IntroductionThe automated breast volume scanner (ABVS) is the fi rst of its kind and utilises a large, 17 cm × 15 cm high-frequency ultrasound probe which sweeps across the whole breast generating images that can be reformatted into multiple planes and a 3D volume. ABVS will change breast ultrasound practice by: introducing operator standardisation, reproducibility and repeatability of measurement and interpretation; changing who acquires the volume set and how breast ultrasounds are reported; and allowing accurate comparison of previous and current examinations for screening and assessing treatment change. Methods Patients presented to the symptomatic clinic for conventional 2D ultrasound assessment with a variety of conditions. An additional ABVS was performed. Results Cases were classifi ed into: benign -for example, cysts, fi broadenomas, diabetic mastopathy; and malignant. Conclusion We present a review of our initial experience and highlight its advantages over conventional ultrasound, which include: improved mapping of lesions enabling more accurate future assessment and follow-up, and improved assessment of distortion over conventional 2D ultrasound. Further research is required to explore other potential benefi ts. Introduction A study of symptomatic breast units geographically spread over Ireland collected image quality, compression and radiation dose data from 18 mammography units; so how do these optimisation parameters compare nationally and internationally? The mean glandular dose (MGD) diagnostic reference level was proposed for the all-digital breast screening service [1] but not for the symptomatic breast service. Methods The quantitative and qualitative data were analysed using SPSS. Recommendations of MGD diagnostic reference levels were made at various levels for fi lm-screen mammography (FSM) and full-fi eld digital mammography (FFDM) units to match those levels published in worldwide. O2 Symptomatic breast services inResults MGDs received by symptomatic breast patients within Ireland are higher than those received in the all-digital Irish Breast Screening service, although the diff erences for FFDM are not substantial; 55 to 65 mm breast: 1.75 mGy (screening) versus 2.4 mGy (symptomatic) at the 95th percentile. The four-view routine mammography MGDs obtained in symptomatic breast units in Ireland are, however, substantially diff erent from other screening units with mixed FSM/FFDM modalities: 4.5 mGy (UK); 4.98 mGy (USA) versus 5.96 mGy (FFDM, symptomatic) and 9.63 mGy (FSM, symptomatic). Various reasons are proposed for the diff erences. Conclusion MGD diagnostic reference levels achieved in the screening service may be lower due to the exacting requirements for radiographer training, nonsurgical alteration of patient breasts and equipment quality assurance levels. Greater training of radiographers performing mammography in the symptomatic breast services is required to standardise mammographic projections with regard to MGDs delivered. Reference O3Correlations between shear wave elastog...

No abstract

O1Utility of MRI in low and low to moderate density breasts with invasive lobular carcinoma Objective: To determine the feasibility of excluding MRI from the preoperative diagnostic pathway of invasive lobular carcinoma (ILC) in women with low and low to moderate density breasts on mammography. Methods: A total of 179 cases of ILC were diagnosed between 2009 and 2012. Forty-eight cases were identified as low and low to moderate density breasts. The study group includes 32 cases who underwent MRI. Parameters scrutinised include size and number of lesions on mammography, ultrasound and MRI, second-look ultrasound, type of surgery, further surgery and histology. Results: Twenty-nine cases had low to moderate density breasts and three had purely low density breasts. Average age of women was 64. Size of lesions ranged between 2 and 50 mm with an average of 20.14 mm. In 25/32 cases (78.12%) conventional imaging matched MRI. MRI identified additional disease in 7/32 (21.8%). This was predominantly in the form of satellites around the index lesion resulting in multifocality in 6/7. Four resulted appropriately in mastectomy. Two led to wider WLE appropriately. In one case, multicentric disease was correctly detected and subjected to mastectomy. Second-look ultrasound was recommended in 4/7 cases. All these cases had low to moderate density breasts on mammography and 6/7 cases measured more than 15 mm in size. Ultrasound matched MRI in one mammographically occult case and was subjected to appropriate WLE. In two cases there was much more disease than anticipated from conventional imaging and MRI (6.25%). Conclusion: Even in low and low to moderate density breasts where mammography has a higher exclusion value, MRI identified additional disease in 21.8% (7/32). O2Is ultrasound axillary staging less accurate in invasive lobular breast cancer than in ductal breast cancer? P Sankaye Objective: To identify whether axillary US is less accurate in invasive lobular breast cancer than in ductal breast cancer. Methods: Randomised cohorts of screening and symptomatic patients were retrospectively identified from histology records of 2010/11. Axillary US of 65 patients with primary breast cancers (BC) from each group of invasive lobular cancer (ILC) and invasive ductal cancer (IDC) were reviewed. Preoperative US-guided needle biopsy sampling was performed on abnormal lymph nodes (LN). Results: See Tables 1 and 2. Conclusion: The previous literature on this topic is inconclusive. Some authors have suggested axillary ultrasound in ILC may be less accurate than in IDC, with a higher false-negative axillary assessment rate. Another study concluded that axillary US accuracy rates in ILC were comparable with previous published studies of IDC, used FNA in all cases. We specifically compared accuracy rates of preoperative axillary staging between ILC and IDC in own institution, with 14G needle biopsy as the procedure of choice to sample abnormal nodes. We found that there is no statistical difference in accuracy in US axillary staging betwee...

No abstract

Twenty-five years after its first description the p53 protein has been shown to play a key role in both cancer and ageing. The p53 protein is activated by many different stress pathways, including oncogene action and DNA damage. The elucidation of the p53 response, which is aberrant in most cancers (including breast, lung, stomach and colorectal cancer), has provided many new targets for drug development and p53 gene therapy is now approved in China. In tumours where p53 is mutant small molecules may be able to restore its function. In many tumours the wild-type p53 gene remains intact but its function is compromised by loss of upstream signalling pathways or downstream effectors.A key regulator is Mdm2, an E3 ubiquitin ligase, that binds and ubiquitinates p53 and directs its degradation via the proteosome. Small potent peptides that can block the p53 Mdm2 interaction and activate the p53 response have been described. Growing selections of lead small molecules that mimic the action of these peptides have also been recently discovered. Cell-based screens have revealed that inhibitors of nuclear export and inhibitors of transcription (one of which is in clinical trial) can also activate the p53 response therapeutically. The pharmaceutical regulation of the p53 pathway offers great hope for improved treatment of human cancer.