A-346 09:30 C. CT urography N.C. Cowan; Oxford/UK Technological advances in computed tomography (CT) have improved the diagnostic imaging of the urinary tract, surpassing ultrasound and the intravenous urogram. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one imaging series acquired during the excretory phase of contrast enhancement. In adults, CT urography is now the preferred initial examination for patients with haematuria at high risk for upper urinary tract urothelial cell cancer (UUT-UCC). A practical method for risk stratification will be discussed. Technical aspects of image acquisition and processing will be explored and technical tips relating to protocol design given to optimise CT urography for ultimate reporting. The principal reason for the existence of CT urography is for diagnosing UUT-UCC. Examples of the typical and atypical upper urinary tract urothelial tumours and bladder cancers will be demonstrated. A method for reporting CT urography will be demonstrated. For patients with haematuria, early and accurate diagnosis helps optimise prognosis but conventional investigative pathways are complicated and lengthy, utilising multiple imaging tests and many diagnostic algorithms exist without rigorous evaluation. CT urography offers a single imaging test of high diagnostic accuracy with the potential to replace multiple alternative imaging tests in the diagnostic pathway, improve patient experience, improve diagnostic performance and accelerate diagnosis. A system for imaging haematuria involving use of shown that large core needle biopsy (LCNB) is less costly and better tolerated by the patient than open surgical biopsy, while still achieving high diagnostic accuracy, i.e. 98%. A disadvantage of minimally invasive breast biopsy is malignancy underestimation, defined as less severe pathology in the biopsy specimen than in the subsequent surgical excision specimen. Consequently, these patients might receive insufficient treatment or need to undergo additional surgery. Improvement of breast biopsy methods to reduce malignancy underestimation is ongoing. Vacuum-assisted large core needle biopsy (VACNB) enables removal of larger tissue volumes from the target region with a single needle insertion. A recently introduced biopsy method, the Breast Lesion Excision System (BLES), allows image-guided, percutaneous removal of an intact lump of the target lesion. Malignancy underestimation in breast biopsy specimens is addressed in two recent meta-analyses. Brennan et al. report pooled DCIS underestimation rates of 30.3% for LCNB and 18.9% for VACNB. Specifically for stereotactic breast biopsy, Bruening et al. report pooled DCIS underestimation rates of 24.4% (LCNB) and 13.0% (VACNB), and pooled high-risk underestimation rates of 43.5% (LCNB) and 21.7% (VACNB). Reported DCIS underestimation rates for BLES vary from 3.2% to 21.3%, and high-risk underestimation rates from 0% to 9.4%. In conclusion, malignancy underestimation is an important issue in minimally invasive breast biopsy. With BLES, further reduction of underestimation rates may be realised. Learning Objectives: