Meeting Abstracts from the British Society of Breast Radiology annual scientific meeting 2023

The COVID-19 pandemic led to recommendations for decreased or ceased breast screening services. Prior studies that examine the COVID-19 impact on mammography volumes are limited to single regions and rates of less than 9 months post-pandemic. This study aims to assess the recovery of screening mammography volumes from 3 months pre COVID-onset through 12 months post COVID-onset across 7 participating sites from four countries. We collected mammography volume data from 7 breast screening services (Canada, Germany, USA, UK) between December 2019 and April 2021 using an artificial intelligence software tool. The study was approved by the research ethics at participating sites. 249,817 screening mammograms were collected. Of the 7 participating sites, 4 returned to and occasionally exceeded pre-COVID volumes, whereas the other 3 sites approached but did not fully return to pre-COVID volumes in the 12 months post COVID. Sites varied substantially in the time taken to re-initiate screening mammography after the first COVID wave (1–6 months). One site shut down screening services in successive COVID waves, while other sites experienced short dips in volumes but generally recovered within one month. In the 1-year period post COVID-onset, mammography screening volumes recovered to varying extents at differing rates, with some sites returning to pre-pandemic levels and others lagging behind. This international multi-center study may inform future opportunities for collaboration between sites to develop strategies for increasing screening volumes and sharing best practices for pandemic recovery.

Background: Targeted axillary dissection (TAD) offers less invasive surgery and more individualised axillary management.It can be an alternative to axillary clearance in node-positive patients who respond to neoadjuvant chemotherapy (NAC).However, identifying appropriate candidates for a TAD procedure is critical.This study is a multi-modality review of axillary imaging with correlation to the surgical outcomes TAD patients.The validity of the pre-treatment marking of the metastatic axillary node is also assessed.Methods: Between 2018 and 2022, breast cancer patients with biopsy-proven axillary disease who received NAC and subsequently underwent a TAD and sentinel lymph node (SLNB) were retrospectively identified.Results: 37 patients met the inclusion criteria.The baseline US identified positive nodes in 92% (34/37) with 100% detection on MRI.On the post-treatment US, 89% (34/37) demonstrated complete imaging response.The pre-treatment clip used for localisation allowed for successful identification of the involved node in 97% of cases (35/36).49% (18/37) of patients had complete response to NAC with no evidence of nodal involvement on the axillary specimen histopathology.Of the 51% (19/37) who did demonstrate residual disease, a completion axillary clearance was performed with only 3 cases showing disease in the remaining nodes.

Conclusion:
Approximately half of the node-positive patients treated with NAC can avoid an axillary nodal clearance (ANC) by being offered a TAD procedure instead.As the paradigm shifts towards minimally invasive surgery, the role of the radiologists will become ever more crucial in identifying suitable candidates for this procedure.

O5.
A multicentre review of the direct access mammography programme in Ireland for women with breast pain Dr Caoimhe Geoghegan 1 , Dr Michelle Horan 1 , Dr Emily Crilly 2 , Dr Aisling Kelly 3 , Dr Rachel Lyons 4 , Dr Laoise Geoghegan 1 , Dr Deirdre Duke 2 , Dr Laura Sweeney 3 , Damian MacCartan 4 , Dr Sylvia O'Keeffe Background: Targeted Lung Health Check (TLHC) is a national program for detection of early lung cancer, rolled out as a series of pilot programmes, based on lung cancer mortality rates.High risk patients between 55 and 74 years, receive a low dose CT thorax.Inevitably there are significant numbers of incidental breast lesions detected on these scans.In our region, the TLHC catchment area overlaps significantly with the breast screening catchment area.Method: Our unit started receiving referrals from TLHC in December 2022.Recognising the need for a filtering process for these referrals, we set up a pathway where the lead chest physician emails our team with details of patients with incidental breast findings.Our team reviews the patient's previous screening and symptomatic imaging.If the lesion is longstanding, unchanged or proven benign, we advise no further action.If new or enlarging, we advise assessment in symptomatic clinic.Results: In 7 months, 37 requests for imaging review have been made from 2035 women screened by TLHC.9 out of 37 were recalled for assessment.Of 9 recalled, 4 were cancer, 4 benign and 1 is awaiting assessment.All 4 patients diagnosed with cancer had not attended multiple breast screening appointments.Of the 4 benign cases, 2 had no previous mammograms and 2 showed change from previous mammograms.Conclusion: This pathway is effective in preventing unnecessary referral to the symptomatic breast services.TLHC CTs could be useful in detecting breast cancers in women who do not attend their screening mammograms.

