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We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery.

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

association with thrombo-embolic complications and to refine our care of patients with this condition. Method: All patients referred for STP or query DVT, between 2000 and 2008 with STP had a colour flow duplex scan (CFDS). All case notes and scans were available for review. Results: Two hundred and ten patients had STP. Two hundred and ninetyone CFDS were performed and each patient had at least one scan. Predisposing factors to STP included varicose veins (31%), previous DVT/phlebitis (20%), cancer (13%), recent long distance travel (12%), trauma (6%), puerperium (2%) and use of oral contraceptive pills (2%). Thrombus was located along the course of the long saphenous vein in 171 patients (82%) and short saphenous vein in 39 patients (18%). Sixty-four patients (30%) had a thrombo-embolic complication: 57 DVTs; 7 PEs. Fourteen patients had DVT which progressed to PE. Treatment was a variety of combinations of antibiotics, NSAIDS, compression stockings, warfarin, low-molecular-weight heparin and surgical disconnection (28). Eleven patients had a change of treatment plan following a follow-up scan. Conclusion: Our findings show that STP is far from a benign condition with potential life-threatening thrombotic complications occurring in a third of patients. The benefits of operative intervention are unclear and studies are needed to answer this question as well as the best medical management.Objective: To compare percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined therapy (PTA+SEP) in the treatment of intermittent claudication (IC) due to femoro-popliteal disease. Method: Over a 6-year period, 178 patients (108 men, median age 70 years) with angioplastiable femoro-popliteal lesions were randomised to: PTA, SEP or PTA+SEP. Patients were assessed prior to and at 1, 3 6 and 12 months post-treatment. ISCVS outcome criteria (ankle pressures, treadmill walking distances) and Quality of Life (QoL) questionnaires (SF-36 and VascuQoL) were analysed. Results: All groups were well matched at baseline. Thirty-three patients withdrew. Intra-group analysis: all groups demonstrated significant clinical and QoL improvements (Friedman test, p < 0·05); SEP (59 patients, 13 withdrew) −69·6% of patients (n = 32) improved following treatment (19 mild, 10 moderate, 3 marked), 13% (n = 6) no improvement and 17·4% (n = 8) deteriorated; PTA (60 patients, 8 withdrew) −71·2% of patients (n = 37) improved following treatment (16 mild, 16 moderate, 5 marked), 17·3% (n = 9) no improvement and 11·6% (n = 6) deteriorated; PTA+SEP (59 patients, 12 withdrew) −85·2% of patients (n = 40) improved following treatment (18 mild, 20 moderate, 2 marked), 14·9% (n = 7) no improvement and 0% (n = 0) deteriorated. Inter-group analysis: PTA+SEP produce a sustained

We describe the imaging appearances of a patient with bilateral, synchronous, multiloculated renal cell carcinoma with a predominantly cystic nature. The patient had progressive chronic renal failure. He was initially erroneously diagnosed as having autosomal dominant polycystic kidney disease (ADPKD) on the basis of the imaging findings. We believe this to be the first report describing bilateral synchronous renal carcinomas replacing the renal parenchyma imitating ADPKD.