Introduction: This multicentre randomised controlled trial investigated whether a computed tomography (CT) scan of the axilla could more accurately assess whether the axillary lymph nodes were involved with malignancy in patients with newly diagnosed breast cancer and therefore influence surgical decision-making with regard to axillary surgery. Methods: Patients with newly diagnosed breast cancer (via screening and symptomatic routes) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care (usual care). In addition, one group received a CT scan of their axilla on the same side as the breast cancer. Results: The study recruited 297 patients, of whom 291 contributed to findings. CT scan-guided care did not result in a change in the need for a second operation, with about 20% of both groups needing further surgery. Patients within the two groups were similar before treatment, had similar types and grade of cancer, experienced similar pattern complications and reported similar experiences of care. Conclusion: New diagnostic imaging technologies regularly enter NHS centres of excellence as research tools. It is important these are evaluated rigorously before becoming routine care. In patients newly diagnosed with breast cancer, CT-augmented diagnosis of cancer in the axilla was not found to improve surgical outcomes or patient experience. O2Preoperative assessment of breast volume to aid surgical planning: comparison of software-based mammographic measurements with subsequent mastectomy volumes. Introduction: The proportion of breast volume excised during conservation surgery for breast cancer is crucial to cosmetic outcomes. Validated, expedient methods for accurate preoperative quantification of breast volume are lacking. This study evaluated breast volume measurements calculated by Volpara® breast density software, by comparing them with actual mastectomy volumes. Methods: From a prospective clinical database, 31 patients were identified for whom Volpara® (Matakina Technology Limited, New Zealand) volume measurements and mastectomy volumes were available. All patients had undergone skin-sparing mastectomy (SSM), bilateral in one case. Specimen volumes had been measured using a water-displacement technique. Volpara® volumes for the corresponding CC and MLO view of each of the 32 breasts were averaged and compared with the mastectomy volumes. Correlation was assessed using the Pearson correlation coefficient. Results: Volpara® breast volumes were, as expected, consistently higher than SSM volumes but with a very strong correlation (Pearson correlation coefficient for average Volpara® volumes and mastectomy volumes = 0.82 (P < 0.01)). Conclusion:The excellent correlation between Volpara® and SSM volumes suggests that this readily available and convenient preoperative measure of breast volume could be used as a tool to aid surgical planning in women with breast cancer, which might be particularly useful in those women not ...

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Introduction: This multicentre randomised controlled trial investigated whether a computed tomography (CT) scan of the axilla could more accurately assess whether the axillary lymph nodes were involved with malignancy in patients with newly diagnosed breast cancer and therefore influence surgical decision-making with regard to axillary surgery. Methods: Patients with newly diagnosed breast cancer (via screening and symptomatic routes) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care (usual care). In addition, one group received a CT scan of their axilla on the same side as the breast cancer. Results: The study recruited 297 patients, of whom 291 contributed to findings. CT scan-guided care did not result in a change in the need for a second operation, with about 20% of both groups needing further surgery. Patients within the two groups were similar before treatment, had similar types and grade of cancer, experienced similar pattern complications and reported similar experiences of care. Conclusion: New diagnostic imaging technologies regularly enter NHS centres of excellence as research tools. It is important these are evaluated rigorously before becoming routine care. In patients newly diagnosed with breast cancer, CT-augmented diagnosis of cancer in the axilla was not found to improve surgical outcomes or patient experience. O2Preoperative assessment of breast volume to aid surgical planning: comparison of software-based mammographic measurements with subsequent mastectomy volumes. Introduction: The proportion of breast volume excised during conservation surgery for breast cancer is crucial to cosmetic outcomes. Validated, expedient methods for accurate preoperative quantification of breast volume are lacking. This study evaluated breast volume measurements calculated by Volpara® breast density software, by comparing them with actual mastectomy volumes. Methods: From a prospective clinical database, 31 patients were identified for whom Volpara® (Matakina Technology Limited, New Zealand) volume measurements and mastectomy volumes were available. All patients had undergone skin-sparing mastectomy (SSM), bilateral in one case. Specimen volumes had been measured using a water-displacement technique. Volpara® volumes for the corresponding CC and MLO view of each of the 32 breasts were averaged and compared with the mastectomy volumes. Correlation was assessed using the Pearson correlation coefficient. Results: Volpara® breast volumes were, as expected, consistently higher than SSM volumes but with a very strong correlation (Pearson correlation coefficient for average Volpara® volumes and mastectomy volumes = 0.82 (P < 0.01)). Conclusion:The excellent correlation between Volpara® and SSM volumes suggests that this readily available and convenient preoperative measure of breast volume could be used as a tool to aid surgical planning in women with breast cancer, which might be particularly useful in those women not ...

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 ...

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