Cohort profile of the Sloane Project: methodology for a prospective UK cohort study of >15 000 women with screen-detected non-invasive breast neoplasia.

Purpose: The introduction of breast screening in the UK led to an increase in the detection of non-invasive breast neoplasia, predominantly ductal carcinoma in situ (DCIS), a non-obligatory precursor of invasive breast cancer. The Sloane Project, a UK prospective cohort study of screen-detected non-invasive breast neoplasia, commenced in 2003 to evaluate the radiological assessment, surgical management, pathology, adjuvant therapy and outcomes for non-invasive breast neoplasia. Long-term follow-up and accurate data collection are essential to examine the clinical impact.

The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project.

Background: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.

Methods: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.

Results: Microinvasion was recorded in 521 of 11,285 patients (4.

Unresected screen-detected ductal carcinoma in situ: Outcomes of 311 women in the Forget-Me-Not 2 study.

Background And Aim: The natural history of ductal carcinoma in situ (DCIS) is poorly understood. The aim of this cohort study was to determine the outcomes of women who had no surgery for screen-detected DCIS in the 6 months following diagnosis.

Methods: English breast screening databases were retrospectively searched for women diagnosed with DCIS without invasive cancer at screening and who had no record of surgery within 6 months of diagnosis.

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast.

Background: Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared.

Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?

Purpose To assess whether individual reader performance with digital breast tomosynthesis (DBT) and two-dimensional (2D) mammography varies with number of years of experience or volume of 2D mammograms read. Materials and Methods After written informed consent was obtained, 8869 women (age range, 29-85 years; mean age, 56 years) were recruited into the TOMMY trial (A Comparison of Tomosynthesis with Digital Mammography in the UK National Health Service Breast Screening Program), an ethically approved, multicenter, multireader, retrospective reading study, between July 2011 and March 2013. Each case was read prospectively for clinical assessment and to establish ground truth.

Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?

Aim: To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC).

Materials And Methods: A retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates.

Upgrade of ductal carcinoma in situ on core biopsies to invasive disease at final surgery: a retrospective review across the Scottish Breast Screening Programme.

Aim: To identify factors affecting upgrade rates from B5a (non-invasive) preoperative core biopsies to invasive disease at surgery and ways to improve screening performance.

Material And Methods: This was a retrospective analysis of 1252 cases of B5a biopsies across all six Scottish Breast Screening Programmes (BSPs), ranging between 2004 and 2012. Final surgical histopathology was correlated with radiological and biopsy factors.

The use of imaging in patients post breast reconstruction.

Aim: To evaluate the usefulness of mammographic surveillance for asymptomatic patients and as a problem-solving tool in symptomatic patients with reconstructed breasts.

Materials And Methods: The imaging records over 4 years identified 227 patients with a history of breast reconstruction post-mastectomy due to cancer. Clinical and imaging records were reviewed to evaluate the use of imaging in the follow-up management of these patients.

Imaging breast augmentation and reconstruction.

Breast augmentation and breast reconstruction, either immediate or delayed, are increasingly common operations. All radiologists need to be able to recognize the normal appearances of the more commonly used implants on various imaging modalities, and breast radiologists in particular are facing new challenges when imaging the women involved. This article aims to review the normal and abnormal findings in women who have had breast augmentation and reconstruction, including implant insertion and reconstruction by autologous myocutaneous flaps.

Magnetic resonance imaging and explantation investigation of long-term silicone gel implant integrity.

Background: Information about silicone gel implant longevity is sparse. Magnetic resonance imaging studies have superseded explantation studies in the search for data on their long-term integrity. Unfortunately, the majority of studies are based predominantly on second-generation implant cohorts.

Does the insertion of more than one wire allow successful excision of large clusters of malignant calcification?

Aim: To determine whether the insertion of more than one localization wire for larger areas of malignant microcalcification reduces the need for re-excision.

Method: This is a retrospective study of 101 cases of malignant calcifications preoperatively marked by one or more wires. Surgical and histopathology data were obtained from hospital records.

Screening for breast cancer.

