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e20600 Background: Breast and arm cellulitis (BAC) is a recognized risk following treatment for early stage breast cancer with case reports suggesting an incidence 30 days post chemotherapy/radiation completion. Chi-square test was used to assess variables associated with BAC recurrence. Results: 391,603 breast cancer pts (2.5%) were identified with BAC with median age 59 years. The median interval between completion of primary treatment and incident cellulitis was 330 days (30 – 3,650 days). 13 out of 39 pts (33%) had recurring BAC (range 1-7 events). Median duration of Abx therapy was 30 days (7 – 2,190). Lymphedema (p=0.04), chemotherapy (p=0.01), Stage > I (p=0.02) and initial poor response to Abx (p=0.003) were significantly associated with recurring BAC. Positive bacterial cultures were obtained in 4 of 62 BAC events. Initial Abx failure was lowest with vancomycin (Vanc). A protracted course (30 days) of oral Abx after initial Vanc was associated with a lower risk of early recurrence. Chronic Abx therapy, for pts with 3 episodes, appeared to reduce subsequent recurrent episodes. Conclusions: Results indicate that while BAC is relatively uncommon following breast cancer therapy, pts with BAC are at significant risk for recurring events. Lymphedema, higher stage and initial poor response to Abx proofed as parameters for recurrence. Despite treatment with Abx a significant number will have recurring events. For pts presenting with these variables we recommend a protracted course of initial Abx. Pts with recurring BAC should receive chronic Abx suppressive therapy. This approach was associated with good long term control in our pts.

e22192 Introduction: CXCR4 is a chemokine receptor that is linked to breast cancer metastasis. The putative mechanism involves activation of the HER-2/PI3K/PTEN/Akt/mammalian target of rapamycin (mTOR) pathway, resulting in enhanced synthesis of downstream proteins such as CXCR4 and eukaryotic initiation factor 4E (eIF4E). Overexpression of eIF4E has been shown to be an independent predictor of breast cancer outcome. Because HER-2/mTOR/CXCR4 pathway has mainly been observed in vitro, it deserves scrutiny to determine whether it is also seen in human breast cancers. We hypothesize that HER-2/mTOR axis is not significantly associated with CXCR4 regulation in human breast cancers. Method: 107 stages 1 - 3 breast cancers from a prospective breast cancer database were analyzed. Samples were quantified for mTOR, CXCR4, and eIF4E levels by Western Blot. mTOR, and eIF4E levels were quantified as fold-over benign breast tissues and CXCR4 levels were quantified as fold-over Hela cells. CXCR4 overexpression was defined as low (< 6.0 fold) or high (≥ 6.0 fold), and eIF4E expression level was separated into tertiles. Primary end points were cancer recurrence and death. Statistical analyses performed were independent student t-test, Spearman correlation, Kaplan-Meier survival curves, log-rank test, and Cox proportional hazard model. Results: All 59 HER-2 (-) and 48 HER-2 (+) breast cancer specimens overexpressed CXCR4 (mean=6.18 ±4.4), mTOR (mean=1.24 ±1.58), and eIF4E (mean=9.53 ±6.42). Unlike in vitro data, there was no difference in mean CXCR4 expression level between HER-2 (-) and HER-2 (+) tumors (mean=6.55, 5.72, respectively) (p=0.33). While mTOR correlated significantly with eIF4E level (p=0.0006, r = 0.34), it did not correlate with CXCR4 level (p=0.713, r=0.036). Only nodal status (p=0.04) and eIF4E level (p=0.03) were independent predictors of breast cancer death. Conclusions: We demonstrate that CXCR4 regulation in human breast cancers is more complex than previously thought. There was no correlation between mTOR and CXCR4 levels, nor was there a difference in mean CXCR4 overexpression levels between HER-2 (+) and HER-2 (-) tumors. Pathways regulating CXCR4 expression warrant further investigation. No significant financial relationships to disclose.

10578 Background: Despite significant advances made in the treatment of locally advanced breast cancer (LABC) with neoadjuvant chemotherapy, a significant number of patients continue to die. A molecular predictor to identify those who are at an increased risk for relapse is sorely needed. CXCR4 is a chemokine receptor that has been linked to breast cancer invasion and metastasis. We postulate that CXCR4 overexpression levels in cancer specimens following neoadjuvant chemotherapy predict cancer outcome in patients with LABC. Methods: 54 patients with LABC were prospectively accrued and analyzed. All had neoadjuvant chemotherapy, followed by definitive surgical and adjuvant chemo-radiation therapy. Study homogeneity was maintained by standardized treatment, surveillance, and compliance protocols. A 1 cm 3 cancer from the surgical specimens of each patient was retrieved for analysis. CXCR4 levels were detected using Western blots and results were quantified against 1 μg of HeLa cells (positive controls). CXCR4 expression was defined as low ( No significant financial relationships to disclose.

729 Background: : Positron Emission Tomography (PET) is a relatively new imaging modality that has gained wide acceptance for the detection of recurrent disease in colorectal adenocarcinoma and melanoma. However, its role in evaluating patients with locally advanced breast cancer has not been as well studied. We sought to evaluate its role in the detection for recurrent disease in stage III breast cancer patients. Methods: A retrospective review of 195 patients with stage III breast cancer treated between January of 2000 to November of 2003 was performed. Patients were staged according to the 2003 AJCC staging system. Data on patients who had a PET scan as part of their metastatic work-up were culled. Results of their PET scans were compared to CT scans, MRIs, bone scans, and/or tissue biopsies. Results: Eighteen stage III breast cancer patients had a PET scan as part of their metastatic work-up. PET scans were compared with tissue biopsies in all patients, with CT scans in 15 patients, with MRI’s in 2 pa...

5535 Background: As positron emission tomography (PET) becomes more utilized in the clinical setting, the finding of an incidental focal thyroid uptake (thyroid incidentaloma) presents a diagnostic...