P2. 5 year retrospective analysis of Vacuum Assisted Excision for B3 breast lesions at University Hospital Southampton, UK
Dr Charis Brook 1 , Dr Ruth Walker 1 , Dr Selina Lam 1 , Dr Brenna Fielding 1 , Dr Monica Banerjee 1 1 University Hospital Southampton, Southampton, United Kingdom Breast Cancer Research 2024, 26(1):P2 We present our Vacuum Assisted Excisions data performed for B3 breast lesions over 5 years.Management guidelines for B3 lesions introduced in 2016 by the NHS Breast Screening Programme (NHS BSP) addressed concerns of overtreatment, recommending Vacuum Assisted Excision (VAE) in the majority of B3 lesions instead of surgery.VAE is a well-tolerated procedure that allows adequate sampling to ensure no concurrent malignancy.Methods: All patients who underwent VAE from September 2017 to October 2022 in our breast unit were analysed.Initial histology was compared with histology at VAE, to look for upgrade.Results were compared with published upgrade rates from NHSBSP.All subsequent recurrence/development of breast malignancy following VAE in the 1-5 years following their procedure was reviewed.Results: 244 VAEs were performed.Overall upgrade rate of B3 lesions was 10.6%.The most frequently upgraded histology was AIDEP (28%).Most patients (92%) undergoing VAE were of screening age population (47-73 yr old).19 patients < 50yrs underwent VAE following symptomatic presentation.3 patients (1.2%) who were discharged following VAE with nonupgraded histology presented with malignancy within 5 years of VAE.All these were under 50 yrs at the time of VAE.We have since modified our practice and do not perform VAE for B3 lesions in patients under 50yrs old.Conclusion: VAE allows adequate sampling of B3 lesions and is both less invasive than surgery, and provides cost saving to a stretched NHS.VAE can provide an effective, definitive, and well-tolerated treatment of B3 breast lesions.Background: Mammography is the surveillance test of choice post primary breast malignancy.Current Irish guidelines are for annual mammography until the age of 70 or for 5 years post-surgery, whichever is later.This generates significant workload and has little evidence to support it.Aim: To analyse post breast cancer mammographic surveillance in a single symptomatic breast centre, with reference to potential areas of improvement.Methods: All patients diagnosed with breast cancer between Jan 2010-Dec 2014 were identified.Histological subtypes and receptor status was recorded.Number of routine surveillance mammograms, recalls and subsequent investigations were recorded and interpreted using descriptive statistics and logistic regression models.Results: 1,491 patients were diagnosed with breast cancer over 5 years.69 were excluded and 1,083 removed from surveillance.Of those removed, 35% developed metastases, 21% reached 70 + , 13% were managed medically, 13% had bilateral mastectomies and 18% were medically unwell.339 patients were still undergoing mammographic surveillance in 2022, generating 3,109 single-read mammograms since diagnosis.There were 321 recalls for further imaging and 46 biopsies.Recall rate within the first 5 years is significantly higher compared to years thereafter; odds ratio 0.5 (p value = 0.00, CI 0.39-0.64).There were 12 malignant biopsies within 3,109 routine mammograms (0.38%).If the surveillance interval reduced to biennial after 5 years, workload would be reduced by 934 mammograms and identification of 4 malignancies would have been delayed by 1 year.

