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Vinnicombe, Sarah
Biography
I am a clinical radiologist specialising in cancer imaging, particularly of breast cancer and lymphoma. I have been lead breast radiologist and deputy director of breast screening for GHNHSFT since 2018. Prior to that I was clinical Senior Lecturer and honorary consultant radiologist at the University of Dundee and NHS Tayside from 2011 till 2018. Prior to that I was Director of Breast Screening and lead breast radiologist at Barts and The London NHS Foundation Trust.
I have over 110 peer reviewed publications, have written 16 book chapters and was co-editor of the last edition of Husband and Reznek's Imaging in Oncology.
I lecture and teach nationally and internationally and have had visiting professorships with ESOR, ECR and the British Society of Breast Radiology (BSBR). I am regularly on the faculty for RSNA and ECR and am an elected fellow of the International Cancer Imaging Society.
I was president of BSBR from 2019-2022, a Trustee and outgoing Chair of the conference organising committee of Symposium Mammographicum. I serve on the organising committee of the UK International Breast Cancer Symposium and am a member of the NHS Breast Screening Programme, Research Innovation Development Advisory Committee, the Clinical Professional Group and the NSC's breast Working Group.
I have served in guideline development groups, the NHSE Breast Faster Diagnostic Pathway Working Group and was a member of the Lancet International Commission on Breast Cancer.
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Publication Metadata only A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK(Elsevier, 2022-08-16) Carpenter, Sarah; Graham, Yitka; Kulkarni, Trupti; Lyburn, Iain; Vinnicombe, Sarah; Sharma, Sheetal; Sharma, Nisha; Lowes, Simon; Lyburn, Iain; Vinnicombe, Sarah; Medical and DentalAim: To investigate the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK from the perspective of trainees and new consultants. Materials and methods: A survey comprising 25 questions was distributed to UK radiology trainees via the regional Junior Radiologists Forum representatives under the auspices of the British Society of Breast Radiology (BSBR). Results: Sixty-nine eligible responses were received representing all UK training regions. Fifty-five per cent of respondents completing either a core or higher breast rotation felt that the pandemic had a negative effect on their breast training. There was an overall reduction in exposure to the key breast imaging methods when rotations took place during the pandemic. Completing a core breast rotation during the pandemic was less likely to attract trainees to higher breast training. Three out of four breast radiology consultants in their first year after receiving their Certificate of Completion of Training (CCT) felt the pandemic reduced their preparedness for becoming consultants. Positive outcomes included the increased use of online educational resources and remote multidisciplinary meetings. Conclusions: As well as having a negative impact on breast radiology training overall, the pandemic has had a detrimental effect on attracting trainees to breast radiology as a future career. It is of key importance that trainees have a positive core breast rotation as this experience appears central to many trainees' decisions to pursue higher breast training. Increased use of online learning resources has also been positively received and is a valuable approach to learning that can be maintained in the longer term.Publication Metadata only Fair shares: building and benefiting from healthcare AI with mutually beneficial structures and development partnerships(Springer Nature, 2021-07-14) Sidebottom, Richard; LYBURN, IAIN; Brady, Michael; Vinnicombe, Sarah; Sidebottom, Richard; Lyburn, Iain; Vinnicombe, Sarah; Medical and DentalArtificial intelligence (AI) algorithms are used in an increasing range of aspects of our lives. In particular, medical applications of AI are being developed and deployed, including many in image analysis. Deep learning methods, which have recently proved successful in image classification, rely on large volumes of clinical data generated by healthcare institutions. Such data is collected from their served populations. In this opinion article, using digital mammographic screening as an example, we briefly consider the background to AI development and some issues around its deployment. We highlight the importance of high quality clinical data as fundamental to these technologies, and question how the ownership of resultant tools should be defined. Though many of the ethical issues concerning the development and use of medical AI technologies continue to be discussed, the value of the data on which they rely remains a subject that is seldom considered. This potentially controversial issue can and should be addressed in a way which is beneficial to all parties, particularly the population in general and the patients we serve.Publication Metadata only Determining patient abdomen thickness from a single digital radiograph with a computational model: clinical results from a proof of concept study(Oxford University Press, 2020-04-17) Worrall, Mark; Vinnicombe, Sarah; Sutton, David; Vinnicombe, Sarah; Medical and DentalObjective: A computational