Abstracts of the 5th Nottingham International Breast Cancer Conference 247 We conclude that sampling less than four axillary nodes is associated with a significantly poorer survival from breast cancer. The survival differences far outweigh any benefits due to differential treatment of the axilla, however this has not adversely affected their survival. O-SO.A randomised prospective study of preservation of the intercostobrachial nerve in axillary node clearance Abdullah TI, Iddon J, Walls J, Baildam AD and Bundred NJ University Hospital of South Manchestel; UK Division of the intercostobrachial nerve (ICBN) during axillary node clearance (ANC) may lead to numbness and parasthesia in the area of its distribution. To determine whether there is any benefit from preserving the nerve 120 patients were randomised to have either preservation or division of the ICBN at surgery. Sensation, shoulder movements and arm circum- ference were objectively assessed pre-operatively, on discharge and at three months. Time taken to complete the ANC was recorded and the ade- quacy of the clearance determined by the number of nodes cleared. Patients completed a questionnaire at three months. Of the 60 patients randomised to preservation of ICBN, 21 had the nerve divided in order not to compromise clearance or due to technical difticul- ty. One patient had the nerve preserved by mistake. Fourteen did not attend at 3 months follow-up. Preserving the nerve increased operative time by median 5 minutes (range 5-15). Total node yield did not differ between groups. Number of patients with sensory deficit Number of patients with reduced movement at 3 months no. at discharge at three months abduction flexion ICBN 40 lS(45%;) 22 (61.1%) 25 19 preserved 1CBN 80 67 (83.7%) 56(80%) 49 39 divided P < 0.001 P = n.s. P = n.s. P = n.s. The range of shoulder movement was similar in each group. ICBN preservation is possible in the majority of patients but does not provide long term (3 months) benefit in terms of reduction of sensory and motor function. 041. Regional recurrence following a positive axillary node sampling in patients with breast cancer. Is further treatment necessary? Christie R, Brooks M, van Dalen R, Bates A, Houghton J, Bates T The Breast Unit, William Harvey Hospital, Ashford, Kent, UK The surgical management of the axillary lymph nodes in patients with breast cancer provides important diagnostic and prognostic information, and a rational basis for selecting adjuvant therapy. However, the extent of axillary surgery or radiotherapy necessary to achieve freedom from regional recurrence is controversial. Between January 1986 and December 1993, 484 patients with early breast cancer were managed by one surgeon. Three hundred and thirty-six patients had breast conserving surgery. Axillary sampling was performed in 216 patients (23.4% node +ve). Fifty-nine patients had an axillary clear ante (34.4% node +ve). No patient received radiotherapy to the axilla. No axillary procedure was performed in 61 mainly elderly patients with a clinically node negative axilla. Mastectomy with an axillary clearance was performed in 148 patients. At a mean follow-up of 61 months, sixteen (3.3%) patients had region- al recurrence. The rate of recurrence after axillary sampling was 3.2% (node +ve 5/50 [lo%]. node -ve 2/166 [1.2%%] ), after axillary clearance, 2.4% (node +ve 4/106 (3.881, node -ve l/l01 [l.O%] ) and in those patients who had no axillary procedure (4/61) [6.6%]. Metastatic disease was present at the time of diagnosis of regional recurrence in 11 of the 16 patients, all of whom have died within a mean of 10 months. An axillary clearance was performed in 2 patients who remain disease free and 3 patients responded to endocrine therapy. Patients with a positive axillary node sample were managed without further surgery or radiotherapy but in no patient did the treatment of regional recurrence present a clinical problem. 0442. Audit of selectivemanagement of the axilla in elderly patients with operable breast cancer Al-Hilaly MA, Willsher PC, Robertson JFR, Blarney RW Nottingham City Hospital Between April 1982 and February 1994,344 consecutive women aged > 70 years with cancers < 5 cm in diameter were treated at the City Hospital Breast Unit. The majority were in two successive randomised trials. One hundred and eighty-four patients had primary surgery (mastectomy or wide local excision). 53 received adjuvant Tamoxifen. One hundred and fifty-nine of the women without obvious palpable lymph nodes did not have axillary exploration. 25 women noted preoperatively to have clinically palpable lymph nodes greater than around 1 cm in diameter, had excision of those nodes only in addition to their breast surgery. None received axillary clearance nor axillary irradiation. At a median follow-up of 54 months, 27 of the total 184 women have subsequently developed axillary recurrence (14% and 16%). (23 of the 159 without palpable nodes, and 4 of 25 with palpable nodes). Regional relapse was treated successfully with different therapeutic modalities (surgery. radiotherapy or endocrine manipulation) and none have died with uncon- trolled regional disease. Management of the axilla in elderly women with primary operable breast cancer with neither prophylactic clearance nor radiotherapy appears justified. O-83. Differential expressionof growth factors in metastases to different sites Downey SE, Hoyland JA, Freemont AJ, Bundred NJ University Hospital of South Manchester and University of Manchester Parathyroid hormone related protein (PTHrP) is an osteolytic factor involved in bone metastasis in breast cancer patients. Interleukin 6 (IL-6) is a pleiotropic cytokine also involved in bone resorption as is Interleukin ICC (IL-la). Expression of these growth factors was compared between pri- mary and secondary turnours. Using in situ hybridisation to identify the cellular location of mRNA for these peptides, we studied expression in primary breast cancers and metastases to bone and other sites. cDNA probes were labelled with 35s and control slides treated with crude RNAse. Tumours were scored by 2 independent observers using the product of intensity of signal and number of positive tumour cells.