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Background: oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. Methods: all available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki67 2wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. Findings: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki67 2wk (p2wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. Interpretation: our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse. Funding: Cancer Research UK (CRUK/07/015).

A novel surface flow wetland demonstrates high-rate nitrification by recirculating water supersaturated with oxygen. Design of the wetland was based on two hypotheses: (1) Oxygen supersaturation of a recirculating sidestream would support nitrification in a surface flow wetland at rates comparable to aerated subsurface flow wetlands, and; (2) Nitrification would be maintained in cold water conditions (0.5–5.0 °C) with minimal bioaugmentation using commercially available liquid suspensions of nitrifying bacteria. The wetland has an area of 23,000 m2, of which the final 21,000 m2 is oxygenated. Mean flow was 863 m3 d−1. A downflow oxygen contactor (Speece cone) maintains dissolved oxygen at or over saturation in the wetland. Mean inflow NH3-N was 8.0 mg L−1, mean outflow 0.6 mg L−1. In winter, nitrification began to degrade slowly at a water temperature of 0.5 °C to about half the summer rate but was restored by bioaugmentation with nitrifying bacteria in one month at water temperatures less than 3.3 °C. Determination of nitrification rates by a first-order, tanks-in-series model (P-k-C*) was hindered by the method detection limit (0.2 mg L−1 NH3-N) of analytical methods and the inherent limitations of first order models for complete nitrification. The median monthly nitrification areal rate coefficient from April 2016 through June 2017 was at least 216 m y−1, which is 15 times greater than median passive wetland literature rates. High nitrification rates allow for at least a 90% reduction of required treatment area for nitrification at approximately one third the capital cost of aerated subsurface flow wetlands. Denitrification rates were well within observed literature values. The peak monthly mean denitrification rate, observed in June 2017, was 76 m y−1, but winter denitrification rates were close to zero.

s / International Journal of Surgery 10 (2012) S1–S52 S12 ABSTRACTS Conclusion: Wound infection following breast cancer surgery can have severe consequences by delaying the start of adjuvant chemo-radiotherapy and affect the outcome of patient. This audit indicates that prophylactic antibiotics substantially reduce the risk of post-operativewound infections in breast surgery and thus avoid delay in start of adjuvant treatment or any additional operation required for definitive treatment. 0747: ULTRASOUND MARKING OF THE WIRE-TIP PRIOR TO WIRE GUIDED WIDE LOCAL EXCISION SHOWS PROMISE IN IMPROVING OUTCOME FOR IMPALPABLE BREAST CANCER Andy Kordowicz , Susie Flexer , David Sapherson , Gary Dyke . Department of Breast Surgery, Harrogate and District Hospital, Harrogate, North Yorkshire, UK,; Department of Radiology, Harrogate and District Hospital, Harrogate, North Yorkshire, UK Aim: We examined whether pre-operative ultrasound marking (PUM) of the wire-tip improved outcome for women undergoing wire-guided wide local excision (WLE) of impalpable breast cancer. Methods: Between 01/2010 and 06/2011, 33 women underwent wireguidedWLE in our institution. Via a retrospective analysis of case-notes we identified patients who had undergone PUM of the wire-tip. Patient age, tumour characteristics, operating time, mass of specimen excised and further procedures (cavity-shave) were recorded. Results: 12 women underwent PUM of the wire-tip (group a), 21 women did not (group b). Both groups were well matched for age, histological grade of tumour and tumour size. The median mass of specimen excised was 48.5g(range 24-92g) for group a and 57g(range 22-140g) for group b (p1⁄40.14). Median operating time was 36.5mins(range 19-52mins) for group a compared to 41mins(range 24-103mins) for group b (p1⁄40.01). None of the patients in group a (0%) required a further cavity-shave compared with 5 of the patients in group b (24%). Conclusions: PUM of the wire-tip shows promise as an adjunct in wireguided WLE of impalpable breast cancer, reducing the mass of specimen removed (with obvious aesthetic implications), the operating time, and the number of repeat procedures to which the patient is subjected. 0782: ANALYSIS OF SOCIAL STATUS AND BREAST CANCER PROGNOSIS USING WELSH INDEX OF MULTIPLE DEPRIVATION AND ACORN CLASSIFICATION: DOES A GAP EXIST? Thomas Micic, Rachel Barnes, Kelvin Gomez. Anuerin Bevan Health Board Trust, Abergavenny, South Wales, UK Introduction: There has always been an implied association between poor health and social deprivation. Our study assessed whether a gap in patient outcome for breast cancer exists between different strata of society within a geographical region in Wales. Methods: A retrospective cohort of 745 breast cancer patients was recruited using cancer registry data from January 2008 to February 2011. Welsh Index of Multiple Deprivation (WIMD) along with 4 deprivation categories from the ACORN classification based on patient postcodes were used as a measure of deprivation. Nottingham Prognostic Index (NPI) was used as a marker of patient outcome. Results: Analysis of WIMD demonstrated no correlation with NPI (coefficient: 0.042, p: 0.25). The incidence of breast cancer was highest (30%) in the least deprived category of patients (20%-26% for the remaining categories). The mean NPI score was 3.1 for the least deprived group (3.2 for other categories). 38% of the least deprived patients had an excellent prognostic outcome (32%-34% for other categories).11% of the least deprived patients had a poor prognosis (9%-11% for other categories). Conclusions: Our results show no statistically significant difference in either the incidence of breast cancer or outcome from treatment of the disease between different strata of society. 0858: WHAT DO PATIENTS UNDERSTAND ABOUT OF THE ROLE OF HOSPITAL STAFF AND INVESTIGATIONS IN BREAST CANCER SERVICES? Rachel L O'Connell, Edward R St John, Nizar Din, Sidonie HartridgeLambert, Omotayo Johnson. Ashford and St Peter's NHS Foundation Trust