model has been created to estimate the abdominal thickness of a patient following an X-ray examination; its intended application is assisting with patient dose audit of paediatric X-ray examinations. This work evaluates the accuracy of the computational model in a clinical setting for adult patients undergoing anteroposterior (AP) abdomen X-ray examinations. Methods: The model estimates patient thickness using the radiographic image, the exposure factors with which the image was acquired, a priori knowledge of the characteristics of the X-ray unit and detector and the results of extensive Monte Carlo simulation of patient examinations. For 20 patients undergoing AP abdominal X-ray examinations, the model was used to estimate the patient thickness; these estimates were compared against a direct measurement made at the time of the examination. Results: Estimates of patient thickness made using the model were on average within ±5.8% of the measured thickness. Conclusion: The model can be used to accurately estimate the thickness of a patient undergoing an AP abdominal X-ray examination where the patient's size falls within the range of the size of patients used to create the computational model. Advances in knowledge: This work demonstrates that it is possible to accurately estimate the AP abdominal thickness of an adult patient using the digital X-ray image and a computational model.Publication Open Access FAST MRI: DYAMOND trial protocol (can an abbreviated MRI scan detect breast cancers missed by mammography for screening clients with average mammographic density attending their first screening mammogram?)—a diagnostic yield study within the NHS population-risk breast screening programme(BMJ Publishing Group, 2025-09-25) Jones, Lyn; Geach, Rebecca; Loose, Abi; McKeown-Keegan, Sadie; Marshall, Andrea; Halling-Brown, Mark; Curtis, Sian; Harding, Sam; Rose, Jan; Matthews, Helen; Vinnicombe, Sarah; Shaaban, Abeer; Taylor-Phillips, Sian; Dunn, Janet; Vinnicombe, Sarah; Medical and DentalIntroduction First post-contrAst SubtracTed (FAST) MRI, an abbreviated breast MRI scan, has high sensitivity for sub-centimetre aggressive breast cancer and short acquisition and interpretation times. These attributes promise effective supplemental screening. Until now, FAST MRI research has focused on women above population-risk of breast cancer (high mammographic density or personal history). DYAMOND aims to define the population within the population-risk NHS Breast Screening Programme (NHSBSP) likely to benefit from FAST MRI. The study population is the 40% of screening clients aged 50–52 who have average mammographic density (BI-RADS (Breast Imaging Reporting and Data System) B) on their first screening mammogram. DYAMOND will answer whether sufficient numbers of breast cancers, missed by mammography, can be detected by FAST MRI to justify the inclusion of this group in a future randomised controlled trial. Methods and analysis Prospective, multicentre, diagnostic yield, single-arm study with an embedded qualitative sub-study: all recruited participants undergo a FAST MRI. An internal pilot will assess the willingness of sites and screening clients to participate in the study. Screening clients aged 50–52, with a clear first NHSBSP mammogram and BI-RADS B mammographic density (by automated measurement) will be invited to participate (recruitment target: 1000). The primary outcome is the number of additional cancers detected by FAST MRI (missed by screening mammography). A Fleming’s two-stage design will be used as this allows for early stopping after stage 1, to save participants, funding costs and time continuing to the end of the study if the question can be answered earlier. Ethics and dissemination The NHSBSP Research and Innovation Development Advisory Committee and the Yorkshire and Humber–Sheffield Research Ethics Committee (23/YH/0268, study ID (IRAS): 330059) approved this research protocol. Participation involves a two-stage informed consent process, enabling screening for eligibility through automated mammographic density measurement. Patients with breast cancer helped shape the study design and co-produced participant-facing documents. They will disseminate the results to the public in a clear and meaningful way. Results will be published with open access in international peer-reviewed scientific journals. Trial registration number ISRCTN74193022Publication Open Access Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset(BioMed Central, 2022-07-30) Jones, Lyn; Marshall, Andrea; Elangovan, Premkumar; Geach, Rebecca; McKeown-Keegan, Sadie; Vinnicombe, Sarah; Harding, Sam; Taylor-Phillips, Sian; Halling-Brown, Mark; Foy, Christopher; O'Flynn, Elizabeth; Ghiasvand, Hesam; Hulme, Claire; Dunn, Janet; Vinnicombe, Sarah; Foy, Christopher; Additional Professional Scientific and Technical; Medical and DentalBackground Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). Methods Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. Results 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%). Conclusions Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.Publication Open Access Optimising the diagnostic accuracy of First post-contrAst SubtracTed breast MRI (FAST MRI) through interpretation-training: a multicentre e-learning study, mapping the learning curve of NHS