Conclusion:
A review of current guidelines should be considered accounting for patient age, histological subtype and family history.

P4. A Review of Patient Outcomes at a Low Risk Breast Clinic
Aisling Daly 1 , Dr Elaine Davis 1 1 Belfast City Hospital, Belfast, Northern Ireland, United Kingdom Breast Cancer Research 2024, 26(1):P4 Aim: We describe the outcomes in all non-urgent referrals to our Regional Centre triaged as "routine" and aged under 30 years of age.Background: Breast cancer is rare in young women.The incidence of breast cancer in women younger than 30 has been recorded as 0.43% and in Western countries, women under the age of 30 account for 0.65% of all breast cancers.This low incidence rate provides the rationale behind avoiding unnecessary radiation and biopsy in women under 30 years of age presenting with low risk symptoms.

Method:
1. Retrospective analysis of all referred patients to our institution under the age of 30 over the previous 7 years.Red flag referrals were excluded.2. Non urgent referrals were based on the NICAN (Northern Ireland Cancer Network) guidelines where "Non urgent" is considered in patients under 30 presenting with an unexplained lump with/without pain.3. Clinics were staffed by one Staff Grade in Breast surgery and two breast sonographers.4. Main presenting complaint was a mobile breast lump (± pain).Results: We found 3 cases of breast cancer out of a total of 1300 patients under the age of 30 who had been referred to the low risk breast clinic at our institution over 7 years.

Conclusion:
• Patients under the age of 30 can be safely managed in low risk breast clinics.The NHS breast screening programme has mandatory double reporting of mammograms.Some cancers will only be detected by a single reader.These films are by nature those that are tricky to interpret with less obvious features to perceive.This is a review of the mammographic features, site, size, and tumour types of these cancers.
In this study we reviewed all the single reader called cancers over a period of 5 years.(between 04/2017-04/2022).
No differentiation was made between job role of the reporter or the order of film reading.A total of 132 patients had a cancer diagnosed by a single reader.25% of these were non-invasive and 75% were invasive.
The main feature (78%) of non-invasive disease was calcification and over half ( 56%) of the non-invasive disease was high grade.
The main features of the invasive disease were ill defined masses or distortions.28% of the invasive disease was grade 3. The mean size of the radiographic features detected was less than 13 mm.The locations of the radiographic abnormalities will be mapped onto a large diagram on the poster using symbols for features.O-well defined mass.X-ill defined mass, #-asymmetry.*-distortion and.▲-calcification.48/132 of the features were found in one of the typical review areas for mammography.
The aim of the poster is to highlight these review areas and features of these difficult to perceive malignancies and to highlight these areas to film readers.Background: Based on previous research using an Aixplorer ultrasound system, biopsy is not required for presumed fibroadenomas with benign greyscale ultrasound and shear-wave elastography (SWE) findings for women aged 25-39 years.This service evaluation compares findings between the Aixplorer and Samsung ultrasound systems, and reviews follow-up data.Methods: Patients aged 25-39 years who attended the breast clinic between 03/06/21-12/07/23, with presumed fibroadenoma with benign ultrasound and SWE features were included.Age and average SWE value (across four images) were recorded, grey-scale images were reviewed for benignity.The independent T-test was used to compare patient age and average lesion SWE value between those scanned on the Aixplorer system compared with the Samsung system.Databases were reviewed for patients with at least six months follow-up.

P12. Architectural distortion on digital tomosynthesis mammograms in symptomatic
Results:111 patients were included (Aixplorer cohort: 30 patients, Samsung cohort: 81 patients).Average age was 32.0 years, no significant difference between cohorts (p = 0.4).Average SWE values were significantly higher in the Samsung cohort compared to Aixplorer cohort; 33.19kPA vs 23.27kPA respectively, p < 0.01.36 patients had six months -2 years follow-up with no subsequent malignant diagnosis, two further lesions with benign greyscale and SWE features were biopsied and proven to be fibroadenomas.

Conclusion:
No cancers were detected on follow-up.Average SWE values were significantly higher in the Samsung cohort.This supports that the existing guidance can be safely applied to the new system, however, it suggests that a higher cut-off value may be appropriate to limit unnecessary benign biopsies.Further validation work on the new system is recommended.Aim: To determine epidemiological characteristics, imaging findings and histological properties of MBC in our institution, and compare with published literature.Method: Retrospective review of electronic records and imaging of all male patients diagnosed with breast malignancy at our centre from 2012-2022.

P19. Arbitration of prevalent round recalls in the
Results: 4179 patients in total were diagnosed with breast malignancy from 2012-2022.1% were male.Of those, only 51% were diagnosed with a primary breast malignancy, and 49% with secondary breast metastasis, with lymphoma and melanoma the most common primaries.This contrasts with an 85% primary breast malignancy rate within our female population.Commonest presenting symptoms of MBC were palpable central lumps (54%) and nipple symptoms (42%).Ages ranged from 44-92, with a mean age of 68.38% had a positive family history, of which 2 were BRCA positive.Smoking and alcohol consumption were reported in 25% and 33% respectively.33% were node positive.Invasive ductal carcinoma was diagnosed in 83%, with 88% oestrogen/progesterone receptor positive and 92% HER-2 negative, comparable with female receptor statuses described in literature.

Conclusion:
MBC is rare.The ratio of malignancies that are secondary metastases is higher in the male than female population.Incidence, imaging characteristics and tumour biology of MBC in our institution are similar to previously published studies.Breast cancer (BC) is the most common UK cancer type, with 1 in 8 women diagnosed during their lifetime.Screening for BC automatically stops after 70 years, unless women continue to self refer, but the risk of BC continues to increase with age.

P21. Measurement of LOCalizer
Early diagnosis increases the chance of recovery, and therefore it is vital that radiologists are aware of the early signs of BC and look out for these when reporting imaging performed for another reason, such as a CT pulmonary angiogram (CTPA).Cycle one of this audit was performed in 2021; 892 women were identified who had been diagnosed with BC between 2011 and 2021; of these, 123 had had a CT scan which included the breasts available prior to their diagnosis, in which a BC had been visible and there was the opportunity for a radiologist to report it.Only 49% of visible cancers were reported by radiologists.The results were reported to the local radiology team and the audit repeated in 2023.Data was analyzed for 1000 women diagnosed with BC since 2021 and whom had had a CT performed prior to diagnosis and after the results of the initial audit were delivered.In this cycle, 57 women had had an incidental BC visible on CT, and these were reported in 81% of cases.Therefore, there has been a significant improvement in radiologist identification of incidental breast cancers between the 1st and 2nd audit cycles (49% and 81% respectively), which positively impacts cancer detection pathways.

lesions detected at lung screening (Targeted Lung Health Check CTs): impact to breast services and a pathway for management Dr Anuradha Anand
1 , Dr Lyndsey Brierley 1 , Dr Aninda Saha 1 , Dr Naveed Altaf 1 1 North Tees Breast Screening Unit, Stockton, United Kingdom Breast

Breast Cancer Research 2024, 26(1):P6
compliance with the updated local guidelines and compare compliance with the initial audit.Method: A retrospective audit was conducted of 100 staging CT chest/abdomen/pelvis between 16th September 2022 and 31st December 2022.This included reviewing the indication for the staging CT and the percentage detection rate of metastatic disease.Results: Fifteen cases had a previous history of breast cancer and 2 scans were for follow-up, these were therefore excluded.66/83 cases clearly met the updated guidelines.Four CT scans were requested pre-operatively for several abnormal axillary lymph nodes however the exact number of nodes was not specified.One case, an aggressive papillary lesion progressed rapidly, this didn't meet the guidelines initially however the patient required NACT.Twelve cases did not meet the guidelines, none of these had metastatic disease.Eleven patients had bone/liver/lung metastases.Further imaging was recommended in 50% cases.Conclusion: 80% staging CTs met the locally agreed guidelines.This is unchanged from the initial audit in 2020 and demonstrates the challenge in achieving a sustained change in practice.14% cases didn't meet the guidelines and none of these patients had metastases.From a radiology perspective clearly documenting the number of abnormal axillary lymph nodes would help ensure the correct patients have staging.50% of cases required further imaging which significantly increases the radiology workload.Indeterminate results also lead to continued patient anxiety.coronary heart disease (CHD) than breast cancer.It is estimated that healthcare costs relating to heart and circulatory diseases cost the UK economy £9 billion each year.Breast arterial calcification (BAC) is an incidental finding on mammography that is strongly correlated with coronary artery calcification (CAC) on computed tomography (CT) and incident CVD events including CVD death and ischaemic stroke.By identifying those with BAC, we can identify women who are at higher cardiovascular risk and potentially intervene at an earlier stage to prevent adverse cardiovascular events and outcomes and reduce the economic burden.Currently there are no standardised guidelines for the reporting of BAC on mammography in the UK and Ireland.Learning Objectives 1.To review the most recent literature on the association between breast arterial calcification and CVD outcomes as well as the understanding and reporting habits of breast radiologists in Europe, Canada and the USA. 2. To highlight and describe a quick and easy qualitative BAC grading system that has been previously published in the literature, with suggested wording for mammogram reports, and which has recently been endorsed by the Canadian Society of Breast Imaging (CSBI).3. To review the current management recommendations for BAC on mammography as described by cardiologists in the literature.
minate lesions on mammograms (M3), 55% on ultrasound (U3) and 30% on MRI (MRI3) turned out to be malignant.Common findings on mammograms were mass (27.5%), microcalcifications (17.5%) and distortion (10%).On ultrasound, malignant lesions were frequently well-circumscribed (52.5%) rather than typical spiculated (15%) or microlobulated (12.5%).Additionally, only 20% demonstrated anti-parallel orientation.On MRI, majority were well circumscribed (40%) and 12.5% non-mass enhancement.Total 40% of indeterminate and suspicious lesions on MRI were normal on mammograms, due to extremely dense breast parenchyma.Furthermore, 2 women with marked background parenchymal enhancement and no specific lesions on MRI were subsequently diagnosed cancer on risk-reducing mastectomies.Conclusion: Malignant lesions in high-risk women often appeared indeterminate on all modalities, and typical malignant features were infrequent.Biopsy at initial instance and dedicated screening MRI/ mammograms are crucial for early detection and management of cancer in this group.P7.CT staging in breast cancer-are we over staging?Dr Lucinda Frank 1 , Dr Rebecca Geach 1 1 North Bristol NHS Trust, Bristol, United Kingdom Breast Cancer Research 2024, 26(1):P7 Introduction: Following an initial audit, our local guidelines for CT staging in breast cancer were updated in November 2021.This re-audit aimed to evaluate P8.Breast MRI in the absence of MRI-guided biopsy: A retrospective review with three years follow-up data Dr Soheila Hajialiasgar 2 , Dr Sarah Savaridas 1 1 University of Dundee, United Kingdom; 2 NHS Tayside, Dundee, United Kingdom Breast Cancer Research 2024, 26(1):P8Background: Utilisation of breast MRI is ever-increasing against a backdrop of workforce shortages.MRI has high sensitivity, but lower specificity may result in unnecessary recalls and benign biopsies.This is further hampered by extremely limited access to MRI-guided biopsy.Methods: Clinical reporting systems were used to identify all breast MRIs performed between 01/01/2019-31/12/2019.Indication for MRI and MRI lesion features were recorded, recall rates and biopsy rates were calculated.Pathology was reviewed.Cases were followed-up for a minimum of three years.Results: 283 MRIs (216 women) were included.Indications were; highrisk screening(40), neoadjuvant chemotherapy monitoring(65), locoregional staging(89) and other(22).Twenty-seven MRIs (9.5%) were recalled.Twenty-six biopsies were performed, biopsy results were B1-2 (4), B3 (4), B5 (19).One B3 case was upgraded to ILC at surgery.Cancer detection rate in the screening group was 7.5% (3 of 40).Two cancers were identified in the follow-up period: one in a high-risk screener, one presumed previously occult on all imaging with 1 St James's Hospital, Dublin, Ireland Breast Cancer Research 2024, 26(1):P9 Background: Cardiovascular disease (CVD) is the leading cause of premature death for women in the United Kingdom with twice as many women dying from P10. Stereotactic biopsy of microcalcification using standard 14-and 12-G core biopsy versus vacuum-assisted biopsy during a global needle shortage Dr Chao Jin Ho 1 , Dr Alice Leaver 2 , Dr Alan Redman 2 , Dr Simon Lowes 2 1 Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom; 2 Breast Screening and Assessment Unit, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom Breast Cancer Research 2024, 26(1):P10In 2021 there was a global shortage of VAB (vacuum-assisted biopsy) needles, meaning our unit had to start using standard core biopsy (CB) needles (14-and 12-gauge) for some of our stereotactic biopsies.This study assesses the success of this technique by 1 , Dr Luci Hobson 1 , Michelle Taylor 1 , Dr John Gifford 1 , Dr Nicholas Ridley 1 , Dr Karen Litton 1 1 Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom Breast Cancer Research 2024, 26(1):P11

Breast clinics: Correlation with pathological outcomes Riya Kale 1
= 33) and unchanged distortion (n = 14), there were 111 patients with pure distortion, which were included in this study.A flow chart depicting patients' journey and the management pathway was created.Correlation with histopathology was obtained.All patients were followed for at least two years.
1 Cardiff University, Cardiff, United Kingdom Breast Cancer Research 2024, 26(1):P12 Aim: In our centre, standard two-dimensional mammograms were replaced with Digital Breast Tomosynthesis (DBT) and synthesized 2D views (C view) for symptomatic 'one-stop' clinics from April 2020.The aim of this study was to evaluate the positive predictive value for malignancy in DBT detected Architectural Distortion (AD).Methods: All mammogram reports with the word 'distortion' between April 2020 to October 2022 were assessed.There was a total of 458 mammograms with the word 'distortion' .After excluding mammograms with no distortion (n = 128), post-surgical distortion (n = 173), distortion with mass (n Conclusion: A total malignancy rate of 42.34%, DBT detected architectural distortion has a high enough PPV for malignancy to justify tissue sampling.Chances of malignancy are higher when a US correlate corresponding to AD is present.P13.

Cancer incidence in a 7 year follow up of a B3 cohort-Can we use breast screening for over 50's?
Conclusion:The malignancy rate amongst our local screening post large volume excisions B3 patient cohort is low.Current practice of intensive yearly follow up over a 5-year period may not be the most appropriate way of utilising limited breast radiology resources.Wider discussion on follow up timing of these slow-developing lesions via the breast screening programme, or staggered over a longer time frame should be considered.Our data supports follow up mammography could be done at the regular screening interval.Anticipated results from the Sloane cohort study should provide further clarification on this matter in due course.P14.

Change of arbitration strategy in an NHS BSP unit to include double reader recalled mammograms following change of target recall rate: effect on recall and cancer detection rates
7%).In 2017, the proportion of examinations performed for assessment of NAC increased sharply to 28.2% and it continues to show a year-on-year increase.Spanning 2017-2022, NAC assessment now accounts for an average 35.2% of all scans (range 28.2-38.8%).The second commonest indication for MRI is now lobular carcinoma (20.1% in 2022) then surveillance (16.2%) and occult disease (12.9%).

Cancer Research 2024, 26(1):P16
Histology and MRI lesion size measurements exhibited strong correlations across all cases with paired measurements, and when cases of "A or B" and cases of "C or D" density were considered separately (all r values > 0.7).The strength of correlation did not differ significantly between cases of "A or B" and cases of "C or D" density.
d = 0.085, 90%CI −0.092 to 0.261).Paired histology and MRI lesion sizes did not differ significantly for cases of "A or B" or cases of "C or D" density.Breast Cancer Research 2024, 26(Suppl 1):62

Cancer Research 2024, 26(1):P19 Background:
This re-audit was performed to assess effectiveness of the action plan formulated following baseline audit of prevalent recall rate (pRCR) in 2016/17, which showed a high pRCR of 12.43%, above the then NHSBSP Acceptable Standard of < 10%.In May 2017, unit policy changed to incorporate a consensus arbitration meeting for all prevalent recalls (unless classified M5 by both readers) to try and decrease pRCR.This audit aims to determine if pRCR is now within the NHSBSP Achievable Standard of < 7%, and to establish if there has been any accompanying change in cancer detection rate (CDR).
Introduction: Male Breast cancer (MBC) is uncommon, with 1.2 cases per 100,000, however incidence has steadily increased in past decades.Improved understanding of patient characteristics, risk factors, and pathology, and how those differ from female patients, is paramount for early detection and improved treatment.

71 year old self-referrals in a UK breast screening programme; what is the impact on workload? Dr Wesam Rjoop
1 , Dr Karen Paisley 1 , Frances Kinsman 1 1 University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom Breast

Cancer Research 2024, 26(1):P22 Aim:
To review clients ≥ 71-years who self-referred for screening between April 2019 and March 2022, and to evaluate key performance indicators relative to the invited population aged 50-70 years, and impact on workload.The median time to an event from the date of diagnosis was 35 months (range 0-144 months).Compared to a non-mass enhancement, a mass-like enhancement was statistically associated with fewer events (p = 0.011).The factors most significantly associated with an event were triple negative (TN) status, a higher number of lymph nodes on baseline MRI and post-surgery (ypN).No significant association was found between T stage, tumour grade or MR response pattern (concentric versus crumbling).Conclusion: Of all breast cancer patients receiving NACT, 28.9% showed an adverse event at a median of 35 months.Factors predicting an event in breast cancer patients receiving NACT were TN receptor status, non-mass enhancement on MRI and higher lymph node status.

of MRI in detecting the presence of residual disease post Neoadjuvant Chemotherapy: The Welsh Experience Dr Megan Wallace
2 , Dr Aisha Syed 1 , Dr Jyoti Bansal 1 To evaluate the accuracy of MRI in detecting the presence of residual disease in breast cancer patients post Neoadjuvant chemotherapy (NACT) in our current practice and compare it with published literature.Methods: A retrospective evaluation of all Breast MRIs for NACT monitoring between 2009 and 2018 was performed.All patients were followed up for at least five years with the median age of patients at 48 years (range 23 to 73).Post NACT MRI scan reports were compared with histological findings to determine the accuracy with published data.Results: Out of 135 patients, 101 had adequate data for evaluation in this study.76 patients (75%) had an accurate MRI prediction of response to NACT reported.Out the patients that had inaccurate prediction of response to treatment 68% were triple negative and the remaining 32% were HER 2 positive.(34%) still had residual disease detected on resection of the tumour despite MRI reporting response to NACT as complete.57 patients (76%) whose MRI showed partial response had partial histological response.20% of MRI reports which showed residual disease in breast cancer patients had complete response to NACT demonstrated upon histology findings.Conclusion: For detecting residual disease post NACT, MRI was found to have a sensitivity of 90.4% a specificity of 63% a PPV of 83.5% and NPV of 75.7%.This data is in line with the available publish data.Of those with inaccurate MRI findings.MRI findings predictions were least accurate in triple negative breast cancer.

breast cancers by Radiologists: results of a full cycle audit
Dr Claire Filippini 1 , Dr Louise Wilkinson 1 Oxford University Hospitals NHS Foundation Trust, United Kingdom Breast