Circumscribed masses are a common cause of recall for assessment but most are benign. The aim of this study is to compare the accuracy of digital breast tomosynthesis (DBT) with digital mammography (DM) in assessing the margin of circumscribed lesions as a predictor of benign or malignant disease.

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 …

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.

Discordant breast cancers are identified following differing interpretations on double-read screening mammograms. The aim of this audit was to analyse the mammographic features of discordant breast cancers to improve reader sensitivity.

Background: Needle core biopsy (NCB) is frequently used in the assessment of screen-detected breast lesions. NCB results are reported by the ‘B’ classification, introduced by the NHS Breast Cancer Screening Programme in 2001. Uncertainty remains over the appropriate management of NCBs reported as ‘uncertain malignant potential’ (B3) or ‘suspicious of malignancy’ (B4). Currently all patients with a B3/B4 NCB result are discussed at a multidisciplinary meeting and potentially undergo excision biopsy. However, this approach to management leads to the majority of patients with B3 results having surgery for a benign condition. This study aims to analyse a large screening dataset to establish positive predictive values (PPVs) for malignancy on excision biopsy, for different classifications of B3 and for B4 NCBs.

Needle core biopsy (NCB) is frequently used in assessing screen-detected breast lesions. Uncertainty remains over appropriate management of NCBs reported as 'uncertain malignant potential' (B3) or 'suspicious of malignancy' (B4). This study aims to analyse a large screening dataset to establish positive predictive values (PPVs) for malignancy on excision biopsy, for different classifications of B3 and for B4 NCBs.

Objectives: Women who delay presenting with breast cancer have a reduced chance of survival. Older women, who are at greater risk of developing breast cancer, are more likely to delay presenting with the disease. The aim of this developmental work was to design a psycho-educational intervention to promote early help-seeking by older women with breast cancer symptoms. We also aimed to demonstrate the feasibility of implementing the intervention with women attending for their final invited mammogram in the National Health Service (NHS) Breast Screening Programme. Methods: The intervention was designed to address the factors associated with delayed presentation by women with breast cancer. These risk factors were placed in a theoretical framework to understand patient delay. The intervention incorporated behavioural change techniques that, according to previous research, have been demonstrated to be effective. Results: The intervention was developed in two formats to be delivered by diagnostic radiographers: a booklet alone and a brief interview plus the booklet. The intervention was acceptable to both older women and healthcare professionals in the NHS Breast Screening Programme. Discussion: The intervention will be tested ultimately in a multicentre randomized controlled trial to determine whether it can reduce the proportion of older women who delay their presentation and thereby save lives.

Non-operative diagnosis has become the norm in breast disease assessment and, until relatively recently, fine needle aspiration cytology has been the sampling method of choice. The introduction of automated core biopsy guns in the mid 1990s led to the additional introduction of core biopsy in assessment units. This paper presents a summary of the guidance on handling and routine reporting of breast needle core biopsy specimens in the context of breast disease multidisciplinary assessment. This guidance has been produced by the UK National Coordinating Committee for Breast Screening Pathology and is endorsed by the European Commission working group on breast screening pathology.

Non-operative diagnosis has become the norm in breast disease assessment and, until relatively recently, fine needle aspiration cytology has been the sampling method of choice. The introduction of automated core biopsy guns in the mid 1990s led to the additional introduction of core biopsy in assessment units. This paper presents a summary of the guidance on handling and routine reporting of breast needle core biopsy specimens in the context of breast disease multidisciplinary assessment. This guidance has been produced by the UK National Coordinating Committee for Breast Screening Pathology and is endorsed by the European Commission working group on breast screening pathology.

Non-operative diagnosis has become the norm in breast disease assessment and, until relatively recently, fine needle aspiration cytology has been the sampling method of choice. The introduction of automated core biopsy guns in the mid 1990s led to the additional introduction of core biopsy in assessment units. This paper presents a summary of the guidance on handling and routine reporting of breast needle core biopsy specimens in the context of breast disease multidisciplinary assessment. This guidance has been produced by the UK National Coordinating Committee for Breast Screening Pathology and is endorsed by the European Commission working group on breast screening pathology.

We report the case of a woman who was recalled after screening because an opacity seen on her previous screening mammogram had changed in appearance. The new features were of a circumscribed soft-tissue opacity with some lobulation. Ultrasound showed an oval mass which was slightly hypoechoic compared to the surrounding fatty parenchyma and contained small focal anechoic areas. The lesion was biopsied and found to be a cavernous haemangioma. Haemangioma of the breast is a rare cause of a well-circumscribed soft-tissue mass on a mammogram.

Although there are numerous publications regarding the value (and limitations) of MRI in the diagnosis of a variety of breast conditions, access to MRI in the UK is severely limited.Because prioritisation of all cases needing MRI is necessary, only those that will lead to a clear alteration in clinical management can be justified.Against this background, the current use of MRI in a busy symptomatic and screening practice will be presented and justified.

Objective In the United Kingdom in 1994–95 about 16 500 women aged 50 to 64 were asked to come back earlier than the usual three yearly screening interval for further mammography (early rescreen (ES)) or for a range of further investigations at an assessment centre (early recall (ER)). This study aimed at providing epidemiological data on ES/ER, in particular, how often and why it is used, and what the outcome is of using it. Setting National Health Service breast screening programme in the United Kingdom. Methods All breast screening units were invited to complete a postal questionnaire. Two reminders were sent. The units were asked retrospectively to provide breast screening data about women aged 50 to 64 from their local computer systems. Women placed on ES/ER were followed up for at least one year. Results The response rate was 71% (69/97), of which 14% (10/69) were unable to provide the required data, leaving 59 completed questionnaires (61%). The rate of placing women on ES/ER was above 1.0% for 26/54 (48%) responding breast screening units and above 2.0% for 13/54 (24%) units. Women were placed on ES/ER because of ( a) previous breast cancer (21% of cases; cancer detection rate 2.4%), ( b) diagnostic uncertainty (51%; cancer detection rate 3.0%), or ( c) family history (27%; cancer detection rate 0.6%). Breast screening units with a high rate of placing women on ER were significantly more likely to have a high recall rate ( rS=0.63; n=53; p<0.0005) or a high benign surgical biopsy rate ( rS=0.33; n=49; p<0.05), or both. The cancer detection rate of ES/ER tended to decrease with increasing ES/ER rates ( rS=−0.37; n=51; p<0.01). Conclusions A relatively large number of women were placed on ES or ER for a range of reasons. If the recommendations given are followed, the number of women placed on ER may be reduced while maintaining the cancer detection rate at the required level. The option of ES should not be used.

OBJECTIVE:To investigate the strength of association between past life events and the development of breast cancer.DESIGN:Case-control study. A standardised life events interview and rating was administered before a definitive diagnosis.SETTING:Breast Cancer Screening Assessment Unit and surgical outpatient clinics at King's College Hospital, London.SUBJECTS:119 consecutive women aged 20-70 who were referred for biopsy of a suspicious breast lesion.MAIN OUTCOME MEASURES:Odds ratio of the risk of developing breast cancer after life events in the preceding five years after adjustment for confounders.RESULTS:41 women were diagnosed as having malignant disease while the remainder had benign conditions. Severe life events increased the risk of breast cancer. The crude odds ratio was 3.2 (95% confidence interval 1.35 to 7.6). After adjustment for age and the menopause and other potential confounders this rose to 11.6 (3.1 to 43.7). Multiple logistic regression analysis showed that all severe events and coping with the stress of adverse events by confronting them and focusing on the problems significantly predicted a diagnosis of breast cancer. Non-severe life events and long term difficulties had no significant association.CONCLUSION:These findings suggest an aetiological association between life stress and breast cancer.

OBJECTIVES--To report the results of the NHS breast screening programme for the year March 1991 to April 1992. DESIGN--A report of statistics was derived from Körner (K62) returns and from the radiology quality assurance programme. MAIN OUTCOME MEASURES--Detection rates for breast cancer and small (< or = 10 mm diameter) invasive cancer, benign biopsy rates, and recall and acceptance rates. RESULTS--The acceptance rate for screening across the United Kingdom was 71.3%. The referral rate for further investigation was 6.2% (regional 4.3-9.0%). The breast cancer detection rate was 6.2 cancers per 1000 women screened (5.1-9.0) and the detection rate of invasive cancers < or = 10 mm was 1.4/1000 (1.0-2.3). 72% of screening programmes reached the target 70% acceptance rate, and 95% of programmes achieved a recall rate of less than 10%. 75% of programmes had a cancer detection rate of more than 5/1000, but only 32% had a detection rate for invasive cancers < or = 10 mm of more than 1.5/1000. CONCLUSIONS--Overall, the results of the screening programme for the year 1991-2 can be regarded as extremely satisfactory, given the size and complexity of the operation.