many women reported a feeling of relief that their risk of recurrencewas minimized after mastectomy. A surgeon’s recommendation andpersonal choice were the primary influencing factors on the women’streatment choice of mastectomy, and therefore adequate time spentin discussion between a woman and her surgeon is essential.

QS125. PANCREAS CANCER SURVIVAL CAN BE PRE-CISELY PREDICTED BY GRADE AND STAGE. Mitch-ell S. Wachtel, Tom Xu, Yan Zhang, Maurizio Chiriva-Internati, Eldo E. Frezza; Texas Tech University HealthSciences Center, Lubbock, TX

Background and aims: This study attempted to empirically esti-mate survival after a diagnosis of pancreas cancer with narrow 95%confidence intervals (c.i.). Methods: The survival experience of34,191 patients reported to SEER from 1973 to 2002 was analyzed;32,197 (94.1%) died within 30 months of their diagnosis. Univariateand multivariate regression on the conditional likelihood of deathevaluated stage (distant, loco-regional, and unstaged), grade (highgrade, low grade, and ungraded), age at diagnosis, year of diagnosis,site of origin within the pancreas, and gender to determine theirrelative importance as risk factors. Results: Patient’s whose stagesand grades differed had hazards of death, relative to one another,that were inconstant with respect to time. After stratifying for gradeand stage, all other variables effected highly-statistically significant(P � 0.00001) changes in the risk of death, but the effects were small.Similarity was seen in point estimates of the grade/stage strata forhazard ratios of ten additional years of age at diagnosis (1.1 - 1.2),being diagnosed ten years earlier (1.0 - 1.2), and having an originwithin the pancreas outside the head (1.1 - 1.2), which in turn weregreater than those seen for being a man (1.0 - 1.1). Because theeffects of these explanatory variables were small, grade and stagesufficed to produce survival estimates. Empirical survival at 30months (95% c.i.) for patients with high grade lesions with metasta-ses was 0.9% (0.7 - 1.2), with high grade lesions without metastases,5.9% (5.0 - 6.9), with low grade lesions with metastases, 1.4% (1.1 -1.9), and with low grade lesions without metastases 11.4% (10.5 -12.4). Conclusion: Grade and stage suffice to estimate survival forpancreas cancer with sufficient precision.

QS126. UTILITY OF BREAST MRI AND PET/CT IMAGING INTHE SURGICAL MANAGEMENT OF BREAST CAN-CER PATIENTS. Kathryn Leonard, Pam Hunborg, Med-hat M. Osman, Eddy C. Hsueh; Saint Louis University, St.Louis, MO

Introduction: Mammogram has been considered the standard im-aging modality for breast cancer. Dedicated breast MRI can increasethe detection of breast cancer in high-risk women. Recently, the useof PET/CT has been instrumental for evaluation of systemic diseasein solid tumors. We evaluated the utility of breast MRI in addition towhole-body PET/CT imaging for the preoperative management ofbreast cancer patients. Methods: From November, 2003 to Febru-ary, 2007, 33 patients with biopsy-proven breast cancer underwentpreoperative PET/CT and/or MRI tests at our institution. BreastMRI was performed using GE 1.5 Tesla scanner and coil. PET/CTwas performed using Phillips Gemini-16 scanner until 12/06 andthen Phillips 64-slice TF scanner from 12/06 on. The surgical man-agement decisions before and after the imaging were obtained frompatient charts. The radiographic findings and pathology reports werereviewed. Statistical analysis was performed using Chi-square test.Results: Of the 33 study patients, 20 underwent partial mastecto-mies with sentinel lymph node dissections (SLND), 11 had modifiedradical mastectomies (MRM), and 2 had bilateral mastectomies. Themedian tumor size was 2.5 cm (range: 0.06 to 6 cm). Seventeenpatients had PET/CT scans only and 16 had breast MRI in additionto PET/CT. Overall, changes in the surgical management were madein 6 of the 33 study patients: 3 of the 17patients (18%) in the PET/CT

