN identification rate (SLN-IR) & false negative rate (FNR) of SLNB using fluorescein and its combination with blue dye, with those of the gold standard (RB). Methods: After obtaining approval from IEC, in this prospective, comparative validation SLNB study, 40 cN0 early BC patients treated were recruited, starting March 2018. After getting due consent from the patients, SLNB was performed using 99mTc-Sulphur-colloid(and gamma probe), methylene blue & fluorescein (and blue LED light), using the standard injection techniques and timings for R and B. One ml Inj Fluorescein 4%, diluted in 4 ml of saline was injected peri-tumoral and sub-areolar (half and half) just before axillary incision. ALND was performed irrespective of SLNB histology, and the SLN-IR and FNR obtained with various methods compared. Results: All in all, SLNs could be identified in 39 (97.5%) patients using one or the other dye. The SLN-IRs using the investigational dye- fluorescein (F) alone (92.5%), or in combination with methylene blue (FB combination, 92.5%) were identical, and comparable with the gold standard RB combination (SLN-IR 92.5%). However the SLN-IR using radiotracer (R) alone (87.5%), and blue dye alone (72.5%) were significantly inferior compared to the investigational F or FB combination, or the conventional gold standard RB combination. The SLN FNRs were 0% using Radiotracer alone, RB combination, Fluorescein alone and FB combination, while it was 50% using methylene blue dye (B) alone. Conclusions: Results of this novel prospective, comparative validation SLNB study suggest that SLN identification rates and false negative rates using the novel inexpensive fluorescein dye and an LED blue light, used alone or in combination with methylene blue, are comparable to those achieved by using the current gold standard combination of radio-colloid and methylene blue. By replacing the radio-colloid with fluorescein, and gamma probe with LED blue light, we could perform SLNB with similar efficacy and accuracy, but at a fraction of the cost by obviating the use of expensive radio-pharmaceutical and the gamma probe. This low-cost innovation has the potential to be helpful in implementation of cost-effective SLNB across developing world. Citation Format: Gaurav Agarwal, VC Ramya, Sabaretnam Mayilvahanan, Gyan Chand, Anjali Mishra, Amit Agarwal, Saroj K Mishra, Sanjay Gambhir, Vinita Agrawal, Narendra Krishnani, Punita Lal. Low-cost fluorescein guided sentinel lymph node biopsy as an alternative to radio-pharmaceutical guided SLNB -Results of a prospective, comparative validation study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-02.