Glossary

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References

See Mediolateral Oblique.

Assessment

"The process a woman undergoes following an abnormal mammogram, in order to obtain a definitive diagnosis. This usually takes the form of triple assessment." -- Clinical Standards for Breast Screening.

Assessment Clinic

"Specific clinics set up for the purpose of assessing women who have an abnormal screening mammogram. Procedures such as further x-ray views, ultrasound, fine needle aspiration cytology, core biopsy (wide bore needle) or clinical examination may be carried out at an assessment clinic in order to diagnose whether a woman has breast cancer." -- NHSBSP 47.

Assessment Centre

"The preferred organisation for a breast screening programme is to have a single assessment centre with all members of the assessment team being based at the same site as the assessment centre. However, this is not always possible in practice. The need to ensure that a programme serves a large enough population to enable it to be properly quality assured and achieve the NHSBSP minimum standards may mean that assessment will take place at several sites, or that referrals for surgical assessment and treatment are made to breast surgeons at one or more peripheral hospitals." -- NHSBSP 52.

Asymmetric Density

An asymmetric area may be indicative of a developing mass, a variation of normal breast tissue, postoperative change from a previous biopsy, or merely poor positioning and compression during imaging.

Batch

"A term used to describe a defined group of women to be taken through the screening process. Each batch of women will be given a unique identifying number." -- NHSBSP 47.

Benign

"Non-cancerous. Refers to tumours which grow slowly in one place and which, once removed by surgery, tend not to recur." -- Clinical Standards for Breast Screening.

Biopsy Process

Removal of a sample of tissue or cells from the body (either under local anaesthetic or during a more major operation) to assist in diagnosis of a disease." -- Investigation At Hammersmith Hospital.

BI-RADS

The American College of Radiology(ACR) Breast Imaging Reporting and Data System. BI-RADS is a "guide to standardized mammographic reporting, including a breast-imaging lexicon of terminology, a report organization and assessment structure and a coding system".

Breast Cancer

"A malignant tumour of the breast. Breast cancer is the commonest form of cancer in women, but the cause is not yet known." -- Clinical Standards for Breast Screening.

Breast Care Unit (BCU)

Many hospitals refer to their breast screening programme as a "breast care unit".

Breast Screening Programme (BSP)

At its simplest, a breast screening programme is an assessment clinic with one or more associated screening units. Formally, a breast screening programme is a group of screening units and assessment clinics such that (1) screening units all share the same clinical protocols, (2) the assessment clinics share the same clinical lead and (3) the group shares the same MDT meetings (see NHSBSP 52). Breast screening programmes are sometimes referred to as local breast screening programmes to distinguish them from their coordinating body, the NHS breast screening programme (NHSBSP).

Computer Aided Detection Tool

Examples include R2 and PROMAM. CADe is preferable to the abbreviation CAD, which can also mean "Computer Aided Diagnosis".

CADe

See Computer Aided Detection Tools.

CADT

See Computer Aided Detection Tools.

Cancer

"The name given to a group of diseases that can occur in any organ of the body, and in blood, and which involve abnormal or uncontrolled growth of cells." -- Clinical Standards for Breast Screening.

Case

A screening case is the collection of films and other material that is available to the film reader during a particular screening round for a particular patient.

CC (Craniocaudal view)

An X-ray image that looks vertically down through the breast. The breast is compressed from the top and bottom.

Cease

"The term used to describe a woman who is no longer included in the screening programme. See Call/Recall Status: Cease and Suspend (Guide to Good Office Practice 8, May 1997, under revision). Issues of consent are covered in Consent to Breast Screening (Good Practice Guide No 1, November 1998)." -- NHSBSP 47.

Client Label

"Labels that are usually printed from the screening office computer system, giving basic demographic data for each client. The client labels are used for a variety of purposes, including client information sheets, screening packets and films." -- NHSBSP 47.

Clinic

"Labels that are usually printed from the screening office computer system, giving basic demographic data for each client. The client labels are used for a variety of purposes, including client information sheets, screening packets and films." -- NHSBSP 47.

Core Biopsy

"A core biopsy or wide bore needle biopsy (WBN) is a procedure used during the assessment process to obtain a preoperative diagnosis for a woman who potentially could have breast cancer. The procedure involves inserting a wide bore needle into the area of uncertainty in a womans breast, sometimes under ultrasound or x-ray control, and withdrawing a core of tissue from that area. The core of tissue is then sent to the histopathology laboratory for histological examination by a pathologist." -- NHSBSP 47.

Cytology/Cytopathology

"The study of the structure and function of cells under the microscope, and of their abnormalities (cytopathology)." -- Clinical Standards for Breast Screening.