Breast Screening Programme (NHSBSP) mammogram readers using an enriched dataset(BioMed Central, 2024-05-28) Jones, Lyn; Marshall, Andrea; Geach, Rebecca; Elangovan, Premkumar; O'Flynn, Elizabeth; Timlin, Tony; Mckeown-Keegan, Sadie; Rose, Janice; Vinnicombe, Sarah; Taylor-Phillips, Sian; Halling-Brown, Mark; Dunn, Janet; Vinnicombe, Sarah; Medical and DentalBackground Abbreviated breast MRI (FAST MRI) is being introduced into clinical practice to screen women with mammographically dense breasts or with a personal history of breast cancer. This study aimed to optimise diagnostic accuracy through the adaptation of interpretation-training. Methods A FAST MRI interpretation-training programme (short presentations and guided hands-on workstation teaching) was adapted to provide additional training during the assessment task (interpretation of an enriched dataset of 125 FAST MRI scans) by giving readers feedback about the true outcome of each scan immediately after each scan was interpreted (formative assessment). Reader interaction with the FAST MRI scans used developed software (RiViewer) that recorded reader opinions and reading times for each scan. The training programme was additionally adapted for remote e-learning delivery. Study design Prospective, blinded interpretation of an enriched dataset by multiple readers. Results 43 mammogram readers completed the training, 22 who interpreted breast MRI in their clinical role (Group 1) and 21 who did not (Group 2). Overall sensitivity was 83% (95%CI 81–84%; 1994/2408), specificity 94% (95%CI 93–94%; 7806/8338), readers’ agreement with the true outcome kappa = 0.75 (95%CI 0.74–0.77) and diagnostic odds ratio = 70.67 (95%CI 61.59–81.09). Group 1 readers showed similar sensitivity (84%) to Group 2 (82% p = 0.14), but slightly higher specificity (94% v. 93%, p = 0.001). Concordance with the ground truth increased significantly with the number of FAST MRI scans read through the formative assessment task (p = 0.002) but by differing amounts depending on whether or not a reader had previously attended FAST MRI training (interaction p = 0.02). Concordance with the ground truth was significantly associated with reading batch size (p = 0.02), tending to worsen when more than 50 scans were read per batch. Group 1 took a median of 56 seconds (range 8–47,466) to interpret each FAST MRI scan compared with 78 (14–22,830, p < 0.0001) for Group 2. Conclusions Provision of immediate feedback to mammogram readers during the assessment test set reading task increased specificity for FAST MRI interpretation and achieved high diagnostic accuracy. Optimal reading-batch size for FAST MRI was 50 reads per batch. Trial registration (25/09/2019): ISRCTN16624917.Publication Open Access Contrast-enhanced digital breast tomosythesis and breast MRI to monitor response to neoadjuvant chemotherapy: patient tolerance and preference(British Institute of Radiology, 2022-02-18) Savaridas, Sarah; Whelehan, Patsy; Warwick, Violet; Vinnicombe, Sarah; Evans, Andrew; Vinnicombe, Sarah; Medical and DentalObjective: Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography and tomosynthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques. Methods: Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE-DBT and MRI following pre-treatment and end-of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with Wilcoxon signed rank test and McNemar test for related samples using SPSS v. 25. Results: 18 patients were enrolled in the pilot study. Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE-DBT with no difference between pre-treatment and end-of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE-DBT. However, more breast pain was experienced during CE-DBT when measured on both VAS (p = 0.011) and categorical scale (p = 0.021). Conclusion: Our paper suggests that patients prefer CE-DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques. Advances in knowledge: Contrast mammographic techniques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of contrast-enhanced spectral mammography, this is the first study to directly explore patient preference for CE-DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE-DBT despite the relatively long breast compression.Publication Open Access Triple-Negative Pleomorphic Lobular Carcinoma in a Mutation Carrier: A Case of Complete Pathological Response(International Scientific Information, 2024-08-11) Jinadasa, Maheshika; Humphreys, Alex; Massey, Eleanore; Vergani, Patricia; Jacob-Pearson, Makaela; Smith, Katherine; Vinnicombe, Sarah; Papathomas, Thomas; Jinadasa, Maheshika; Massey, Eleanore; Vergani, Patricia; Vinnicombe, Sarah; Medical and DentalBACKGROUND Hereditary breast cancer arising in BRCA1-deficient patients is commonly diagnosed as invasive carcinoma of no special type (NST) with medullary features, while invasive lobular carcinoma (ILC) appears to be significantly under-represented in BRCA1 mutation carriers. We report a case of pleomorphic ILC arising in a 28-year-old woman harboring a germline BRCA1 c.3756_3759delGTCT p.