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. O2 Preoperative 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 …

This study evaluates the use of annual breast MRI surveillance for high-risk women, evaluating the recall rate for further imaging, biopsy and cancer detection rate. We have used breast MRI for surveillance of high-risk women since 2008.

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?

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?

Introduction All breast cancer patients in our centre undergo ipsilateral axillary ultrasound, followed by fi ne needle aspiration (FNA) where appropriate in line with NICE guidelines.We use two needle passes into a suspicious node, without suction.Improved preoperative detection of nodal metastasis allows patients improved triage to appropriate axillary surgery.We present our analysis of the impact of the second needle in our axillary FNA procedure.Methods All breast cancer patients undergoing axillary FNA from April 2010 to July 2010 were included, where possible.The fi rst FNA was labelled '1' and the second '2' .Individual and overall FNA results were compared with fi nal surgical pathology, where available. ResultsThe study included 27 female patients.There was a diff erence in the cytology grading (described LN0 to LN5) allocated between the fi rst and second needle in fi ve cases (19%).The second needle increased sample adequacy on three (11%) occasions.Of the 17 patients that had axillary surgery, three had no lymph node metastases and the preoperative FNA cytology was LN2.There were no false positive cytology results.Preoperative cytology was LN5 overall in 11/14 (79%) patients with nodal metastases, with LN5 obtained only in the second pass in 4/14 (29%) cases (fi rst-pass results: LN2/LN2/LN0/LN0).No complications were reported.Conclusions A second needle pass into suspicious axillary lymph nodes in breast cancer patients has been validated by this study, increasing our preoperative rate of detection of lymph node metastases. P24