Mammographic screening for breast cancer commenced in the UK in 1988 following the recommendations of the Forrest Committee and is now well established. This article reviews the evidence for efficacy of mammographic screening, the mode of delivery of the service including the assessment of mammographic abnormalities and the role of needle biopsy in diagnosis. Despite the established position of breast screening in the UK there are continuing challenges, not least workforce issues and the recent extension of the programme.

The role of needle biopsy in the diagnosis of breast lesions.

14G core biopsy has contributed enormously to the pre-operative diagnosis of breast malignancy, although it is still subject to certain shortcomings. It is important to review core biopsy results in a multidisciplinary environment, especially when dealing with benign results, to minimize the potential for false negative cases. In certain circumstances, FNAC (fine needle aspiration cytology) still has an important part to play although this is very much dependent upon local circumstances.

Symptomatic women with normal screening mammograms: is assessment by the breast screening programme justifiable?

Since the commencement of screening in 1988, the West of Scotland Breast Screening Programme has invited women with symptoms, but normal screening mammograms, for assessment. This paper reviews the results of 344 such assessments. Malignancy was detected in three patients; two had invasive carcinoma and one Paget's disease of the nipple.

The effects of HRT on screening mammography.

The effects of hormone replacement therapy on screening for breast cancer by mammography are reviewed. There is a decline in specificity in screen mammography for women over the age of 50 taking oral preparations, The use of HRT also reduces the sensitivity of breast screening by regular mammography.

Do pre-operative abdominal exercises prevent post-operative donor site complications for women undergoing DIEP flap breast reconstruction? A two-centre, prospective randomised controlled trial.

The deep inferior epigastric perforator (DIEP) flap is the gold standard for breast reconstruction using abdominal tissue. Unlike the transverse rectus abdominis myocutaneous (TRAM) flap, no rectus abdominis muscle is removed with the flap, but intra-muscular scarring can still cause post-operative complications. Strong abdominal muscles have been advocated as a prerequisite for surgery, but without any evidence as to the potential benefits.

Should fine needle aspiration cytology in breast assessment be abandoned?

Fine needle aspiration cytology (FNAC) has been used extensively in the U.K. for the diagnosis of breast lesions over the past 15 years.

The effect of hormone replacement therapy on the sensitivity of screening mammograms.

Aim: The use of hormone replacement therapy (HRT) can lead to various changes on the mammogram including increasing density. The object of this study was to assess the effect of HRT on the sensitivity of mammographic screening by comparing HRT usage in women with screen detected breast cancers with HRT usage at the time of screening in women presenting with interval cancers.

Methods: The West of Scotland Breast Screening Programme serves a population of 180,000 women aged 50-64 years old.

The effect of hormone replacement therapy on recall rate in the National Health Service Breast Screening Programme.

Purpose: Hormone replacement therapy (HRT) can lead to an increase in the density of breast parenchyma on mammography and to the development of mammographically visible cysts and fibroadenomas. These changes may obscure features indicative of benign processes or mimic those of a carcinoma on screening mammography. This study was designed to assess the effect of HRT usage on the recall rate of women attending for routine breast screening.

The impact of core-biopsy on pre-operative diagnosis rate of screen detected breast cancers.

The UK breast screening Surgical Quality Assurance guidelines suggest a target for pre-operative diagnosis of screen detected cancer of over 70%. Core biopsy was introduced in our breast screening assessment clinics in April 1994 and this study reports the impact of introducing core biopsy on the pre-operative diagnosis rate. Between April 1994 and March 1995, 100 cancers were detected.

Computed tomographic peritoneography: CT manifestations in the investigation of leaks and abnormal collections in patients on CAPD.

Continuous ambulatory peritoneal dialysis (CAPD) is now a common form of treatment for patients with chronic renal failure. However, peritoneal leaks and abnormal intraperitoneal collections can be problematic in these patients, leading to poor dialysate returns, anterior abdominal wall oedema, and genital oedema. We report on a series of 62 computed tomographic peritoneograms performed using a standard protocol on 39 symptomatic patients over 6 years.