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Introduction: Previous research in this centre enabled the introduction of a local protocol of nonbiopsy and discharge of women <30 years old with presumed fibroadenomas (FAs). Four years on, we have audited protocol accuracy, effect on biopsy workload, safety and its potential for influencing UK and European practice. Methods: Women aged <30 attending the breast unit between 1 February 2009 and 31 January 2013 were retrospectively identified. Clinical and imaging results were scored following national guidelines locally adapted to incorporate a nonbiopsy protocol such that presumed FAs scored E2/U2 meeting specific protocol criteria were discharged without core biopsy. In addition, a survey assessing European practice was completed by 31 centres. Results: A total of 1,571 women age <30 were referred to the breast unit. Seven cancers were diagnosed, all aged 25 to 29. In total, 266 presumed FAs E2/U2, meeting nonbiopsy criteria were discharged without biopsy, 84 were aged 25 to 29. Fourteen re-attended with increase in size, none biopsied but five excised due to patient choice. Sixty-six E2/U2, probable FAs were biopsied due to noncompliance with the protocol. Of these, 54 were FAs, seven phyllodes tumours, and one cancer. The protocol resulted in a 78% reduction in biopsy workload in women aged ≥20 and a 72% reduction in women aged 25 to 29. No cancers developed in discharged patients, mean follow up 2.4 years. European survey results demonstrate 29% of respondents routinely sample FAs in women age ≥20, 55% in women age ≥25. Seventy-nine per cent of non-UK respondents follow-up FAs regardless of patient age. Conclusion: With rigorous adherence, our nonbiopsy protocol for presumed FAs in women age <30 appears safe and reduces biopsy/followup workload. O2 4.2: Vacuum biopsy in the management of lobular in situ neoplasia: a single-centre experience

)Purpose To validate the predictive power for determining breast cancer risk of an automated breast density measurement system with full-fi eld digital mammography (FFDM). Materials and methods Two hundred cancers and 200 controls were imaged with FFDM. Density was measured separately on MLO and CC images using an integral automated volumetric breast density measurement system (Hologic, Quantra). For each cancer, the contralateral mammogram was used. Each cancer was matched to a control case by date of birth, age at examination and laterality of mammogram used for density determination. Breast density (percentage of fi broglandular tissue) was analyzed by Quantra. Data were analyzed by conditional logistic regression to determine the eff ect on breast cancer risk. Results The percentage of breast density ranged from 6% to 63%. Density declined signifi cantly with age (P <0.001). Overall, there was no signifi cant association of density with risk of breast cancer (P = 0.4). There was a suggestive increase in risk with dense volume higher than 35% (OR = 1.80, 95% CI = 0.96 to 3.39, P = 0.07). There was signifi cant heterogeneity by age in the eff ect of density on risk (P = 0.04). In women aged <50, density was signifi cantly associated with increased risk (P = 0.02), with odds ratios of 6.06, 3.98 and 10.59 for density volumes of 15 to 24%, 25 to 34% and ≥35% respectively, relative to those with <15%. In women aged ≥50 years there was no association of density with risk (P = 0.5). Conclusions Quantra automated volumetric breast density measurement is strongly associated with breast cancer risk in women aged under 50, but not in women aged ≥50 years or over. O2Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study K Taylor Introduction NICE guidelines recommend conventional ultrasound (CU) of the axilla as preliminary staging in patients with breast cancer. However, up to one-third of nodes showing normal morphology are metastatic on surgical histology [1]. Ultrasound elastography (UE) uses received radiofrequency data to produce an elastogram depicting tissue stiff ness. UE has been researched in the breast but there are no published data regarding UE of the axilla. Methods Fifty women attending the breast unit as symptomatic GP referrals with breast lesions sonographically suspicious of breast cancer underwent UE of the axilla simultaneously with routine CU examination. Elastograms were visually scored, strain measurements calculated and nodal perimeter and area measurements recorded. UE was compared with CU with histology as the reference standard. Results Twenty-nine nodes were histologically normal, 21 were metastatic. Normal nodes were indistinguishable from surrounding tissue on UE. Using cut-off points for biopsy selected for the study, sensitivity was 90% for UE visual scoring, 100% for strain scoring and 76% for CU. Specifi cities were 86%, 48% and 78% respectively. ROC analysis yielded AUC values ...

Introduction: Women with B5a (non-invasive) preoperative core biopsies upgraded to invasive disease at surgery have a high chance of needing further surgery. The average B5a upgrade rate across UK breast screening programmes is around 20%. Through this Scottish review, we aim to identify factors affecting upgrade rates and ways to improve our performance. Methods: This was a retrospective analysis of 1,252 cases of B5a biopsies from the Scottish Breast Screening Programme between 2004 and 2012. Final surgical pathology was correlated with radiological and biopsy factors. Results: B5a upgrade rates for the units ranged from 19.2 to 29.2%, with average of 23.6%. Mean sizes of invasive tumours were small (3 to 11 mm). Upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion or asymmetry, compared with microcalcification alone (33.2% vs. 21.7%) (P = 0.0004). The upgrade rate was significantly lower with use of large-volume vacuum-assisted biopsy (VAB) devices than 14-gauge core needles (19.9% vs. 26%) (P = 0.013). The upgrade Introduction: MRI is a common method for detecting breast cancer in women at high risk [1,2] These women may instead be diagnosed mammographically or present symptomatically. The aim of this study was to investigate how breast cancer is diagnosed in high-risk women and determine whether there are specific characteristics related to the type of presentation. Methods: A total of 125 high-risk patients with 134 breast cancers (69 BRCA, 65 family history) were managed at the Royal Marsden Hospital from 1994 to 2013. Following ethical approval, data were collected retrospectively for each presentation of breast cancer: method of presentation/diagnosis (MRI, mammography, symptomatic), age at diagnosis, cancer type, grade, size, presence of DCIS, lymphovascular invasion (LVI), nodal status and tumour subtype. Chi-squared and ANOVA analyses determined any association between the parameters, P < 0.05 was significant. Results: Ten breast cancers were MRI detected, 43 mammography detected and 81 symptomatic (mean age 41, 51, and 45 years (P = 0.008); mean size 17, 29, and 34 mm (P = 0.076) respectively).The majority of cancers were high-grade (68%) invasive ductal carcinomas (78%) without LVI (76%). MRIdetected cancers were triple negative in 60% (P = 0.03), node negative in 100% (P = 0.005) with DCIS in 70% (P = 0.007). Mammography-detected cancers were luminal in 77% (P = 0.03), node negative in 77% (P = 0.005), with DCIS in 81% (P = 0.007). Symptomatic cancers were luminal in 54%, triple negative in 41%, node negative in 56% and DCIS positive in 51%. Conclusion: In this high-risk cohort, MRI detects small, triple-negative, node-negative cancers in younger women, while mammography detects larger, luminal, cancers in older women that may be node positive. Introduction: Anisotropy is the directional dependence of the measurement of a property. As breast tissue structure and some breast diseases (DCIS) are anisotropic in structure, we aimed to establish ...