Introduction Digital breast tomosynthesis (DBT) may improve the accuracy of mammography by enabling visual separation of overlapping tissues (Andersson et al. 2008, Poplack et al. 2007). Methods Following local research ethics approval, all women attending the assessment clinic for evaluation of a mammographic abnormality found on routine screening (film-screen) were invited to take part in the study subject to informed consent. Participants underwent bilateral two-view two-dimensional (2D) digital mammography and bilateral twoview DBT. Mammography scores using the RCR Breast Group classification were sequentially obtained for the screening mammogram, 2D digital and DBT, and these were each compared with the final assessment outcome. Results Ninety-one percent of eligible women participated. Results from the first 300 participants are presented in Table 1 below. Kappa coefficients for agreement of each imaging method with final assessment outcome were calculated. Screening mammograms had the lowest agreement with the final outcome (Kappa = 0.02; P = 0.22), 2D digital mammography was better (Kappa = 0.26; P = 0.0000) and DBT had the highest score (Kappa = 0.37; P = 0.0000). Conclusion The preliminary results of this ongoing study show that DBT increases the diagnostic confidence of the radiologist. This supports the need for a larger multicentre study. Markers of screen reading performance (overall and first reader cancer detection rates, recall rates, positive predictive value of recall and missed cancers) were compared with volume of films read. Readers were categorised into four groups, according to film reading volume over the 3-year period: <15,000 (that is, on average less than the recommended 5,000/year); 15,000 to <20,000; 20,000 to <25,000; and ≥25,000. Statistical analysis was undertaken using SPSS for Windows version 13. Results The recall rate in low volume readers (<5,000/year) was 6.9% and was significantly higher than in the other groups combined (4.8%; P ≤ 0.001). These readers also had a lower positive predictive value than higher volume readers (11.7% versus 15.7%, P ≤ 0.001).The cancer detection rate at first read was significantly lower in the higher volume readers (≥25,000) in comparison to the other groups combined (6.6 per 1,000 versus 8.2 per 1000, P ≤ 0.001). Conclusion These data support the recommendation that readers should read a minimum of 5,000 mammograms/year. They also suggest that there is an upper limit above which reader performance deteriorates (in terms of cancer detection). With the imminent programme expansion this has implications for service quality. Consideration should be given to the introduction of an upper limit of mammographic reads. O2 Breast Cancer Research

Background The evolution of Tumor Necrosing Factor inhibitor (TNFi) in the treatment and management of chronic inflammatory disease has revolutionised patients' disease and improved their quality of life substantially. However evidence shows there is an increased risk of infection, in particular mycobacterium infection and reactivation of a latent TB infection (LTBi)1, in patients receiving TNFi treatment. The screening of patients for LTBI is mandatory before initiating TNFi therapy; although TST is widely used in the diagnosis of LTBI, there is a lack of sensitivity and specificity2. Despite our initial TB screening policy, which included risk history assessment, chest X-ray (CXR), and TST, approximately 1% of patients over a 10 year period who screened negative subsequently developed active TB, frequently extra-pulmonary and treatment-resistant3. Data from our previous study revealed Quantiferon testing may identify additional patients with latent TB in Mantoux negative patients, indicating a potential benefit for Quantiferon testing as part of TB screening4. Objectives In this study, we sought to evaluate performance and benefits of incorporating Quantiferon in a TB screening protocol in our Rheumatology centre. Methods 109 patients were screened for LTBi. Their diagnoses including rheumatoid arthritis, psoriasic arthritis, ankylosing spondylitis, inflammatory arthritis and all patients were screened over a twelve month period (December 2011-December 2012). In the modified screening protocol, TST was replaced with Quantiferon blood test; however risk history assessment and CXR remain part of the screening protocol. Quantiferon positive patients were treated with isoniazid for LTBi. Results Mean age 50.5 years, 55% female. Diagnosis: 50.5%, 27% and 21% had RA, PsA and AS, respectively, 8% (9 patients) had positive Quantiferon, all received LTBi chemoprophylaxis. CXR suggestive of LTBi in 2.8% (3), all subsequently had normal CT- thorax. These 2.8% (3) had negative Quantiferon testing. 7% (8) had high TB risk history, only one patient tested Quantiferon positive. To date, no patient from this cohort has developed active TB after a mean follow-up of two years. Conclusions Replacing Mantoux testing with Quantiferon has proven a safe and effective strategy for LTBi screening. Quantiferon testing helpes improve TB testing compliance and eliminates false – positive results associated with BCG5. Quantiferon testing requires one clinic visit with substantial benefits for the patient and the rheumatology nurse specialist identified in terms of time and indirect costs. Mantoux testing can be inconvenient as it requires two patient visits. References Kane J. TNF blocking agents and tuberculosis; new drugs illustrate an old topic. Rheumatology (Oxford) 2005; 44, (10), 1205-1206. American Thoracic Society.Targeted tuberculin testing and treatment for latent tuberculosis infection.Am J Respir Crit Care Med 2000;161:221S-47S. Mongey A-B et al. Late Onset Tuberculosis Infection in Patients Receiving Anti-TNFα...

The emphasis of mammographic breast screening is to detect small invasive breast cancers at a time in their natural history when early detection and treatment will reduce significantly the risk of death. However, breast screening cannot be absolutely specific in its approach and detects a wide spectrum of breast cancer, ranging from microfocal low-grade ductal carcinoma in situ to large highgrade invasive cancer. It is well recognized that many of the lowgrade, special invasive cancers identified at screening have an excellent prognosis but may be so indolent that they would never have presented clinically or have threatened the life of the patients. It has been proposed alternatively that a proportion of these low-grade invasive tumours might, if not detected, de-differentiate over time into more aggressive, less well-differentiated tumours. Identification and removal of such cancers when they are at a low grade would avoid such progression. Detection of high-grade invasive cancers when they are small is clearly a means by which screening could reduce breast cancer mortality; for example, the Two-County Trial in Sweden has shown that histological grade 3 invasive cancers detected when <10 mm have an excellent prognosis, while it is widely recognized that large high-grade invasive cancers have a poor prognosis. In addition, the presence of vascular invasion and lymph node metastasis, which are associated with development of metastatic disease, are rare in grade 3 tumours <10 mm, grade 2 tumours <10 mm and grade 1 tumours <20 mm, indicating that detecting tumours under a certain size should be beneficial. 3 Ultra-small iron particle-enhanced magnetic resonance imaging of axillary lymph nodes in breast cancer

Introduction Digital breast tomosynthesis (DBT) may improve the accuracy of mammography by enabling visual separation of overlapping tissues (Andersson et al. 2008, Poplack et al. 2007). Methods Following local research ethics approval, all women attending the assessment clinic for evaluation of a mammographic abnormality found on routine screening (film-screen) were invited to take part in the study subject to informed consent. Participants underwent bilateral two-view two-dimensional (2D) digital mammography and bilateral twoview DBT. Mammography scores using the RCR Breast Group classification were sequentially obtained for the screening mammogram, 2D digital and DBT, and these were each compared with the final assessment outcome. Results Ninety-one percent of eligible women participated. Results from the first 300 participants are presented in Table 1 below. Kappa coefficients for agreement of each imaging method with final assessment outcome were calculated. Screening mammograms had the lowest agreement with the final outcome (Kappa = 0.02; P = 0.22), 2D digital mammography was better (Kappa = 0.26; P = 0.0000) and DBT had the highest score (Kappa = 0.37; P = 0.0000). Conclusion The preliminary results of this ongoing study show that DBT increases the diagnostic confidence of the radiologist. This supports the need for a larger multicentre study. Markers of screen reading performance (overall and first reader cancer detection rates, recall rates, positive predictive value of recall and missed cancers) were compared with volume of films read. Readers were categorised into four groups, according to film reading volume over the 3-year period: <15,000 (that is, on average less than the recommended 5,000/year); 15,000 to <20,000; 20,000 to <25,000; and ≥25,000. Statistical analysis was undertaken using SPSS for Windows version 13. Results The recall rate in low volume readers (<5,000/year) was 6.9% and was significantly higher than in the other groups combined (4.8%; P ≤ 0.001). These readers also had a lower positive predictive value than higher volume readers (11.7% versus 15.7%, P ≤ 0.001).The cancer detection rate at first read was significantly lower in the higher volume readers (≥25,000) in comparison to the other groups combined (6.6 per 1,000 versus 8.2 per 1000, P ≤ 0.001). Conclusion These data support the recommendation that readers should read a minimum of 5,000 mammograms/year. They also suggest that there is an upper limit above which reader performance deteriorates (in terms of cancer detection). With the imminent programme expansion this has implications for service quality. Consideration should be given to the introduction of an upper limit of mammographic reads. O2 Breast Cancer Research

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