DCIS (Ductal Carcinoma In Situ)

Sometimes DCIS may be described as pre-cancerous, pre-invasive, non-invasive or intraductal cancer. This is when cancerous changes occur in the cells lining the milk ducts (the channels in the breast that carry milk to the nipple), but the breast cancer cells are completely contained within the ducts and have not spread into the surrounding breast tissue. The DCIS usually shows up on a mammogram as an area where calcium has been deposited in the ducts (microcalcification). It is important to know that most microcalcification is not DCIS or cancer. http://www.cancerbacup.org.uk/info/dcis.htm

Distortion of Architecture (DOA)

See Asymmetric Density.

DNA (Did Not Attend)

"This applies to women who do not attend for their screening appointment." -- NHSBSP 47.

Double Reading

"The process whereby mammograms are checked for abnormalities, or read, by two independent film readers." -- Clinical Standards for Breast Screening.

Early Recall

"The term used to describe women who are asked to reattend for assessment earlier than the routine three year recall. A common early recall interval is one year." -- NHSBSP 47.

Film Reader

A consultant breast radiologist or radiographer who is qualified to read mammograms.

Fine Needle Aspiration Cytology (FNA)

"A procedure used during the assessment process to obtain a preoperative diagnosis for a woman who potentially could have breast cancer. The procedure involves inserting a fine needle into the area of uncertainty in a womans breast, sometimes under ultrasound or x-ray control, and withdrawing cells from that area. The cells are spread onto a slide, stained and examined by a cytopathologist." -- NHSBSP 47.

Front

An additional X-ray taken to fully image a large breast.

Grid

A dynamic distributed computing infrastructure enabling the creation of virtual organisations to collaborate in problem solving or to execute tasks without a notion of central control. The Global Grid Forum defines open standards for Grid computing.

Histology / Histopathology

"The study of the structure, composition and function of tissues under the microscope, and of their abnormalities (histopathology)." -- Clinical Standards for Breast Screening.

Ill-defined Lesion

An area of radiographically-dense tissue appearing as a bright patch that might indicate a developing tumor. (see Hartswood et. al. 2002).

Impalpable

"Describing a structure in the body that cannot be detected by feeling with the hand." -- Clinical Standards for Breast Screening.

Incident round

A screening round is said to be incident if the woman has been screened previously. For example, "Of the women screened, 5% were referred for assessment; the rates for women attending for the first time (in the prevalent round) and those attending who had been previously screened (in the incident round) were markedly different. About 8.3% of women in the prevalent round were referred for assessment, compared with only 3.9% of women in the incident round." -- Statistical Bulletin 2000-01.

Interval Cancer

"A breast cancer that occurs in the interval following a screening mammogram with a negative result and before the next routine screening episode." Clinical Standards for Breast Screening. Most interval cancers are either new or are so obscured that they could not have been reasonable spotted during screening. False negative interval cancers are specifically those cancers that should have been picked up by a previous screening round.

Invasive Cancer

"Cancer that can or has spread from its site of origin." -- Clinical Standards for Breast Screening.

Lesion

A suspicious object on a mammogram. Not all lesions are cancers.

LCIS (Lobular Carcinoma In Situ)

"LCIS is not a cancer but its presence means an increased risk of developing breast cancer later in life. Even so, most women with LCIS do not develop breast cancer. Although LCIS itself does not show up on a mammogram (breast x-ray), it may be found incidentally after removing a suspicious area which has shown up on a mammogram." -- http://www.cancerbacup.org.uk/info/lcis.htm

Malignant

"Cancerous. Malignant tumours can invade and destroy surrounding tissue and have the capacity to spread." -- Clinical Standards for Breast Screening.

Mammogram

"X-ray examination of the female breast." -- Investigation At Hammersmith Hospital.

Medical Physics

"The application of physics and related sciences to the clinical practice of medicine. In breast screening, a medical physics service ensures the quality and safety of the imaging equipment." -- Investigation At Hammersmith Hospital.

Metastatic Cancer

"Cancer that has spread from its original site to other parts of the body; most commonly bone, lung, liver, brain, lymph nodes." -- Clinical Standards for Breast Screening.

MDT (Multidisciplinary Team)

"All patients with a diagnosis of breast cancer are reviewed at the MDT meeting at regular intervals along the care pathway. Diagnosis and management decisions made during the MDT meeting are documented at the time of discussion and are communicated to the patient at their next out patient visit. Data generated from the MDT meeting are recorded by the data clerk on the Breast Unit database. General Practitioners are informed of a patients cancer diagnosis by the Consultant via telephone or faxed letter on the day the patient is seen in clinic." -- Breast Service Operations Policy.

Micro-Calcification Clusters

Small deposits of calcium visible as tiny bright specks. (see Hartswood et. al. 2002)

MLO (Mediolateral Oblique)

An X-ray image taken by compressing the breast in a diagonal from the shoulder to the stomach.

NBSS (National Breast Screening Computer System)

A computer system "which is operated by 60% of the breast screening services in England, Wales and Northern Ireland. This was originally written by the computer development team based at Oxford Regional Health Authority and is colloquially known as the Oxford system." -- NHSBSP 47.

NHS Breast Screening Programme (NHSBSP)

"The UK-wide programme of free population-based screening for breast cancer." -- Clinical Standards for Breast Screening.

Non-Participant

"A woman who does not wish to participate in the NHS Breast Screening Programme." -- NHSBSP 47.

Normal Result

"The result, usually in the form of a letter, sent to the woman, indicating that her recent NHSBSP mammogram showed no evidence of cancer. This letter is issued by the screening office following authorisation by the reporting radiologist. It is also known as a routine recall letter." -- NHSBSP 47.

Obliques

See Mediolateral Oblique.

OGSA

Open Grid Services Architecture.

Oxford System

See National Breast Screening Computer System.

Palpable

"Describing a structure in the body that can be detected by feeling with the hand." -- Clinical Standards for Breast Screening.

Pathology

"The study of disease processes with the aim of understanding their nature and causes. This is achieved by observing samples of tissue obtained from the living patient or following death (see cytopathology / histopathology)." -- Clinical Standards for Breast Screening.

Prevalent Round

A screening round is said to be prevalent if the woman has never attended screening before. For example, "Of the women screened, 5% were referred for assessment; the rates of women attending for the first time (in the prevalent round) and those who had been previously screened (in the incident round) were markedly different. About 8.3% of women in the prevalent round were referred for assessment, compared with only 3.9% of women in the incident round". -- Statistical Bulletin 2000-01.

R2

A lazy name for the ImageChecker system from R2 Technology. ImageChecker is a Computer Aided Detection Tool (CADT). (See http://www.r2tech.com.prd/).

Radiologist

"A physician who specialises in the interpretation of diagnostic imaging such as mammography, ultrasound, MRI, CT scants etc." (See http://www.northshorelij.com/disease/breast/gloss.htm). Some radiologists are qualified to read screening mammograms these people are typically consultant breast specialist radiologists. Breast specialist radiologists also run assessment clinics.

Radiographer

"A health care professional (not a physician) trained to properly position patients for X-ray or other radiology studies such as CT or mammography, perform the imaging study, and to develop and check the images for quality. Since mammography (breast x-rays) is done in a machine used only for mammography, the technologist must have a special training in mammography." (see http://imaginis.com/glossary_r.asp). Some radiographers are qualified to read screening mammograms. Radiographers are not usually involved in assessment clinic work.

Recall to Assessment

A woman will need to be recalled to assessment if her screening mammogram shows an area of abnormality that requires further investigation. At an assessment clinic, further procedures will be carried out to ascertain the extent of the abnormality." -- NHSBSP 47.

ROC curve

"An ROC curve is a graphical representation of the trade-off between the false negative and false positive rates for every possible cut-off. By tradition, the plot shows the false positive rate on the Z axis and 1 - the false negative rate on the Y axis". (See http://www.cmh.edu/stats/ask/roc10.htm) "We are usually happy when the ROC curve climbs rapidly towards the upper left hand corner of the graph. This means that 1 - false negative rate is high and the false positive rate is low. We are less happy when the ROC curve follows a diagonal pathfrom the lower left hand corner to the upper right hand corner. This means that every improvement in false positive rate is matched by a corresponding decline in the fasle negative rate." (From the asme site).

Scalable Vector Graphics (SVG)

SVG is a W3C standard graphics language expressed as an XML. A free browser plugin to render SVG can be downloaded from the Adobe SVG site. Apache provide a Java toolkit for SVG called Batik.

Sensitivity

"Probability that a test result will be positive when the disease is present (true positive rate, expressed as a percentage)." (see http://www.medcalc.be/manual/mpage06-13a.html).

Screening Episode

The period of time during which all screening activity associated with an eligible woman takes place. In terms of the computer system, it is the storage medium for all the data associated with a womans invitation and attendance or non-attendance for screening. It should be opened and closed within six months." -- NHSBSP 47.

Screening Unit

A site where patients are imaged for screening. "Basic screening by mammography can take place either at a static breast screening unit or on a mobile breast screening unit. Film processing usually takes place at the static unit, where the films are also read and reported." -- NHSBSP 52.

Screening Packet

"A medical record containing the mammograms and paperwork associated with a womans screening attendance." -- NHSBSP 47.

Specificity

"Probability that a test result will be negative when the disease is not present (true negative rate, expressed as a percentage)." (see http://www.medcalc.be/manual/mpage06-13a.html).

Technical Recall

"Recall for another mammographic screen within the same screening episode due to a technically unsatisfactory mammogram. There are a number of reasons why this can occur, such as equipment fault/failure, operator error or movement of the breast during X-ray." -- Clinical Standards for Breast Screening.

Technical Repeat

"Technically Unsatisfactory Mammogram A mammogram that requires to be repeated as the original film(s) are not of an adequate standard for diagnosis." -- Clinical Standards for Breast Screening.

Triple Assessment

"A set of three clinical investigations (examination, mammography and fine needle aspiration cytology) that are performed to diagnose breast cancer. The use of triple assessment reduces the need for surgical biopsy." -- Investigation At Hammersmith Hospital.

Unit

See Screening Unit.