(Ser1253Argfs*10) pathogenic variant. CASE REPORT A nulliparous 28-year-old woman with a family history of BRCA1 mutation presented to the symptomatic breast clinic with a several-week history of a left 80-mm breast lump. Core biopsy established a diagnosis of a poorly differentiated triple-negative breast cancer (TNBC) of pleomorphic lobular phenotype. Her clinical diagnosis was cT3, N0, M0, cStageIIB. The MDT recommended CT staging, MRI breast imaging and neoadjuvant chemotherapy (NACT). PET CT imaging showed no evidence of distant metastatic disease. The patient had a good radiological response to NACT with a FEC-T carboplatin regimen. Post-NACT imaging showed a residual cystic mass and the patient underwent a mastectomy and sentinel lymph node biopsy with plans for a delayed latissimus dorsi reconstruction following her adjuvant radiotherapy treatment. A complete pathological response was subsequently demonstrated without any evidence of metastatic disease. CONCLUSIONS This case is the first report of pleomorphic ILC with a triple-negative receptor status and a complete pathological response in a BRCA1 mutation carrier. Our study expands the heterogeneous spectrum of TNBC and contributes to a better understanding of the molecular genetic landscape that characterizes invasive pleomorphic lobular neoplasia.Publication Metadata only Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women(British Institute of Radiology, 2021-01-07) Whelehan, Patsy; Ali, Kulsam; Vinnicombe, Sarah; Ball, Graham; Cox, Julie; Farry, Paul; Jenkin, Maggie; Lowry, Keith; McIntosh, Stuart; Nutt, Rachel; Oeppen, Rachel; Reilly, Michael; Stahnke, Michaela; Steel, Jim; Sim, Ying; Warwick, Violet; Wilkinson, Louise; Zafeiris, Dimitrios; Evans, Andrew; Vinnicombe, Sarah; Medical and DentalObjective: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer. Methods: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted. Results: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases. Conclusions: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. Advances in knowledge: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.Publication Metadata only A13 Systemic Staging for Breast Cancer: when and how?(Biomed Central, 2021-09-17) Vinnicombe, Sarah; Vinnicombe, Sarah; Medical and DentalWorldwide, breast cancer is the commonest female cancer and the leading cause of female cancer mortality in most countries, with over 2 million new diagnoses and 630,000 deaths in 2018 [1]. Thanks to mammographic screening programmes in most developed countries, many cancers are small at diagnosis. There is a clear relationship between the size of the primary tumour (T stage) and the presence of distant metastases (DM) at presentation. In patients with T1 tumours (smaller than 2cm), the incidence of DM is under 2%. Similarly, if fewer than 4 axillary lymph nodes are involved at imaging, the incidence of DM is under 4%, whereas in patients presenting with T3/4 tumours and N2 nodal disease (four or more abnormal nodes) the incidence of DM rises to 10-20% [2]. Thus, in patients with early stage disease (clinical stage 1-11A), all international guidelines state that screening for asymptomatic DM is not indicated (unless the patient has suspicious symptoms) [3,4]. It frequently generates false positive or indeterminate findings, with significant costs in terms of patient anxiety, resources and radiological follow-up. Though the presence of T3 disease (tumour > 5cm) is often regarded as an indication for whole-body staging, the incidence of DM in clinical stage 11B disease (T3N0, T2N1) is still low with conventional imaging. Units with this policy should robustly audit impact on patient outcomes. For patients with clinical stage 111 disease, a whole-body technique is indicated for staging. Since the commonest sites of DM are the bones, lungs and liver, contrast-enhanced CT (CECT) is the most commonly used modality, being readily available and having acceptable diagnostic accuracy at these sites. Numerous studies have demonstrated that if the scan volume includes the neck and proximal femora, the additional yield from an isotope bone scan is extremely low [5]. The recent 8th edition of the AJCC TNM manual permits inclusion of tumour immunophenotype, which can be used to modify anatomical TNM staging. Aggressive HER2 amplified and ‘triple negative’ cancers (those without HER2 overamplification, oestrogen or progesterone receptor expression) demonstrate different patterns of metastatic disease, but there is as yet no convincing evidence for altering the strategy for staging according to tumour biology [6]. Again, though many oncologists request systemic staging prior to commencement of neoadjuvant chemotherapy for T1/2 tumours, there is little evidence for the utility of this approach. More sophisticated cross-sectional techniques including PET-CT and whole body MRI (WB-MRI) are infrequently used for systemic staging in early stage breast cancer. However, there is good evidence that with increasing clinical stage, the incremental diagnostic yield from FDG PET-CT becomes significant [6], particularly for inflammatory breast cancer, where up to 30% of patients may be upstaged [6]. It is also very helpful in the evaluation of equivocal findings at CECT and in the identification of small volume nodal disease. WB-MRI is advantageous in the diagnosis of bone metastases and hepatic metastases, especially in low grade breast cancers such as invasive lobular cancer. With the continued evolution of personalised medicine and targeted therapies, it is likely that the approach to systemic staging will also evolve.