only group and 3 of the 16 patients (18%) in the PET/CT plus MRIgroup (p�0.946). Three of the 6 patients who had changes in theirsurgical management had MRM, two had additional contralateralprocedures, and one had delay in surgical treatment due to detectionof distant metastases. Additional biopsies were performed in 8 pa-tients (24%) based on PET/CT findings. Seven of these 8 additionalbiopsies (88%) were positive for malignancy. Five patients (15%)underwent additional biopsies based on MRI findings; only 2 of the 5(40%) had positive findings. Both of the positive biopsies based onMRI were also detected on PET/CT. Conclusions: Pre-operativebreast MRI did not contribute to the surgical management of breastcancer patients who also had PET/CT. Breast MRI did not detect anymalignant lesion not found on whole-body PET/CT. Based on theseobservations, routine bilateral breast MRI should not be consideredin the pre-operative evaluation of breast cancer patients also under-going PET/CT.

QS127. RESPONSE OF AXILLARY LYMPH NODES TO NEO-ADJUVANT CHEMOTHERAPY PARALLELS PRI-MARY TUMOR RESPONSE IN BREAST CANCERPATIENTS. John A. Pilavas, Lacy Napper, Kelly Clem-ents, Anees B. Chagpar; University of Louisville, Louis-ville, KY

Introduction: Management of the axilla in breast cancer patientsundergoing neoadjuvant chemotherapy remains controversial. Thepurpose of this study was to determine factors correlating with aresponse of axillary lymph nodes to neoadjuvant chemotherapy.Methods: Records of breast cancer patients who had undergone apositive fine needle aspiration biopsy of axillary nodes prior to neo-adjuvant chemotherapy at our institution over a two year periodwere reviewed. Factors correlating with a complete pathologic re-sponse of the axillary nodes were determined using non-parametricstatistical analysis. Results: Between May 2004 and May 2006, 13patients had cytologically positive axillary lymph node prior to neo-adjuvant chemotherapy. The median patient age was 51 years(range; 25-77), with a median initial tumor size of 2.9 cm (range;1.25-10). Seven patients (53.8%) were negative for estrogen, proges-terone and her-2-neu receptors. Only one patient (7.7%) was hor-mone receptor positive. On the initial core needle biopsy, 8 patients(61.5%) had high grade tumors. All patients were treated with ananthracycline and/or taxane containing regimen, and were subse-quently treated with either partial or total mastectomy and axillarynode dissection. The median number of nodes removed was 22(range; 11-29). Four patients (30.8%) had a complete response toneoadjuvant chemotherapy in the axilla. Two patients (15.4%) had apathologic complete response of their primary tumor. Both of thesepatients also had a complete response of their axillary disease(p�0.018). Older patients were more likely to have a complete patho-logic response in the axilla than younger patients (median age 64 vs.47 years, p�0.034). No correlation was found between initial tumorsize (p�0.825), hormone receptor status (p�0.110), her-2-neu status(p�0.158), or tumor grade (p�0.898) and axillary response. Conclu-sion: Patients with a complete pathologic response to their primarytumor are unlikely to have residual positive lymph nodes and poten-tially may be spared axillary node dissection.

QS128. PROTEIN ANALYSIS OF SERUM USING MALDI TOFMASS SPECTROMETRY DEMONSTRATES 87 PER-CENT ACCURACY IN PREDICTING NODAL STATUSIN PATIENTS WITH BREAST CANCER. Nicholas P.Schaub, Lisa H. Cazares, Eric Feliberti, Oscar J. Semmes,Roger R. Drake, Roger R. Perry; Eastern Virginia MedicalSchool, Norfolk, VA

Objectives: Thirteen percent of women acquire breast cancer overtheir lifetimes, with 200,000 new cases per year in the UnitedStates. Currently, no standardized blood test discriminates when

318 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS