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Imaging plays a critical role in the diagnosis and management of breast cancer. Two-view mammography and ultrasound form the mainstay of breast imaging and are essential components of the triple assessment. Digital mammography is rapidly replacing analogue mammography, and recent advances such as digital tomosynthesis add a third dimension to conventional 2D mammographic images. The versatility of ultrasound allows assessment of the breast and axilla as well as accurately targeted interventions, from the simple diagnostic core biopsy to preoperative tumour localization. It also guides large volume biopsies and excision of certain benign lesions, which in some cases can obviate surgical excision. Newer ultrasound techniques being applied to the breast and axilla include elastography and the use of intradermal microbubbles to guide the radiologist to the sentinel axillary node. Breast MRI is a powerful modality in assessing breast cancer. It can provide accurate information on size and multifocality of lesions, particularly those that are mammographically challenging such as lobular cancers, and it is also used to assess response to neoadjuvant chemotherapy and guide surgical management. CT scans, and in selected cases Positron Emission Tomography, play important roles in the assessment of metastatic disease.

This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to implants, lipomodelling and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists. 1. Pre-aesthetic surgery 2. Post-aesthetic surgery If breast imaging or breast assessment is required, it should be performed in a designated breast facility with access to specialist breast imaging and a complete breast multidisciplinary team in accordance with national guidelines and recommendations.

Imaging plays a critical role in the diagnosis and management of breast cancer. Two-view mammography and ultrasound form the mainstay of breast imaging and are essential components of the triple assessment. Digital mammography is rapidly replacing analogue mammography, and recent advances such as digital tomosynthesis add a third dimension to conventional 2D mammographic images. The versatility of ultrasound allows assessment of the breast and axilla as well as accurately targeted interventions, from the simple diagnostic core biopsy to preoperative tumour localization. It also guides large volume biopsies and excision of certain benign lesions, which in some cases can obviate surgical excision. Newer ultrasound techniques being applied to the breast and axilla include elastography and the use of intradermal microbubbles to guide the radiologist to the sentinel axillary node. Breast MRI is a powerful modality in assessing breast cancer. It can provide accurate information on size and multifocality of lesions, particularly those that are mammographically challenging such as lobular cancers, and it is also used to assess response to neoadjuvant chemotherapy and guide surgical management. CT scans, and in selected cases Positron Emission Tomography, play important roles in the assessment of metastatic disease.

In selected patients, our Unit has recently moved from handheld ultrasound-guided vacuum-assisted core biopsy (VACB) piecemeal acquisition of tissue to the handheld Intact Breast Lesion Excision System (Intact). Intact removes a single piece of tissue, potentially allowing radiologists to excise the entire lesion as well as allowing pathologists to visualise lesion architecture more easily and to calculate margins. We evaluated our early experience of excising benign or likely benign breast lesions using the 20 mm Intact.

Fibroadenomas are benign breast tumours made up of glandular and fibrous tissue. Despite their benign pathology, factors such as size, discomfort, altered breast shape and patient choice sometimes lead to excision. Traditionally, open excision biopsy has been the method of choice for fibroadenoma removal but, since 2005, our breast unit has offered patients minimally invasive ultrasound-guided complete fibroadenoma excision using vacuum-assisted core biopsy (VACB). We present an audit of our practice and patient outcomes regarding VACB excision of fibroadenomas.

Iliac rupture and aneurysm formation at the site of stent placement has rarely been described in the literature. We report four cases, three of iliac rupture, including a delayed rupture, and an aneurysm, with the use of a single type of stent, the Memotherm stent. We believe the design of the stent significantly contributed to damage to the arterial wall and subsequently prevented closure of the arterial tear by balloon tamponade in the two cases where this was attempted. Two patients, one with rupture and one with an aneurysm, were successfully treated with a covered stent obviating surgery and two ruptures resulted in death. We recommend that all interventionists carrying out iliac angioplasty and/or stenting should have access to covered stents for such emergencies.

The aim of this study was to compare the results of fine needle aspiration (FNAC, current practice) with imprint cytology (CIC) from ultrasound-guided cores taken in the one-stop clinic setting. CIC allows same-day results with one biopsy procedure. Literature suggests CIC provides a higher sensitivity/C5 rate, although there are few direct comparisons of CIC with FNAC.

Recent studies have questioned the value of bone scans (BS) in staging breast cancer when a CT chest, abdomen and pelvis is also performed. We retrospectively reviewed breast cancer staging CTs and BS performed within 2 months of each other, to see if BS identified more skeletal metastases than CT.

For several years our breast unit has evaluated indeterminate breast microcalcification using stereo-guided vacuum-assisted core biopsy (VACB) - piecemeal acquisition of unorientated tissue. The Intact Breast Lesion Excision System (Intact) removes a single larger piece of tissue, potentially allowing pathologists to calculate margins and visualise lesion architecture more easily. This study evaluates the role of the 20 mm Intact in assessment of subcentimetre clusters of indeterminate breast microcalcification.

In our Trust, all breast cancer patients undergo preoperative axillary staging with ultrasound. Over the past year we have introduced intradermal sulphur hexafluoride microbubbles ultrasound contrast injection to help identify sentinel lymph nodes for a preoperative needle biopsy in each patient. Only patients with malignant node morphology on grey-scale ultrasound undergo biopsy without microbubbles injection.