Understanding Your Mammogram Report | Johns Hopkins Medicine

Lisa Jacobs, M.D., Johns Hopkins breast cancer surgeon, and Eniola Oluyemi, M.D., Johns Hopkins Community Breast Imaging radiologist, receive many questions about how to interpret common findings on a mammogram report. The intent of the report is a communication between the doctor who interprets your mammogram and your primary care doctor. However, this report is often available to you, and you may want to better understand it. Both experts suggest that you sit down with your doctor to discuss the findings of the report to avoid confusion.

Here are answers to 10 of the most commonly asked questions:

What are calcifications?

Calcifications are calcium deposits in the breast tissue. They are very common, and the great majority are noncancerous. When many microcalcifications (tiny specs of calcium) are seen in one area, they are called a group.

What are clip markers, and why are they used during biopsies?

After a mammogram screening, a small percentage of women will have a
finding that may require additional diagnostic imaging. This is called a
recall. If a patient is recalled, additional imaging will be performed, and
only about 2 percent of women may need a biopsy. During a biopsy, a
radiologist with breast imaging expertise inserts a small metallic clip in
the breast to help locate the biopsy site in case further testing is
needed.

What is BI-RADS?

The Breast Imaging-Reporting and Data System (BI-RADS) is a reporting and
assessment system required by the federal government. This is a dictionary
that radiologists use to describe findings in a breast imaging report. This
system also organizes assessments and explains the importance of the
findings. The assessments range from 0 to 6, with 0 indicating an
incomplete evaluation, meaning more imaging is needed before a final
decision about the findings can be made, and 6 indicating that there is a
known breast cancer diagnosis. The assessments are used to share the
appropriate next steps or recommendations with your healthcare team.

Is tomosynthesis (3-D mammography) a better screening tool?

Yes. Compared to 2-D mammography, tomosynthesis provides a clearer image of
each layer of the breast, which provides greater visibility for the
radiologist. This allows more cancers to be seen and fewer false alarms;
this is a state-of-the-art, improved mammogram.

Should I get a breast MRI scan instead of a mammogram?

Should I get a breast MRI scan instead of a mammogram?

• High-risk screening for patients with more than a 20 percent chance of
  developing breast cancer in their lifetime
• Bloody or clear nipple discharge
• Preoperative testing
• Chemotherapy follow-up

What should I do if I notice abnormal changes or symptoms even after my
mammogram comes back normal?

Breast self-exams are important because they allow you to get to know your
breasts and their “normal” appearance. If you notice abnormal symptoms or
changes to your breast geography, request additional testing. Do not ignore
abnormal breast changes or symptoms, such as discharge or a lump, but keep
in my mind that several lifestyle changes, such as weight gain, weight
loss, hormone changes and hormone replacement therapy, can cause your
breasts to change.

Note: The radiologist may call you back after a baseline mammogram (a
patient’s first mammogram) for additional testing because he or she has
nothing to compare the mammogram to. This will also help identify changes
to your breasts over time.

If I am diagnosed with breast cancer, should my children get mammograms at
an earlier age?

Yes, but depending on the child’s age, an ultrasound or breast MRI scan may
be a better option. Consult with your primary care physician.

What does asymmetry mean in my mammogram report?

Breast asymmetry refers to the appearance of a part of the breast in
comparison to the remainder of that breast and to the other breast. A
radiologist will examine a mammogram to look at the difference in position,
volume and form of the breasts. In most cases, the breasts are generally
symmetric in their density and architecture, but sometimes a report may
reveal asymmetric density, which is common and usually noncancerous.
However, a radiologist may decide to do further testing if there are
changes in breast tissue that are asymmetric, as this could also indicate
an important finding.

What does fibroglandular density mean?

Fibroglandular tissue refers to areas in the breast containing milk glands
and milk ducts. Fibroglandular density refers to scattered areas of density
in the breast, which is normal tissue seen in combination with fat.

My mammogram described my breasts as being “heterogeneously dense, which
may obscure small masses.” What does that mean?

This means that you have moderately dense tissue, which is common and not a
cause for concern. Sometimes, dense tissue can make it difficult to
accurately read a mammogram. You and your doctor can discuss options for
supplemental screening (i. e. screening method in addition to a mammogram),
if necessary.

What Is It, Types, Prep & Results

Overview

What is a mammogram?

A mammogram is a low dose X-ray of the breast tissue. Mammography is performed to look for early signs of breast cancer before a patient develops symptoms. It can also be used to look for any abnormality when a patient develops a new symptom (a lump or focal pain) in her/his breast tissue.

A routine screening mammogram usually includes at least two pictures of each breast taken at different angles, typically from top to bottom and from side to side. When a mammogram is viewed, breast tissue appears white and opaque (cloudy), and fatty tissue appears darker and translucent (semitransparent).

Screening mammograms are recommended every year for all women starting at age 40. Screening mammograms are also done for women who have no signs or symptoms related to the breasts (asymptomatic).

If there is an abnormality or patients have a new symptom (a lump or focal pain), additional evaluation may be needed. With further examination, most of these questionable abnormalities are found to be normal breast tissue or benign (non-cancerous) tissue.

How often are abnormalities found in a screening mammogram?

Potential abnormalities are found in 6 to 8 percent of women who have screening mammograms. This small group of women needs further evaluation that might include breast physical examination, diagnostic mammography, breast ultrasound, or needle biopsy.

After this additional evaluation is complete, most women who have potential abnormalities on a screening mammogram are found to have nothing wrong.

How does an abnormality appear on a mammogram?

A potential abnormality on a mammogram might be called a nodule, mass, lump, density, or distortion:

• A mass (lump) with a smooth, well-defined border is often benign.
• Ultrasound is needed to see and describe the inside of a mass. If the mass contains fluid, it is called a cyst.
• A mass (lump) that has an irregular border or a starburst appearance (spiculated) might be cancerous, and a biopsy is usually recommended.

Microcalcifications (small deposits of calcium) are another type of abnormality. They can be classified as benign, suspicious, or indeterminate. Most microcalcifications are benign. Depending on how the microcalcifications appear on the additional studies (magnification views), a biopsy might be recommended.

What are the different types of mammograms?

There are two common types of mammograms:

• Diagnostic Mammogram
• Digital Mammogram

What is a diagnostic mammogram?

Diagnostic mammograms are done for women who have potential abnormalities that have been detected on a screening mammogram. These mammograms are also done for women who have signs or symptoms related to the breasts (symptomatic). Diagnostic mammograms differ from screening mammograms in that they focus on the potential abnormality or symptom.

Depending on the potential abnormality, different studies might be done. Some women need only additional mammographic images. Other women will have additional mammographic images and an ultrasound.

What is a digital mammogram?

Digital mammograms are newer technology films that use the computer to produce the images. The equipment is very much like a digital camera and can see things better, especially in the case of dense breasts. Digital mammograms are usually recommended for dense breast tissue or for women under the age of 50. The films cannot be lost. However, the amount of compression (squeezing) and radiation is the same as with analog films.

How accurate is mammography?

Mammography is 85 percent to 90 percent accurate. Mammograms have improved the ability to detect breast abnormalities before they are large enough to be felt. However, it is possible that a mass that can be felt (palpable) might not be seen on a mammogram. Any abnormality that you feel when examining your breasts should be evaluated by your health care provider. A diagnostic mammogram might be recommended.

Results and Follow-Up

How often should you have a mammogram?

Multiple professional organizations have made recommendations for when women should start having mammograms and how often they should screen. Although the most lives are saved when patients start screening every year beginning at age 40, the reality is the majority of women will never develop breast cancer. Therefore, it is very important women talk with their healthcare providers about their individual risk factors, and what the most appropriate screening schedule is for them.

Feel free to ask questions

If you have any questions or comments, please feel free to discuss them with your technologist, radiologist, or your regular doctor.

Breast Cancer Glossary – Breast Cancer Terms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

Absolute Risk
A person’s chance of developing a certain disease over a certain period of time. The absolute risk of a disease is estimated by looking at a large group of people who are similar in some way (the same age, for example) and counting the number of people in this group who develop the disease over a certain period of time. For example, if we followed 100,000 women between the ages of 30 and 34 for one year, about 29 would develop breast cancer. This means the one-year absolute risk of breast cancer for a 30- to 34-year-old woman is 29 per 100,000 women (about 1 per 3,450 women).

Acupuncture
Use of very thin needles inserted at precise points on the body. It may help control pain and other side effects of breast cancer treatment or the cancer itself. It is a type of complementary or integrative therapy.

Adjuvant (Systemic) Therapy
Treatment given in addition to surgery and radiation therapy to get rid of breast cancer cells that may have spread from the breast to other parts of the body. It may include chemotherapy, hormone therapy and/or HER2-targeted therapy.

Advocacy (see Breast Cancer Advocacy)

Aesthetic Flat Closure
Surgery done after a mastectomy to create a smooth chest wall that appears flat. Extra skin, fat and other tissue in the breast area may be removed. This surgery is an option for people who wish to “go flat” after a mastectomy. It may also be done if a breast implant is removed (an implant that was part of breast reconstruction after a mastectomy).

Alopecia
Hair loss.

Alternative Therapy
Any therapy used instead of standard medical treatments such as surgery, chemotherapy and hormone therapy. Alternative therapies are different from complementary and integrative therapies, which are used in addition to standard treatments. Alternative therapies have not been shown to be effective in treating breast cancer, so it’s not safe to use them.

Amenorrhea
The absence or stopping of menstrual periods.  

Anesthesia
Loss of feeling or sensation that keeps a person from feeling pain during surgery or other medical procedures. Local or regional anesthesia may be used for a specific part of the body, such as the breast, by injection of a drug into the area. General anesthesia numbs the entire body and puts a person to sleep with drugs that are inhaled or injected into a vein.

Aneuploid (DNA Ploidy)
The presence of an abnormal number of chromosomes in cancer cells.

Angiogenesis
The growth of new blood vessels that cells need to grow.  

Antibody
A protein made by white blood cells that’s part of the body’s immune system. Each antibody binds to a certain antigen (foreign substance, such as bacteria) and helps the body fight the antigen.

Antibody-Drug Conjugate
A combination of a HER2-targeted antibody drug and a chemotherapy drug. The combination allows the targeted delivery of chemotherapy to certain cancer cells. Ado-trastuzumab emtansine (Kadcyla, T-DM1, trastuzumab emtansine) is an example of an antibody-drug conjugate used to treat breast cancer.

Antibody Therapy
A drug containing an antibody specially made to target certain cancer cells. See Antibody.

Anti-Carcinogen
An agent that counteracts carcinogens (things that cause cancer).

Antiemetic
A medicine that prevents or relieves nausea and vomiting.

Antigen
A substance that causes an immune response in the body. This immune response often involves making antibodies.

Antioxidant
A substance that protects the body against damage from oxidizing agents. Oxidizing agents are always present in the body and are often beneficial. However, when large amounts of oxidants are present in cells, they can cause damage, especially to DNA. This can lead to abnormal cell growth. Antioxidants include beta-carotene, vitamin A, vitamin C and vitamin E.

Apoptosis
A normal cell process that leads to the death of a cell. Cancer cells may block apoptosis.

Areola
The darkly shaded circle of skin around the nipple.

Aromatase Inhibitors
Hormone therapy drugs that lower estrogen levels in the body by blocking aromatase, an enzyme that converts other hormones into estrogen. Aromatase inhibitors are used to treat hormone-receptor positive breast cancer.

Aspirate
To remove fluid and a small number of cells.

Atrophic Vaginitis (see Vaginal Atrophy)

Atypical Hyperplasia
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). The proliferating cells look abnormal under a microscope. Although atypical hyperplasia is not breast cancer, it increases the risk of breast cancer.

Autologous
A blood donation or tissue graft from a person’s own body rather than from another person (a donor). For example, autologous breast reconstruction techniques use skin and tissue flaps (grafts) from a person’s own body.

Axilla
The underarm area.

Axillary Dissection (Axillary Sampling)
Surgical procedure to remove some or all of the lymph nodes from the underarm area so the nodes can be examined under a microscope to check whether cancer cells are present.

Axillary Lymph Nodes
The lymph nodes in the underarm area.

Ayurveda
A complementary or integrative medical system from India that involves diet, exercise, meditation and massage. Ayurveda means “life-knowledge.”

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B

Benign
Not cancerous. Does not invade nearby tissue or spread to other parts of the body.

Benign Breast Conditions (Benign Breast Disease)
Noncancerous conditions of the breast that can result in lumps or other abnormalities. Examples include cysts and fibroadenomas.

Benign Phyllodes Tumor
A rare benign (not cancer) breast condition similar to a fibroadenoma. A lump may be felt, but is usually painless.  

Bilateral Prophylactic Mastectomy
Surgery where both breasts are removed to prevent breast cancer from developing.

Biobank (Tissue Repository)
A large collection of tissue samples and medical data used for research studies.

Bioimpedance (Bioelectrical Impedance Analysis)
A method of measuring the amount of fluid in body tissues.

Biological Therapy
A therapy that targets something specific to the biology of a cancer cell, as opposed to chemotherapy, which attacks all rapidly dividing cells. Often used to describe therapies that use the immune system to fight cancer (immunotherapy).

Biomarker
Any molecule in your body that can be measured and can give information about your health.

Biopsy
Removal of tissue to be tested for cancer cells.

Biosimilars 
“Generic-like” versions of drugs containing biological products (such as antibodies) used for a variety of conditions and diseases, like breast cancer.

Bisphosphonates
Bone density medications used to help prevent bone loss (osteoporosis). These drugs can be used to lower the risk of breast cancer recurrence in some women with early breast cancer. They are also used to strengthen bones and decrease the rate of bone fractures and pain due to breast cancer metastases to the bone.

Body Mass Index (BMI)
A measure used to estimate body fat. BMI takes into account a person’s height and weight. Calculate your BMI.

Bone Scan
A test done to check for signs of cancer in the bones. A small amount of radioactive material is injected into the bloodstream. It collects in the bones, especially abnormal areas, and is detected by a scanner. Bone scans can show cancer as well as benign bone diseases (like arthritis).

Boost
Additional dose of radiation to the part of the breast that had the tumor.

BRCA1 and BRCA2 Genes (BReast CAncer genes)
Genes that help limit cell growth. A mutation (change) in one of these genes increases a person’s risk of breast, ovarian and certain other cancers.

Brachytherapy
A procedure that uses targeted radiation therapy from inside the tumor bed.

Breast Cancer
An uncontrolled growth of abnormal breast cells. 

Breast Cancer Advocacy
Influencing targeted audiences to promote the support of breast cancer issues.

Breast Cancer Survivor (see Survivor)

Breast Conserving Surgery (see Lumpectomy)  

Breast Density
A measure used to describe the relative amounts of fat and tissue in the breasts as seen on a mammogram.

Breast-Specific Gamma Imaging (see Molecular Breast Imaging)

Breast Imaging Reporting and Data System (BI-RADS^®)
A system developed by the American College of Radiology to provide a standard way to describe findings on a mammogram. 

Breast Reconstruction
Surgery to restore the look and feel of the breast after mastectomy.

Breast Self-Examination (BSE)
A method that may help some women become familiar with the normal look and feel of their breasts. BSE is not recommended as a breast cancer screening tool because it has not been shown to decrease breast cancer death.

Breast Tomosynthesis (3D Digital Mammography, Digital Tomosynthesis)
A tool that uses a digital mammography machine to take multiple 2-dimensional (2D) X-ray images of the breast. Computer software combines the multiple 2D images into a 3-dimensional (3D) image.

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C

Cachexia
Loss of appetite and weight.  

Calcifications
Deposits of calcium in the breast that appear as bright, white spots on a mammogram. Most calcifications are not cancer. However, tight clusters or lines of tiny calcifications (called microcalcifications) can be a sign of breast cancer.

Cancer
General name for over 100 diseases with uncontrolled cell growth.

Cancer Rehabilitation
Programs that help people with cancer improve their quality of life by regaining physical strength and emotional well-being during and after cancer treatment. These programs help people stay active in their home and work lives and may include exercise, nutrition counseling and pain management.

Cancer Staging (see Staging) 

Carcinoma in Situ (in Situ Carcinoma)
Condition where abnormal cells are found in the milk ducts or lobules of the breast, but not in the surrounding breast tissue. In situ means “in place. ” See ductal carcinoma in situ and lobular carcinoma in situ.

Case-Control Study
An observational study that looks at 2 groups–one with people who already have the outcome of interest (cases), and one with people who do not (controls). For example, the cases may be women with breast cancer and the controls may be women who do not have breast cancer. The 2 groups are compared to see if any factor was more common in the past history of one group compared to the other.

Case Series
A health care provider’s observations of a group of patients who are given a certain type of treatment.

Catheter
A small tube used to deliver fluids to (or remove them from) the body.

CDK4/6 Inhibitors
A class of drugs designed to interrupt the growth of cancer cells by blocking the enzymes CDK4 and CDK6 (important in cell division). Abemaciclib (Verzenio) is an example of a CDK4/6 inhibitor used to treat breast cancer.

Centigray (Centigrays)
One centigray describes the amount of radiation absorbed by the body and is equivalent to 1 RAD (radiation absorbed dose).

Checkpoint Inhibitor
A type of immunotherapy drug that “takes the brakes off” the natural factors that limit how the immune system can control cancer cells. Atezolizumab (Tecentriq) is an example of a checkpoint inhibitor immunotherapy drug used to treat breast cancer.

Chemoprevention (Risk-Lowering Drugs)
A drug or combination of drugs used to lower the risk of breast cancer in women who do not have breast cancer, but are at higher risk.

Chemotherapy
A drug or combination of drugs that kills cancer cells.

Clinical Breast Examination (CBE)
A physical exam done by a health care provider to check the look and feel of the breasts and underarm for any changes or abnormalities (such as lumps).

Clinical Trials
Research studies that test the benefits of possible new ways to detect, diagnose, treat or prevent disease. People volunteer to take part in these studies.

Cognitive Function
Mental processes related to understanding, such as reasoning and problem-solving.

Cohort Study
A study that follows a large group of people (a cohort) over time.

Co-Insurance (see Co-Payment)  

Complementary Therapies (Integrative Therapies)
Therapies (such as acupuncture or massage) used in addition to standard medical treatments. Complementary therapies are not used to treat cancer, but they may help improve quality of life and relieve some side effects of treatment or the cancer itself. When complementary therapies are combined with standard medical care, they are often called integrative therapies.

Complex Cyst
A fluid-filled sac. A breast ultrasound finds the cyst has thick walls and contains some solid matter. A biopsy is needed to confirm that a complex cyst is benign (not cancer).

Complicated Cyst
A fluid-filled sac. A breast ultrasound finds small echoes in the cyst, but the cyst only contains fluid. A biopsy may be done to confirm a complicated cyst is benign (not cancer).

Computer-Assisted Detection (CAD)
Software developed to help radiologists find suspicious areas on a mammogram.

Computerized Axial Tomography (CAT) Scan (see CT Scan)

95% Confidence Interval (95% CI)
A statistical concept that shows there is a 95 percent probability the true measure is found within a range of measures computed from a single study. For example, if the 95% confidence interval for a survival rate is 75 to 90 percent, there is a 95 percent chance the true survival rate falls between 75 and 90 percent.  

Co-Payment (Co-Insurance)
In an insurance plan, the portion of medical costs a person must pay (the portion not covered by his/her insurance policy).

Core Needle Biopsy
A needle biopsy that uses a hollow needle to remove samples of tissue from an abnormal area in the breast.

Co-Survivor
A person who gives support to someone diagnosed with breast cancer, from the time of diagnosis through treatment and beyond. Co-survivors may include family members, spouses or partners, friends, health care providers and colleagues. 

CT Scan (Computerized Tomography Scan, Computerized Axial Tomography (CAT) Scan)
A series of pictures created by a computer linked to an X-ray machine. The scan gives detailed internal images of the body.

Cumulative Risk
The sum of a person’s chances of developing a disease (such as breast cancer) over the course of a lifetime. For example, the cumulative (lifetime) risk of breast cancer for women is about 1 in 8 (or about 12 percent). This means for every 8 women, one will be diagnosed with breast cancer during her lifetime.

Cyst
A fluid-filled sac. See Simple Cyst, Complicated Cyst and Complex Cyst.

Cytopathologist
A pathologist who specializes in looking at individual cells. A cytopathologist is needed to interpret the results of a fine needle aspiration (fine needle biopsy).

Cytotoxic
Toxic, or deadly, to cells. Often used to describe chemotherapy.

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D

Deductible (Insurance Deductible)
The pre-set amount of medical costs a person must pay before insurance payments begin.

Definitive Surgery
All of the known tumor is removed and no follow-up surgery is needed.

Diabetic Mastopathy
A rare benign (not cancer) breast condition that consists of small, hard masses in the breast. It occurs most often in women with insulin-dependent (type 1) diabetes.

Diagnosis
Identification of a disease from its signs and symptoms.

Diagnostic Mammogram
A mammogram used to check symptoms of breast cancer (such as a lump) or an abnormal finding on a screening mammogram or clinical breast exam. It involves 2 or more views of the breast.

Diagnostic Radiologist (Radiologist)
A health care provider who specializes in the diagnosis of diseases using X-rays.

Diploid (DNA Ploidy)
The presence of a normal number of chromosomes in cancer cells.

Disease-Free Survival Rate
Percent of people alive and without disease at a certain time (often 5 years or 10 years) after treatment. Those who die from causes other than the disease under study are not included in this measure.

Distant Recurrence (see Metastases)

Distress
Emotional, spiritual or physical pain or other suffering that may cause sadness, fear, depression, anxiety or loneliness.

DNA (Deoxyribonucleic Acid)
The information contained in a gene.

Dose-Dense Therapy
Chemotherapy given over a shorter (more condensed) time period compared to standard therapy. The frequency of treatment sessions is increased, so the length of the treatment period is shortened.

Down-Staging
Lowering the stage of a cancer from its original stage (or the stage it was thought to be). Down-staging occurs most often after a good response to neoadjuvant therapy. Neoadjuvant therapy is chemotherapy or hormone therapy used as a first treatment (before surgery). Neoadjuvant therapy can shrink a tumor enough that it lowers the stage of the breast cancer and a lumpectomy, instead of a mastectomy, can be done.  

Duct (Milk Duct, Mammary Duct)
A canal that carries milk from the lobules to a nipple opening during breastfeeding (see figure). 

Ductal Carcinoma in Situ (DCIS, Intraductal Carcinoma)
A non-invasive breast cancer that begins in the milk ducts of the breast, but has not invaded nearby breast tissue. Also called stage 0 or pre-invasive breast carcinoma.

Ductal Papilloma (see Intraductal Papilloma)

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E

Early Breast Cancer 
Cancer that is contained in the breast or has only spread to lymph nodes in the underarm area. This term often describes stage I and stage II breast cancer.

Edema
Excess fluid in body tissues that causes swelling.

Endocrine Therapy (see Hormone Therapy)

Endometrial Cancer
Cancer of the endometrium (the lining of the uterus).

Enzyme
A protein that speeds up biologic reactions in the body.

Epidemiology
The study of the causes and prevention of disease.

Estradiol
The most biologically active, naturally-occurring estrogen in women.

Estrogen
A female hormone produced by the ovaries and adrenal glands that’s important to reproduction. Some cancers need estrogen to grow.

Estrogen Receptors
Special proteins in cells that estrogen hormones attach to. A high number of estrogen receptors in a breast cancer cell often means the cancer cell needs estrogen to grow.

Etiology
The cause(s) of a disease.

Excisional Biopsy
Surgical procedure that removes the entire abnormal area (plus some surrounding normal tissue) from the breast.

External Beam Radiation Therapy (see Radiation Therapy)

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F

False Negative
A test result that incorrectly reports a person is disease-free when she/he actually has the disease.

False Positive
A test result that incorrectly reports a person has a disease when she/he does not have the disease.

Family History (Family Medical History)
A record of the current and past health conditions of a person’s biological (blood-related) family members that may help show patterns of diseases within a family.

Fat Necrosis
A benign (not cancer) breast change in which the breast responds to trauma with a firm, irregular mass, often years after the event. The mass is the result of fatty tissue dying, after either surgery or blunt trauma to the breast. This breast change does not increase risk of breast cancer.

Fibroadenoma
A benign (not cancer) fibrous tumor that may occur at any age, but is more common in young adulthood.

Fibrocystic Condition (Fibrocystic Changes)
A general term used to describe a benign (not cancer) breast condition that may cause painful cysts or lumpy breasts.

Financial Toxicity (Financial Burden)
The economic hardship and distress caused by high medical care costs.

Fine Needle Aspiration (FNA, Fine Needle Biopsy)
A biopsy procedure that uses a thin, hollow needle to remove a sample of cells from the abnormal area of the breast.

First-Degree Relative (Immediate Family Member)
A person’s mother, father, sister, brother or child.

First-Line Therapy
The initial (first) therapy used in a person’s cancer treatment.

Flow Cytometry
A laboratory test done on tumor tissue to measure the growth rate of the cancer cells and to check if the cells have too much DNA.

Fluorescence In Situ Hybridization (FISH)
A laboratory test done on breast tumor tissue to find out the number of copies of the HER2 gene contained in the cancer cells.

Frozen Section
Process where a portion of tissue from a surgical biopsy is frozen so a thin slice can be studied to check for cancer. Frozen section results are only preliminary and always need to be confirmed by other methods.

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G

Gail Model (Breast Cancer Risk Assessment Tool)
A tool that uses personal and family breast cancer history as well as other factors to estimate a woman’s risk of invasive breast cancer.

Galactocele
A milk-filled cyst.

Galactorrhea
Milky nipple discharge not related to breastfeeding.

Genes
The part of a cell that contains DNA. The DNA information in a person’s genes is inherited from both sides of a person’s family (you get half of your genes from your mother and half from your father).

Gene Expression
Process in which a gene gets turned on in a cell to make RNA and proteins.

Gene Expression Profiling (see Tumor Profiling)

Gene Mutation
Any change in the DNA (the information contained in a gene) of a cell. Gene mutations can be harmful, beneficial or have no effect.

Gene Variant of Uncertain Significance
A gene mutation not currently known to increase breast cancer risk.

General Practitioner (Internist, Physician)
Personal or family physician.

Generic
The chemical name of a drug, not the brand name. The chemical formulas of a generic drug and the brand name drug are the same.  

Genetic (Hereditary)
Related to genes. The information in a person’s genes can be passed on (inherited) from either parent.

Genetic Counseling
A discussion between a genetic counselor or other trained health professional and a person concerned about inherited gene mutations related to health risks. The person’s personal and family health history are discussed. Genetic counseling helps determine whether or not genetic testing is appropriate. The risks and benefits of genetic testing are also discussed.

Genetic Susceptibility (Genetic Predisposition)
An increased likelihood or chance of developing a disease due to specific changes in a person’s genes passed on from either parent.

Genetic Testing (Germline Testing)
Analyzing DNA to look for an inherited gene mutation in a person that may show an increased risk for developing a specific disease.

Genome
The total genetic information of an organism.

Genomic testing
Analyzing DNA to check for gene mutations. Some use genomic testing to refer to genetic testing, which tests the DNA of a person. Others use it to refer to tumor profiling (gene expression profiling), which tests the DNA of a cancer. 

Genomics
The study of genes and their functions.

Germline Mutation
An inherited change in the genetic code of a person that affects the function of a gene. Germline mutations can be passed on from parents to children (you get half of your genes from your mother and half from your father). Also called inherited gene mutation.

Germline Testing (see Genetic Testing)

Glandular Tissue (in the breast)
The tissue in the breast that includes the milk ducts and lobules. 

Grade (see Tumor Grade)

Guaranteed Renewable Insurance
A health insurance policy that requires the insurance company to renew your policy for a certain amount of time, even if your health condition changes.

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H

H&E (Hematoxylin and Eosin) Staining
A laboratory test that gives color to cells so cell structures can be identified.

HER2 (Human Epidermal Growth Factor Receptor 2, HER2/neu, erbB2)
A protein involved in cell growth and survival that appears on the surface of some breast cancer cells. HER2-negative breast cancers have little or no HER2 protein. HER2-positive breast cancers have a lot of HER2 protein. HER2-positive tumors can be treated with HER2-targeted therapies, such as trastuzumab (Herceptin). 

HER2-Targeted Therapies
Drugs designed to target and treat HER2-positive breast cancers. The breast cancers have a lot of HER2 protein on the surface of their cells. Trastuzumab (Herceptin) is an example of a HER2-targeted therapy.

Hereditary (see Genetic)

Homeopathy (Homeopathic Medicine)
A medical system based on a belief that “like cures like. ” Natural substances are specially prepared in small amounts to restore health. These substances cause symptoms similar to the condition they are meant to treat in healthy people. There are limited data on the safety of these substances.

Hormones
Chemicals made by certain glands and tissues in the body, often in response to signals from the pituitary gland or the adrenal gland. Hormones have specific effects on specific target organs and tissues. Examples include estrogen and progesterone. Hormones can also be made in a lab.

Hormone Receptors
Specific proteins in cells that hormones attach to. A high number of hormone receptors on a breast cancer cell often means the cancer cell needs the hormone to grow.

Hormone Receptor Status
Shows whether or not a breast cancer needs hormones to grow. A hormone receptor-positive (estrogen and/or progesterone receptor-positive) cancer needs hormones to grow. A hormone receptor-negative (estrogen and/or progesterone receptor-negative) cancer does not need hormones to grow. See Hormone Receptor.

Hormone Replacement Therapy (see Menopausal Hormone Therapy)  

Hormone Therapy (Endocrine Therapy)
Treatment that works by keeping cancer cells with hormone receptors from getting the hormones they need to grow.

Hospice
A philosophy of care focusing on improving quality of life and easing pain and other symptoms at the end stage of a terminal illness. Hospice care also provides support services to patients and their families.

Hyperplasia (Usual and Atypical Hyperplasia)
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). Although hyperplasia is not breast cancer, it increases the risk of breast cancer. In usual hyperplasia, the proliferating cells look normal under a microscope. In atypical hyperplasia, the proliferating cells look abnormal.

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I

Immediate Family Member (First-Degree Relative)
A person’s mother, father, sister, brother or child.

Immunotherapy
Therapies that use the immune system to fight cancer. These therapies target something specific to the biology of the cancer cell, as opposed to chemotherapy, which attacks all rapidly dividing cells. Atezolizumab (Tecentriq) is an example of a checkpoint inhibitor immunotherapy drug used to treat breast cancer.

Immunohistochemistry (IHC)
A lab test done on tumor tissue to detect the amount of HER2 protein on the surface of the cancer cells.

Implant (Breast Implant)
An “envelope” containing silicone, saline or both, that is used to restore the breast form after a mastectomy (or for other cosmetic reasons).

In Situ Carcinoma (see Carcinoma in Situ)

In-Network Provider
The health care providers and medical centers (hospitals and other treatment centers) that are part of a group health plan or health maintenance organization (HMO).

Incidence
The number of new cases of a disease that develop in a specific time period.

Incisional Biopsy
Surgical biopsy that removes only part of the tumor.

Indemnity Policy
A prepayment insurance plan that gives services or a cash payment for medical care needed in times of illness or disability.

Induction Chemotherapy (see Neoadjuvant Chemotherapy)

Inflammatory Breast Cancer (IBC)
A rare, aggressive form of invasive breast cancer. Its main symptoms are swelling (inflammation) and redness of the breast. The skin on the breast may look dimpled, like the skin of an orange, and may be warm to the touch.

Informed Consent
The process through which a person learns about the possible benefits and risks (including side effects) of a treatment plan and then accepts or declines the treatment. The person is usually asked to sign a consent form, but may stop the treatment at any time and get other medical care.

Infraclavicular Lymph Nodes
The lymph nodes below the clavicle (collarbone). See Lymph Nodes.

Insurance Payment Cap
A maximum amount an insurance company will pay out in a given time period.

Insurance Premium (Premium)
The cost of insurance coverage for a certain period of time.

Integrative Therapies (see Complementary Therapies)

Intraductal
Within the milk duct. Intraductal can describe a benign (not cancer) or malignant (cancerous) process.

Intraductal Hyperplasia
An excess of cells growing within the milk ducts of the breast. 

Intraductal Papilloma (Ductal Papilloma)
Small, benign (not cancer) growths that begin in the milk ducts of the breast and usually can’t be felt. Symptoms include a bloody or clear nipple discharge.

Intravenous or IV
Being within or entering the body through the veins.  

Invasive Breast Cancer
Cancer that has spread from the original location (milk ducts or lobules) into the surrounding breast tissue and possibly into the lymph nodes and other parts of the body. Invasive ductal cancer begins in the milk ducts. Invasive lobular cancer begins in the lobules of the breast.

Investigational New Drug (New Experimental Treatment)
A chemical or biological drug approved for use by researchers in studies, but is not yet available outside of a clinical trial.

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K

Ki-67 Rate
A common way to measure proliferation rate. The more cells the Ki-67 antibody attaches to on a tissue sample, the more likely the tumor cells are to grow and divide rapidly.

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L

Lactation
The process of producing milk and breastfeeding a child.

Large Veins (Deep Veins)
The large veins deep inside the legs that carry blood from the legs back to the heart.

Lesion
Area of abnormal tissue.

Lifetime Risk
The chance of developing a disease (like breast cancer) over the course of a lifetime. For example, the lifetime risk of breast cancer for women is 1 in 8 (or about 12 percent). This means for every 8 women, one will be diagnosed with breast cancer during her lifetime.

Linear Accelerator
The device used during radiation therapy to direct X-rays into the body.

Liquid Biopsy
A test that measures levels of circulating tumor cells or circulating tumor DNA in the blood. Although the term includes the word “biopsy,” these tests are not used for breast cancer diagnosis.

Liver Scan
An image of the liver that can show the presence or absence of a tumor. 

Lobular Carcinoma in Situ (LCIS, Lobular Neoplasia in Situ)
A condition where abnormal cells grow in the lobules of the breast. LCIS increases the risk of breast cancer.

Lobular Neoplasia in Situ (see Lobular Carcinoma in Situ)  

Lobules
Ball-shaped sacs in the breast that produce milk.

Local Anesthetic
Anesthesia that only numbs the tissue in a certain area. See Anesthesia.

Local Treatment
Treatment that focuses on getting rid of the cancer from a certain (local) area. In breast cancer, the local area includes the breast, the chest wall and lymph nodes in the underarm area. Local treatment for breast cancer includes surgery and for some people, radiation therapy.

Localized Breast Cancer
Cancer that is contained in the breast and has not spread to nearby tissue, lymph nodes or other organs.

Locally Advanced Breast Cancer
Cancer that has spread beyond the breast to the chest wall, the skin of the breast or to many lymph nodes in the underarm area, but not to distant organs such as the lungs or liver.

Local Recurrence (Recurrence)
The return of cancer to the same (treated) breast or to the same side chest wall.

Lump
Any mass in the breast or elsewhere in the body.

Lumpectomy (Breast Conserving Surgery)
Breast surgery that removes only the tumor and a small rim of normal tissue around it, leaving most of the breast skin and tissue in place. 

Lymph Nodes (Lymph Glands)
Small groups of immune cells that act as filters for the lymphatic system. Clusters of lymph nodes are found in the underarms, groin, neck, chest and abdomen.  

Lymph Node Status
Shows whether or not cancer has spread to the lymph nodes. Lymph node-positive means the lymph nodes contain cancer (the cancer has spread to the lymph nodes). Lymph node-negative means the lymph nodes do not contain cancer. See Lymph Nodes.

Lymphatic System
The network of lymph nodes and vessels in the body.

Lymphedema
Swelling due to poor draining of lymph fluid that can occur after surgery to remove lymph nodes or after radiation therapy to the area. Most often occurs in the upper limbs (arm, hands or fingers), but can occur in other parts of the body.

Lymphoscintigraphy
An imaging method used to check the lymph system for diseases or conditions, such as lymphedema.

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M

Macrobiotics (Macrobiotic Diet)
A complementary or integrative dietary therapy that includes a mostly vegetarian, organic food diet with certain methods of food preparation.

Magnetic Resonance Imaging (see MRI)

Malignant
Cancerous.

Mammary Duct (see Duct)

Mammary Duct Ectasia
A benign (not cancer) breast condition resulting from inflammation (swelling) and enlargement of the ducts behind the nipple. Often there are no symptoms, but calcifications seen on a mammogram may point to its presence. No treatment is needed unless there are symptoms such as burning, pain or itching in the nipple area.

Mammary Glands
The breast glands that produce milk.

Mammogram 
An X-ray image of the breast.

Margins
The rim of normal tissue surrounding a tumor that’s removed during breast surgery. A margin is clean (also known as uninvolved, negative or clear) if there’s only normal tissue (and no cancer cells) at the edges. Clean margins show the entire tumor was removed. With involved (also known as positive) margins, normal tissue doesn’t completely surround the tumor. This means the entire tumor was not removed and more surgery may be needed to get clean margins.

Mastectomy
Surgical removal of the breast. The exact procedure depends on the diagnosis. See Total Mastectomy and Modified Radical Mastectomy.

Mastalgia
Breast pain related to menstrual periods or other causes.

Mastitis
An inflammation (swelling) of the breast usually occurring during breastfeeding. Symptoms include pain, nipple discharge, fever, redness and hardness over an area of the breast.

Mean
The average of a group of numbers.

Mean Survival Time
The average time from the start of treatment (or diagnosis) that people in a study stay alive.

Median
The middle value (50^th percentile) of a group of numbers.

Medical Oncologist
A physician who specializes in the treatment of cancer using chemotherapy, hormone therapy, HER2-targeted therapy and other drug therapies.

Melatonin
Hormone made by the pineal gland in the brain. It’s an important part of the body’s internal timing system.

Menarche
The first menstrual period.  

Menopausal Hormone Therapy (Postmenopausal Hormone Use, Hormone Replacement Therapy)
The use of hormone pills containing estrogen (with or without progestin) to ease symptoms of menopause.

Menopause
The ending of the normal menstrual cycle in women. It occurs most often in the late 40s or early 50s.

Meta-Analysis
A method for taking the results reported in a group of studies and averaging them to come up with a single, summary result.

Metabolized
The chemical process in the body that breaks down drugs and food. 

Metastasis
The spread of cancer to other organs through the lymphatic and/or circulatory system. Metastases is the plural of metastasis.

Metastasize
When cancer cells spread to other organs through the lymphatic and/or circulatory system.

Metastatic Breast Cancer
Breast cancer that has spread beyond the breast to other organs in the body (most often the bones, lungs, liver or brain). Metastatic breast cancer is not a specific type of breast cancer, but rather the most advanced stage (stage IV) of breast cancer.

Microcalcifications
Small, clustered deposits of calcium in the breast that may be seen on a mammogram. These may or may not be related to breast cancer.

Microvascular Surgery
Surgery that involves connecting small blood vessels.

Modified Radical Mastectomy
Surgical removal of the breast, the lining of the chest muscles and some of the lymph nodes in the underarm area. Used to treat early and locally advanced breast cancer.

Molecular Breast Imaging (Nuclear Medicine Imaging of the Breast)
An imaging technique that uses short-term radioactive agents given through an IV. Cancer cells absorb these agents and can be imaged with a special camera. Molecular breast imaging is not a standard breast cancer screening tool. Breast-specific gamma imaging and positron emission mammography are types of molecular breast imaging.

Monoclonal Antibodies
Immune proteins that can locate and bind to cancer cells. They can be used alone or they can be used to deliver drugs, toxins or radioactive material directly to tumor cells. Trastuzumab (Herceptin) is an example of a monoclonal antibody used to treat breast cancer.

Morphea (Radiation-Induced Morphea, Post-Irradiation Morphea)
A rare scleroderma-like condition caused by radiation therapy to the breast. The skin and connective tissue of the breast hardens and tightens, causing pain and affecting the look and shape of the breast. (This is a more severe condition than the usual skin changes people getting radiation therapy may have.)

Mortality Rate
Number of deaths in a given group of people over a certain period of time.  

MRI (Magnetic Resonance Imaging)
An imaging technique that uses a magnet linked to a computer to make detailed pictures of organs or soft tissues in the body.

mTOR (Mammalian Target of Rapamycin) Inhibitors
A class of drugs that may increase the benefit of hormone therapy. Everolimus (Afinitor) is an example of an mTOR inhibitor.

Multifocal Tumors (Multicentric Tumors)
One or more tumors that develop from the original breast tumor.

Multimodality Therapy
Use of 2 or more treatment methods (such as surgery, radiation therapy, chemotherapy, hormone therapy and HER2-targeted therapy) in combination, or one after the other, to get the best results.

Mutation (Gene Mutation) 
Any change in the DNA (the information contained in a gene) of a cell. Gene mutations can be harmful, beneficial or have no effect.

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N

Naturopathy (Naturopathic Medicine)
A medical system based on a belief in using natural elements to maintain health and to help the body heal itself. It includes nutrition and massage.

Needle Localization (see Wire Localization)  

Neoadjuvant Chemotherapy (Induction Chemotherapy, Primary Chemotherapy, Preoperative Chemotherapy)
Chemotherapy used as a first treatment (before surgery). Often used for large or locally-advanced breast cancers (including inflammatory breast cancer) to shrink tumors before surgery.

Neoadjuvant Hormone Therapy
Hormone therapy used as a first treatment (before surgery). Often used for large or locally-advanced breast cancers to shrink tumors before surgery.

Neoadjuvant Therapy (Preoperative Therapy)
Chemotherapy or hormone therapy used as a first treatment (before surgery). Often used for large or locally-advanced breast cancers to shrink tumors before surgery.

Neoplasia
Abnormal growth.

Neoplasm
Excess number of cells in a mass that can be either benign (not cancer) or malignant (cancerous).

Nested Case-Control Study
A case-control study done within a prospective cohort study. The major advantage of a nested case-control study over a regular case-control study is the exposure of interest (for example, diet or alcohol use) is measured before any of the participants have disease. This makes it less subject to bias.

Nipple-Sparing Mastectomy
A skin-sparing mastectomy (the surgeon removes the tumor and margins as well as the fat and other tissue in the breast, but leaves as much of the skin of the breast as possible) that leaves the nipple and areola intact. This skin, the nipple and areola can then be used in breast reconstruction to cover a tissue flap or an implant instead of using skin from other parts of the body.

Node-Negative (Lymph Node-Negative)
Cancer that has not spread to the lymph nodes. See Lymph Node Status.

Node-Positive (Lymph Node-Positive)
Cancer that has spread to the lymph nodes. See Lymph Node Status.

Non-Invasive
1. In treatment, describes a procedure that doesn’t penetrate the skin (or any body opening) with a needle or other instrument.

2. In breast cancer pathology, describes a cancer that has not spread beyond the milk ducts or lobules where it began (see Carcinoma in Situ).

Nonpalpable
Describes a breast lump or abnormal area that cannot be felt but can be seen on an imaging test (such as a mammogram).

Normal Tissue
Cells that do not contain cancer.

Nuclear Medicine Imaging (see Molecular Breast Imaging)

Nucleus
The part a cell that contains the genetic material DNA. Nuclei is the plural of nucleus.

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O

Observational Study
A research study where participants live their daily lives as usual and report their activities to researchers.

Odds Ratio
A measure reported in case-control studies that describes the increase (or decrease) in disease risk related to a risk factor. An odds ratio is interpreted in the same way as a relative risk, though it is calculated differently.

Oligometastasis
Cancer cells that have spread (metastasis) from the original tumor and formed a small number of new metastatic tumors in a few other parts of the body. These tumors may grow more slowly than other metastatic tumors.

Oncologist
The physician in charge of planning and overseeing cancer treatment.

Oophorectomy
Surgical removal of the ovaries.

Opiate
A drug that contains opium or a substance made from opium and is used to treat pain.

Opioid
A drug that does not contain opium or any substances made from opium, but has similar effects to opium, including addiction, and is used to treat pain.

Osteoporosis
A condition marked by a loss of bone mass and density, causing bones to become fragile.

Out-of-Network Provider
Any health care provider or medical center (hospital or other treatment center) that is not part of a person’s group health plan or health maintenance organization (HMO).

Ovarian Suppression
The use of drug therapy or surgery to prevent the ovaries from making estrogen. It stops menstrual periods and lowers hormone levels in the body (similar to a natural menopause). This slows the growth of estrogen receptor-positive breast cancer in premenopausal women by preventing the tumor from getting the estrogen it needs to grow. Ovarian suppression is always given in combination with tamoxifen or an aromatase inhibitor.

Over-Diagnosis
Diagnosis that occurs when a mammogram finds ductal carcinoma in situ (DCIS) or a small, invasive breast cancer that would have never caused symptoms or problems if left untreated. These breast cancers may never grow or a person may die from another cause before the breast cancer becomes a problem.

Over-Treatment
Treatment for ductal carcinoma in situ (DCIS) or a small, invasive breast cancer that would have never caused symptoms or problems if left untreated.  

Overall Survival (Overall Survival Rate, Survival)
The percentage of people alive for a certain period of time after diagnosis with a disease (such as breast cancer) or treatment for a disease.

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P

Paget Disease of the Breast (Paget Disease of the Nipple)
A rare cancer in the skin of the nipple or in the skin closely surrounding the nipple that is usually, but not always, found with an underlying breast cancer (ductal in situ carcinoma or invasive breast cancer). In these cases, the tumor grows from underneath the nipple and breaks out onto the surface of the nipple.

Palliative Care (Palliative Therapy, Palliation)
Care at any stage of disease focused on relieving or preventing symptoms (like pain) rather than treating disease. It’s part of care for people with early breast cancer as well as for those with metastatic breast cancer.

Palpable
Describes a breast lump or abnormal area that can be felt during a clinical breast exam.

Palpation
To examine, using the hands and fingers.

PARP (Poly(ADP-ribose) Polymerase) Inhibitors
A class of drugs that blocks an enzyme involved in tumor DNA repair (called PARP enzyme). These drugs can help chemotherapy better kill cancer cells. Olaparib (Lynparza) is an example of a PARP inhibitor used to treat breast cancer.

Partial Mastectomy (see Lumpectomy)

Pathologic Response
A measure describing how much of the tumor is left in the breast and lymph nodes after neoadjuvant (before surgery) therapy. The pathologic response gives some information about prognosis. A complete pathologic response means there is no invasive cancer in the tissue removed during breast surgery.

Pathologist 
The physician who uses a microscope to study the breast tissue and lymph nodes removed during biopsy or surgery and determines whether or not the cells contain cancer.

Peri-Menopause
The time in a woman’s life prior to menopause when menstrual periods become irregular and some menopausal symptoms may begin.

Peripherally Inserted Central Catheter (PICC)
A small tube used to deliver medicine to the body through a vein. Instead of being reinserted for each use, a PICC is left in place to allow access for a long period of time (weeks to months).

Permanent Section
A preserved tissue sample for diagnosis. Thin slices of tissue are processed and put on a slide so that a pathologist can study them under a microscope. These sections are of better quality than frozen sections.

Perometer
A device that uses infrared light beams to measure limb volume. 

Personalized Medicine (see Precision Medicine)  

PET (Positron Emission Tomography)
A procedure where a short-term radioactive sugar is given through an IV so a scanner can show which parts of the body are consuming more sugar. Cancer cells tend to consume more sugar than normal cells do. PET is sometimes used as part of breast cancer diagnosis.

Pharmacogenomics (Pharmacogenetics)
The study of the way genes affect a person’s response to drugs to help predict which drugs may offer him/her the most benefit.

Phenotype
A characteristic in a person that results from the interaction between his/her genes and his/her environment.

Phyllodes Tumor
A rare sarcoma (cancer of the soft tissue) in the breast.

PI3 Kinase Inhibitors
A class of drugs designed to interrupt PI3 kinase signals and stop the growth of cancer cells with PIK3CA gene mutations. Alpelisib (Piqray) is an example of a PI3 kinase inhibitor used to treat breast cancer.

Pituitary Gland
A part of the brain that controls growth and other glands in the body, such as the ovaries.

Placebo
An inactive medicine sometime used to have a comparison to a new drug in a clinical study. May be called a “sugar pill.”

Pooled Analysis
A method for collecting the individual data from a group of studies, combining them into one large set of data and then analyzing the data as if they came from one big study.

Positron Emission Tomography (see PET)

Postmenopausal Hormone Use (see Menopausal Hormone Therapy) 

Precision Medicine (Personalized Medicine)
Using information about a person’s genes, the tumor’s genes, molecular characteristics of the tumor and the environment to prevent, diagnose and treat cancer (such as the use of HER2-targeted therapies ). This may also be known as personalized medicine.

Predictive Factors
Factors (such as hormone receptor status) that help guide treatment for a person’s cancer.

Predispose
To make more at risk for a disease.

Premenopausal Women
Women who have regular menstrual periods.

Premium (Insurance Premium)
The cost of insurance coverage for a certain period of time.

Preoperative Chemotherapy (see Neoadjuvant Chemotherapy)

Prevalence Rate
The proportion (percentage) of people in a population who have a certain disease, behavior or characteristic at a defined point in time.

Prevention (Risk Reduction)
Steps taken to prevent or lower the risk of a disease.

Primary Chemotherapy (see Neoadjuvant Chemotherapy)

Primary Tumor
The original cancer.

Progesterone
A hormone made by the body that is important in menstrual cycles and pregnancy. May be made in a lab (called progestin) and used in birth control pills, menopausal hormone therapy and other types of hormone treatment.

Progesterone Receptor
Specific proteins in cells that progesterone hormones attach to. A high number of progesterone receptors in a breast cancer cell often means the cancer cell needs progesterone to grow.

Progestin
Any substance (natural or made in a lab) that has some or all of the effects of progesterone in the body.

Prognosis
The expected or probable outcome or course of a disease (the chance of recovery or survival).

Prognostic Factors
Factors (such as tumor type, size and grade) that help determine prognosis.

Progression
The growth or spread of cancer, with or without treatment.

Progression-Free Survival
The length of time a person lives with metastatic cancer (such as metastatic breast cancer) before the cancer grows or spreads.

Proliferative
Rapidly growing and increasing in number. 

Prophylactic Mastectomy
Preventive surgery where one or both breasts are removed in order to prevent breast cancer. When both breasts are removed, the procedure is called bilateral prophylactic mastectomy.

Prospective Study
An observational study that follows people forward in time. See Cohort Study.

Prosthetic (Breast Prosthetic, Prosthesis)
An artificial breast form that can be worn under clothing after a mastectomy.

Protocol
An outline or plan for the use of an experimental drug, treatment or procedure in cancer therapy or diagnosis.

Punch Biopsy
Removal of a small circle of skin (with a special instrument called a punch or trephine) to be tested for cancer cells.

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Q

Quadrantectomy
Surgery where one quadrant or 25 percent of the breast is removed. See Lumpectomy.

Quality of Care
Measures of how well breast cancer is treated and how well a person is cared for during and after treatment.

Quality of Life
A measure of a person’s well-being and overall enjoyment of life.

Quartiles
Categories of an exposure (such as body weight or exercise) based on 4 equal parts of the total number of people in the study.

Quantiles
Categories of an exposure (such as body weight or exercise) based on equal parts of the total number of people in the study. When the total number of people is divided into thirds, the categories are called tertiles. When the total number of people is divided into quarters, the categories are called quartiles.

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R

RAD (Dose of Radiation)
Short for “radiation absorbed dose.” This term describes the amount of radiation absorbed by the tissues. One RAD is equal to 1 centigray. See Centigray.

Radial Scars (Complex Sclerosing Lesions)
A benign (not cancer) breast condition with a core of connective tissue fibers. Milk ducts and lobules grow out from this core.

Radiation Oncologist
A physician specializing in the treatment of cancer using targeted, high-energy X-rays.  

Radiation Therapy (Radiotherapy)
Treatment given by a radiation oncologist that uses targeted, high-energy X-rays to kill cancer cells.

Radical Mastectomy (Halsted Radical)
Surgical removal of the breast, chest muscles and underarm lymph nodes. Used only when the breast tumor has spread to the chest muscles.

Radio-Opaque
Does not allow radiation to pass through. A radio-opaque object will show up on an X-ray.

Radiologist
A physician who reads and interprets X-rays, mammograms and other scans related to diagnosis or follow-up. Radiologists also perform needle biopsy and wire localization procedures.

Radiotherapy (see Radiation Therapy)

Raloxifene
A drug first used to treat osteoporosis and now also used to lower the risk of breast cancer in postmenopausal women at high risk.

Randomized Controlled Trials
Studies where researchers change some participants’ behavior or provide a certain therapy to some participants to see how it affects health. Participants are randomly assigned (as if by coin toss) to either an intervention group (such as one getting a new drug) or a control group (such as one getting standard treatment).

Reconstruction (see Breast Reconstruction)  

Recurrence (Relapse)
Return of cancer. Local recurrence is the return of cancer to the same breast or the same side chest wall. Distant recurrence is the return of cancer that has spread to other parts of the body, such as the lungs, liver, bones or brain. See Metastases.

Regimen
A treatment plan.

Regional Lymph Nodes
In breast cancer, the axillary (in the underarm area) lymph nodes, infraclavicular (under the collarbone) lymph nodes, supraclavicular (above the collarbone) lymph nodes and internal mammary nodes. See Lymph Nodes.

Regression
The shrinking of a tumor. 

Relative Risk
A measure used to describe the increase (or decrease) in risk related to a specific risk factor. A relative risk is the ratio of 2 absolute risks: the numerator is the absolute risk among those with the risk factor and the denominator is the absolute risk among those without the risk factor. A relative risk that is greater than one shows a factor increases risk. A relative risk that is less than one shows a factor decreases risk. And, a relative risk of one shows the factor neither increases nor decreases risk (this means the factor is not likely related to risk of the disease). 

Relative Survival (Relative Survival Rate)
A measure used to compare the survival of people who have a certain disease with those who do not at a given time after diagnosis or treatment. The relative survival rate shows whether the disease shortens life. If relative survival is 100 percent at 5 years after treatment, there’s no difference in survival between those who have the disease and those who do not 5 years after treatment.

Retrospective Study
A study where both the exposure (such as alcohol use) and the outcome (such as breast cancer) occur before the start of the study.

Risk (of Disease)
Probability (chance) of a disease developing in a person during a specified time period.

Risk-Benefit Ratio
The relationship between the possible (or expected) side effects and benefits of a treatment or procedure.

Risk Factor
Any factor—from a lifestyle choice (such as diet) to genetics to an environmental exposure (such as radiation)—that increases or decreases a person’s risk of developing a certain disease.

RNA (Ribonucleic Acid)
A molecule made by cells containing genetic information that has been copied from DNA. RNA performs functions related to making proteins.

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S

Saline
A saltwater solution similar to that found in IV fluids. Saline can be used to fill a breast implant.

Scalp Cooling
The use of a cap filled with a chilled substance during chemotherapy to reduce hair loss due to chemotherapy.

Schedules
The different combinations and timing for chemotherapy and other drugs.

Sclerosing Adenosis
Small, benign (not cancer) breast lumps caused by enlarged lobules. The lumps may be felt and may be painful.

Scintimammography (see Molecular Breast Imaging)

Screening
A test or procedure used to find cancer or a benign (not cancer) condition in a person who does not have any known problems or symptoms.

Screening Mammogram
A test used to find early signs of breast cancer in a woman who does not have any known breast problems or symptoms.

Second Primary Tumor
A second breast cancer that develops in a different location from the first. This is different from a recurrence, which is the return of the first breast cancer.

Selection Criteria
In a summary research table, the specific standards (such as study design and number of participants) a study has to meet to be included.

Selective Estrogen Receptor Modulator (SERM)
A drug that can either block the effects of estrogen or behave like estrogen, depending on the part of the body being treated. Tamoxifen and raloxifene are SERMs.

Sensitivity
A quality of a screening test that shows the proportion (or percentage) of people who truly have the condition of interest who test positive for that condition. A test that had 100 percent sensitivity would correctly identify everyone who has the condition (but would have a lot of false positives).

Sentinel Node Biopsy
The surgical removal and testing of the sentinel node(s) (first axillary node(s) in the underarm area filtering lymph fluid from the tumor site) to see if the node(s) contains cancer cells.

Silicone Gel
Medical-grade, solid form of silicone used for breast implants. Silicone implants can mimic the feel of a natural breast better than saline implants.  

Simple Cyst
A round or oval-shaped fluid-filled sac. Findings from a breast ultrasound show the cyst only contains fluid.

Simple Mastectomy (see Total Mastectomy)

Skin-Sparing Mastectomy
A procedure that surgically removes the breast, but keeps intact as much of the skin that surrounds the breast as possible. This skin can then be used in breast reconstruction to cover a tissue flap or an implant instead of having to use skin from other parts of the body.

Sonogram (see Ultrasound)

Specificity 
A quality of a screening test that shows the proportion (or percentage) of people who truly do not have the condition of interest who test negative for the condition. A test that had 100 percent specificity would correctly identify everyone who did not have the condition (but would have a lot of false negatives).

Stage of Cancer (Cancer Stage)
A way to indicate the extent of the cancer within the body. The most widely used staging method for breast cancer is the TNM system, which uses Tumor size, lymph Node status and the absence or presence of Metastases in addition to other factors to classify breast cancers.  

Staging (Cancer Staging)
Doing tests to learn the extent of the cancer within the body (the cancer stage 0 to IV). Knowing the cancer stage helps determine what treatment is needed and how effective this treatment may be in getting rid of the cancer and prolonging life.

Standard Treatment (Standard of Care)
The usual treatment of a disease or condition currently in widespread use and considered to be of proven effectiveness on the basis of scientific evidence and past experience.

Statistical Significance
Describes whether or not the result of a study is likely due to chance. For example, a statistically significant result likely shows a true link between a risk factor and breast cancer, or a treatment and improved survival.

Stereotactic Needle Biopsy
Core needle biopsy done with the use of stereotactic (3-dimensional) mammography guidance.

Stereotactic Mammography
Three-dimensional mammography used to guide a needle biopsy.

Supraclavicular Lymph Nodes
The lymph nodes above the clavicle (collarbone). See Lymph Nodes.

Surgeon
Physician who performs any surgery, including surgical biopsies and other procedures.

Surgical Oncologist
A physician specializing in the treatment of cancer using surgical procedures.

Survival (see Overall Survival and Relative Survival)

Survivors (Breast Cancer Survivors)
People with a history of breast cancer, from the time of diagnosis to the end of their lives.

Survivorship
The emotional and physical health, life and care of a person diagnosed with breast cancer from the time of diagnosis until the end of life.

Systemic (Adjuvant) Treatment
Treatment given in addition to surgery and radiation therapy to treat breast cancer that may have spread to other parts of the body. It may include chemotherapy, hormone therapy and/or HER2-targeted therapy.

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T

Tamoxifen (Nolvadex)
A hormone therapy drug (taken in pill form) used to treat early and advanced stage breast cancers that are hormone receptor-positive. These breast cancers need estrogen to grow. Tamoxifen stops or slows the growth of these tumors by blocking estrogen from attaching to hormone receptor in the cancer cells. 

Targeted Therapy
Drug therapies designed to attack specific molecules or proteins involved in the development of cancer. HER2-targeted therapies, such as trastuzumab (Herceptin), and PI3 kinase inhibitors, such as alpelisib (Piqray), are examples of targeted therapies used to treat breast cancer.

Tertiles
Categories of an exposure (such as body weight or exercise) based on 3 equal parts of the total number of people in the study.

Therapeutic Touch
A complementary or integrative therapy where trained practitioners enter a semi-meditative state and hold their hands just above a person’s body to sense energy imbalances due to illness. Healing energy is then said to transfer to the person.

Thermography
An imaging technique that uses infrared light to measure temperature differences on the surface of the breast. The U.S. Food and Drug Administration (FDA) and the American College of Radiology do not support the use of thermography as a breast cancer screening tool.

Tissue
A group or layer of cells.

Tomosynthesis (see Breast Tomosynthesis) 

Total Mastectomy (Simple Mastectomy)
Surgical removal of the breast but no other tissue or nodes. Used for the treatment of ductal carcinoma in situ and, in some cases, breast cancer recurrence. Also used in prophylactic mastectomy. 

Trastuzumab (Herceptin)
A drug that is a specially made antibody that targets cancers with a lot of HER2 protein on the cancer cells. When attached to the HER2 protein, trastuzumab slows or stops the growth of the cancer cells. Trastuzumab is used to treat HER2-positive breast cancer. Herceptin is the brand name for trastuzumab.

Triple Negative Breast Cancer
A breast cancer that is estrogen receptor-negative, progesterone receptor-negative and HER2-negative.

Triple Positive Breast Cancer
A breast cancer that is estrogen receptor-positive, progesterone receptor-positive and HER2-positive.

Tumor
An abnormal growth or mass of tissue that may be benign (not cancer) or malignant (cancerous). 

Tumor Grade
Describes how closely cancer cells look like normal cells. Grade 1 tumors have cells that are slow-growing and look the most like normal cells. Grade 3 tumors have cells that are fast-growing and look very abnormal. Grade 2 tumors fall in between grade 1 and grade 3.

Tumor Marker
A substance found in blood that may be a sign of metastatic breast cancer. Tumor markers are found in both normal cells and cancer cells, but they are made in larger amounts by cancer cells. A tumor marker may help indicate metastatic breast cancer treatment activity. The term tumor marker may also be used more broadly to refer to characteristics of tumor cells such as hormone receptors.  

Tumor Profiling (Gene Expression Profiling, Molecular Profiling, Genomic Testing)
Tests that give information about thousands of genes in cancer cells. Specific genes (or combinations of genes) may give information useful in prognosis and in making treatment decisions.

Two-Step Procedure
Biopsy and further surgical treatment done at 2 separate times.

Tyrosine-Kinase Inhibitors
A class of drugs that target enzymes important for cell functions (called tyrosine-kinase enzymes). These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway. Lapatinib (Tykerb) is an example of a tyrosine-kinase inhibitor used to treat breast cancer.

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U 

Ultrasound (Sonogram)
Diagnostic test that uses sound waves to make images of tissues and organs. Tissues of different densities reflect sound waves differently.

Usual Hyperplasia
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). The proliferating cells look normal under a microscope. Although usual hyperplasia is not breast cancer, it increases the risk of breast cancer.

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V 

Vaginal Atrophy (Atrophic Vaginitis)
A condition where the lining of the vagina becomes thin and dry due to a decrease in estrogen. It causes vaginal dryness, pain during intercourse and other symptoms. It most commonly occurs in women who have gone through menopause.

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W 

Wire Localization (Needle Localization)
Insertion of a very thin wire into the breast to highlight the location of an abnormal area so it can be removed during a biopsy or a lumpectomy.

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X

X-Ray
Radiation that, at low levels, can be used to make images of the inside of the body. For example, a mammogram is an X-ray image of the breast. At high levels of radiation, X-rays can be used in cancer treatment.

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Parts of this glossary were adapted from the National Cancer Institute’s Dictionary of Cancer Terms, the American Cancer Society’s Cancer Glossary and the National Comprehensive Cancer Network’s Patient and Caregiver Resources: Dictionary.

Updated 02/10/21

Findings on a Mammogram

Mammography uses X-rays to create images of the breast. These images are called mammograms.

Learn more about mammograms.

Learn about getting a mammogram.

Mammography images

Like other X-ray images, mammograms appear in shades of black, gray and white, depending on the density of the tissue (see images below).

Very dense tissue, like bone, shows up as white on an X-ray. Fat looks dark gray on an X-ray.

Breast cancer and some benign breast conditions are denser than fat and appear a lighter shade of gray or white on a mammogram.   

Dense breast tissue

Dense breast tissue can look light gray or white on a mammogram. This can make abnormal findings hard to see on a mammogram.

Younger women tend to have dense breast tissue, so their mammograms can be harder to read than the mammograms of older women.

After menopause, breast density decreases, making mammograms easier to read.

The mammograms below show a range of breast density. Some breasts are mostly fat (fatty breasts) and some breasts are mostly breast tissue (dense breasts).

Fatty breast

Some breast density

More breast density

Dense breast

Breast density after menopause

Breast density decreases after menopause. This is true for women who go through natural menopause and younger women who are in menopause after surgery to remove the ovaries (oophorectomy).

For women who use menopausal hormone therapy (MHT), breast density may not decrease until they stop using MHT.

Breast density and breast cancer risk

Women with dense breasts (as seen on a mammogram) have a higher risk of breast cancer than women with fatty breasts [22-23].

Learn more about breast density and breast cancer risk.

Komen Perspectives

Read our perspective on breast density and breast cancer risk.*

Learn More

Screening tools under study for women with dense breasts

Dense breast tissue can make abnormal findings hard to see on a mammogram.

There are no special recommendations or breast cancer screening guidelines for women with dense breasts.

Some tools are under study for breast cancer screening in women with dense breasts.

Some data suggest 3D mammography (breast tomosynthesis) may find more breast cancers in women with dense breasts compared to 2D mammography [24].

Breast ultrasound and breast MRI (each combined with mammography) are being studied to learn whether they improve detection in women with dense breasts compared to mammography alone.

Breast density legislation

Many states in the U.S. have laws requiring health care providers to notify (send a letter to) women found to have dense breasts on a mammogram. In 2019, the U.S. Congress passed national breast density legislation. The Food and Drug Administration (FDA), which regulates mammography centers, is developing regulations for notification.

Although this may seem helpful, there are no special recommendations or screening guidelines for women with dense breasts. However, your provider may suggest other types of breast imaging.

If you have any concerns about your breast density or your risk of breast cancer, talk with your provider.

Findings on a mammogram

Benign breast conditions (not cancer)

Some common benign breast conditions (such as cysts and fibroadenomas) may show up on mammograms as round or oval patches with distinct borders. 

Learn more about benign breast conditions.

Calcifications and microcalcifications

Calcifications are bits of calcium that can show up on mammograms as small, bright white spots.

Most calcifications are benign (not cancer). However, certain patterns of calcifications are suspicious and need more testing. Tight clusters or lines of tiny calcifications (microcalcifications) can be a sign of breast cancer.

Calcifications are common, especially after age 50 [25]. They may be related to past injury to the breast or mastitis (an infection in the breast) [25].

In women treated for breast cancer in the past, calcifications may be related to past breast surgery or radiation therapy [25].

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer.

On a mammogram, DCIS usually looks like a cluster of microcalcifications. It can be hard to know from a mammogram image whether the cluster is DCIS or invasive breast cancer. (A cluster of microcalcifications can also be a benign finding on a mammogram. This means it’s not cancer.)

Learn about follow-up after an abnormal mammogram.

Learn more about DCIS.

Invasive breast cancer

Invasive breast cancer can appear as a white patch or mass on a mammogram.

The tumor cells don’t stay within the clear borders of the mass, but instead invade the nearby breast tissue. The outer edges of these cells look fuzzy or spiky (called spiculated).

Learn about follow-up after an abnormal mammogram.

Mammography results

When to expect mammography results

Some centers give you the results of your mammogram at the time of your screening. With others, it may take up to 2 weeks to get your results.

If you don’t get your results within 2 weeks, contact your health care provider or the mammography center.

Don’t assume the results were normal because you didn’t get a report. Follow-up to get your results.

Breast Imaging Reporting and Data System

Most mammography centers report the results of mammograms using the Breast Imaging Reporting and Data System (BI-RADS^®).

BI-RADS^® was developed by the American College of Radiology to provide a standard way to describe the findings on mammograms (with categories numbered 0 to 6).

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.

Updated 03/08/21

What Your Mammogram Results Actually Mean, According to a Doctor

Even when you hear that your annual mammogram is normal, it can be disconcerting to get your hands on the actual report, filled with mysterious, scary terminology. Yes, these reports are meant for communication between doctors, but most of us, if we don’t know what a word means or it sounds bad, think it must be bad…really bad.

The word “negative” is a good example. In life, negative things are bad. In medicine, “negative” means nothing bad was found. (But even after you’ve gotten a negative report, if you feel something in your breast that wasn’t there before, get it checked out.)

Interpreting your mammogram should be left up to the radiologist, but it’s still helpful to know what common phrases mean. Keep in mind that these terms are descriptive, not diagnostic: A biopsy is the only way to diagnose breast cancer. Here are seven terms you might see on your paperwork, and what they mean. Based on all these findings, the radiologist will use the standardized Breast Imaging Reporting and Data System to communicate an overall impression to your doctor, indicating a level of concern and suggested next steps, if any.

Density

The amount of fibrous and glandular tissue, as opposed to fatty tissue, in your breasts. The less fat there is, the higher the density. Having dense breast tissue is common and not abnormal, but this can make it harder to evaluate mammogram results and may be associated with increased risk of breast cancer. Women with dense breasts may also need an ultrasound or an MRI.

Parenchymal Asymmetry

This finding may be due to imperfect positioning during the scan, or maybe your breasts, like most women’s, don’t match. When a woman is “invited” back for more views, it’s often because an area on one breast didn’t look the same as the corresponding area on the other.

Architectural Distortion

No mass was seen, but the appearance of the breast tissue is not normal. The radiologist’s level of concern will depend on what is contributing to the distortion.

Calcifications

Calcium deposits appear as bright white spots on a scan. Most calcifications are not worrisome and do not indicate cancer.

Microcalcifications

Small clusters of calcium deposits are concerning, but while they often indicate that a biopsy is needed (intraductal calcifications generally require a biopsy), they’re not diagnostic of breast cancer.

Mass/lesion tumor

These words, while terrifying, are also not a diagnosis of cancer. A mass is a growth—period. (A bunion is a mass, but not toe cancer.) A fibro­adenoma is an example of a common benign (noncancerous) fibrous tumor. A calcified mass is almost always benign. But of course, some masses are of greater concern than others.

Spiculated focal mass

Up to 80% (but not 100%) of these masses are cancerous. A biopsy of these is essential. If you see this on a report, you have reason to be concerned, but be glad you had the mammogram, since most of these masses can’t be felt during a breast exam. If a biopsy does detect cancer, early detection and removal is the surest way to a cure.

This article was originally published in the October 2019 issue of Prevention.

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Common Breast Imaging Terminology and Findings

1. Women First Care
2. Breast Health
3. Breast Imaging Terms & Findings
4. Digital Mammography
5. 3D Tomosynthesis Mammography

The terminology used in breast imaging can be somewhat confusing and possibly a cause for concern if the meaning isn’t readily clear. So Women First wants you to know the categories used to define results of breast imaging, be familiar with the most common imaging findings, and understand the breast diagnostic procedures that may be used to follow up after a mammogram.

BI-RADS Categories for Breast Images

There are 6 categories that are used for reporting and tracking breast imaging reports.

Category 0: Mammography Incomplete. Need additional imaging evaluation and/or prior mammograms for comparison

Category 1: Negative

Category 2: Benign (but other comments may be present)

Category 3: Probably Benign (usually follow up needed)

While the BI-RADS category 3 can be confusing, this category uses standardized terminology based on science demonstrating that follow-up (usually 3 to 6 months) rather than a biopsy is a safe and effective management plan for imaging findings that are very likely benign.

Category 4: Suspicious

• Category 4A: Low suspicion for malignancy
• Category 4B: Moderate suspicion for malignancy
• Category 4C: High suspicion for malignancy

Category 5: Highly Suggestive of Malignancy

Category 6: Known Biopsy-Proven Malignancy

Common Breast Imaging Findings

Breast Cysts

Our breasts have fluid filled systems that can become congested at times; this fluid may collect and become visible on breast images.

• Breast cysts can be described as “simple” or “complicated.”
• A “simple” cyst is filled with watery-like fluid. These are generally a benign finding and, on occasion, can be aspirated (drained) for a patient’s comfort, or if they are very large.
• “Complicated” cysts have a different appearance on ultrasound; they appear to have debris floating within them. This could be caused by the cyst being older and the fluid has become thicker—like syrup, or the cyst may have a solid component to it.

Focal Asymmetry

This is not a mass or a nodule. Focal asymmetry is a description of an area of tissue that looks a bit different within the breast itself, possibly a more dense area. This usually proves to be a normal change. Our breasts begin as dense tissue, and as we age, and/or have children and/or gain a little weight, our breast tissue becomes more fatty. The islands of breast tissue may appear differently because of the more fatty tissue surrounding it, or due to other changes such as weight gain or loss, more or less caffeine use, or hormonal changes.

Mass

A mass is a nodular finding on the breast image. It may be solid, fatty, or fluid-filled. Additional images are generally needed to determine exactly what this is and/or if further tests are needed.

Architectural Distortion

The breast tissue in an architectural distortion appears different than expected. This could be scar tissue or due to other changes such as weight gain or loss, caffeine use, or hormonal changes.

Additional Procedures for Breast Diagnostics

Cyst Aspiration:

Cyst aspiration is done under local anesthesia with ultrasound for guidance. The radiologist will numb the area and, using ultrasound for guidance, insert a small needle into the cyst to drain it. The fluid is sent to pathology if it is bloody, brown, or green. If the fluid is clear or straw colored, it is usually discarded.

Ultrasound Guided Biopsy:

Done under local anesthesia with ultrasound for guidance, the radiologist will numb the area and insert a needle into the area of concern, using ultrasound to direct these efforts. The needle has suction attached to it to make the process easier. The extracted tissue samples will be sent to pathology and the radiologist or healthcare provider will contact the patient with the results.

Stereotactic Biopsy:

For this type of biopsy, the patient is positioned with her breast through an opening in the machine. The breast is compressed, as with a mammogram machine, and a series of pictures is taken to determine exactly how deep the area of concern is in the breast. Next, a local anesthesia is injected and a small (1/8 inch) incision is made. A needle is inserted to biopsy the tissue, and several tissue samples may be taken. A biopsy clip will be placed at the biopsy site. A post-procedure mammogram will usually be obtained. The tissue samples are sent to pathology and the radiologist or healthcare provider will contact the patient with the results.

Excisional Biopsy:

This type of biopsy is performed by a breast surgeon. The patient is taken to the operating room and put under a heavier sedation. Generally, a needle is placed in the area of concern prior to the biopsy to guide the surgeon to the exact point. The tissue to be biopsied will be removed and sutures placed. The tissue will be sent to pathology, and the breast surgeon will contact the patient with the results.

Mammography Lay Report Letter Templates | American College of Radiology

The Mammography Quality Standards Act (MQSA) requires that “a summary of the written report shall be sent directly to the patient in terms easily understood by a lay person.” This applies to every patient who receives a mammogram, not only self-referred patients. Failure to comply with this reporting requirement will result in a citation by FDA inspectors. Furthermore, “facilities must provide a summary of the results of the mammographic examination written in lay terms to all patients within 30 days.”

The lay letter need only be a summary. It must be a written summary, however; a phone call or verbal communication are not sufficient. A summary regarding abnormal results must give clear direction about the appropriate steps to be taken by the patient.

The ACR recommends that you send the official interpretation to the referring provider prior to sending a lay summary report to the patient. However, BI-RADS® category 4, “Suspicious Abnormality-Biopsy Should be Considered” and category 5, “Highly Suggestive of Malignancy-Appropriate Action Should be Taken” should also be conveyed by phone to the referring physician or primary health care provider immediately.

The FDA Policy Guidance Help System states, “when there are ‘Suspicious’ or ‘Highly Suggestive of Malignancy’ results, the facility must also make reasonable attempts to communicate the results to the referring health care provider or a responsible designee as soon as possible. ‘Suspicious’ or ‘Highly suggestive of malignancy’ results should be communicated to the health care provider within three working days, using either a written report or documented verbal communication. If this is achieved through direct communication with the health care provider, this does not obviate the need to also send written communication within 30 days.”

The FDA further states that “when an assessment is ‘Suspicious’ or ‘Highly suggestive of malignancy’ the lay summary results and recommended course of action must be communicated to the patient as soon as possible. FDA believes that communication of suspicious or highly suggestive results can be accomplished within five working days. One way to achieve this is through direct verbal communication with the patient; however, this does not eliminate the need to also send written communication within 30 days.”

The ACR encourages you to share samples of your lay summary reports with your referring physicians or primary health care providers. These steps, along with an effective communication system and policy, will foster a team approach to patient care.

The MQSA also requires the official mammography report sent to referring medical colleagues and self-referred patients to include the final mammographic assessment (BI-RADS® terminology) somewhere in the report. The actual word description must appear. However, the ACR Committee on Breast Cancer recommends that both the actual word description and the BI-RADS® category number appear, e.g., “Category 1 – Negative.”

We recommend that you take into consideration the following issues as you develop your procedures:

• You must have a written procedure that describes how the written lay summary report is conveyed to the patient. We also recommend that you use a log or your RIS system to track when the written lay summary is sent.
• Tell every patient that they should expect to receive a lay summary report within “X” days (no more than 30 days by law). Providing the patient with an approximate date of arrival may decrease anxiety and phone calls.
• If you choose to hand the patient a written lay summary at the time of the appointment, you should consider the psychosocial impact of how this is done. Having a professional such as a radiologist or a nurse verbally review the summary with the patient may reduce patient anxiety.
• The importance of the correlative breast physical exam should be discussed in the written lay summary, especially for self-referred patients.
• Finally, it is prudent to discuss this issue with your counsel so as to be in compliance also with local and state laws. FDA guidance documents regarding requirements for amended reports and other issues will appear on the FDA website on the MQSA Policy Guidance Help System page or the Communication of Results to Patients page.

90,000 on what day of the cycle to do, decoding of the results

Statistics show that breast cancer affects, on average, one in eight American women. It is the second most common type of cancer (after skin cancer) and the second most dangerous.

The American National Cancer Institute ( NCI ) in 2018 alone identified about 260,000 new cases of invasive breast cancer in the United States.Although the death rate from this disease has decreased over the past decades, the methods of diagnosis are still considered highly controversial.

Clinical trials of breast cancer diagnostic technologies, including mammography, have shown mixed results. More than 85% of American women over the age of 40 have had a mammogram at least once. Today, not all experts agree on which procedures should be recommended, especially for women under 50.

In March 2019, for the first time in 20 years, the US Food and Drug Administration ( FDA ) proposed amendments regarding the quality and safety of mammography procedures. The FDA recognizes, despite the fact that mammography is perhaps the most effective way to diagnose breast cancer, that it fails to detect the disease in all women, especially in patients with high breast density (which occurs in half of women older 40).In this case, the reliability of the mammogram is reduced. This means that doctors and their patients must be aware of the risks associated with breast density and other factors that make it difficult to accurately diagnose breast cancer.

Recommendations for standard mammography

A mammogram is prescribed for two reasons: to diagnose breast cancer and to confirm it if another test shows the presence of cancer cells. However, it cannot prevent or cure cancer.

It is worth considering how often to get mammograms: as needed, once a year or twice a year? You should take into account age, undesirable consequences and many more factors. You also need to understand the full benefits of this procedure, contraindications and risks.

The US Disease Prevention Working Group ( USPSTF ) issued a recommendation in 2009 that women under 50 should not undergo mammography annually unless there is an individual indication.Such a statement runs counter to the recommendations of the American Cancer Society ( ACS ) and other authoritative groups, without giving precise instructions on how to protect yourself from breast cancer.

The American College of Physicians agrees with USPSTF recommendation , and the National Breast Cancer Coalition warns women about the limitations and potential risks of mammography.

The following are the latest mammography guidelines published by the US Disease Prevention Working Group in 2009:

• For women aged 50 to 74, mammography is recommended every two years. USPSTF speaks of “a high degree of likelihood of some benefit from a given procedure, or some likelihood of significant benefit.”
• For women under the age of 50, USPSTF states that “the decision to have mammograms regularly should be made on an individual basis, taking into account the woman’s condition and the risks and benefits of the procedure.”

Women’s health expert Dr. Christian Northrop describes the US Disease Prevention Working Group as a trusted, influential government organization that provides impartial information to doctors, insurance companies and policymakers.In 2009, the company reviewed the available information and advised women to have regular mammograms (every two years) from the age of 50, not 40.

Despite the existence of other methods of detecting cancer, USPSTF believes that mammograms are very effective in examining women over 50 who are at risk.

On the other hand, the American Cancer Society has provided the following guidelines for the diagnosis of breast cancer:

• Women from 40 to 44 years old can have an annual mammogram, if they want it .In doing so, it is worth considering the risks and potential benefits.
• Women aged 45-54 should have a mammogram once a year.
• Women over 55 can have a mammogram every two years or continue with an annual exam.

These instructions are for women with an average risk of developing breast cancer. Women with a personal or family history of breast cancer and a genetic mutation known to increase the risk of developing cancer (such as breast cancer gene 1), and women who have received chest radiation therapy before the age of 30 are at an increased risk of developing breast cancer.

While the American Cancer Society says that mammography can diagnose cancer in its early stages (eg, ductal carcinoma in situ or PCIS), it also notes that “mammograms have their drawbacks,” and can be erroneous. “Sometimes more research is needed to clarify whether a particular feature identified in the diagnosis is cancer or not.”

History of the research method

The first study of all the advantages and disadvantages of mammography took place several years ago, when the technical capabilities of the devices were much lower.Clinical trials of the safety of this procedure were first conducted in the 1970s, and since then they have been often criticized due to the large number of shortcomings and limitations.

Similar trials, conducted by the United States, Sweden, Canada and the United Kingdom, showed that women who underwent routine screening mammograms were more likely to detect breast cancer early than women who were offered only standard care.

As a result of this observation, the scientists concluded that it would be unethical to deliberately deny women mammograms for the sake of research. Thus, randomized controlled blind studies in this area were discontinued.

Since then, other studies on the effectiveness of mammography in women under 50 have tended to be less accurate. A mammogram is recommended mainly for women over 50 for two reasons.Firstly, at this age, the frequency of this disease increases, and secondly, at a younger age, the mammary gland is denser, which means that the results of the examination will be less accurate.

The most reliable mammograms in postmenopausal women, when the mammary gland contains more adipose tissue. Studies have found that the benefits of this method are most limited in women between 55 and 69 years of age, but “outside of this age range, no statistically significant benefit is observed.”

Facts about the low accuracy of mammography in young patients, combined with recent findings that this diagnostic method may have certain risks, has led some health authorities to change their minds about whether to prescribe this procedure to women. Along with knowledge of mammography, the opinion of specialists also changes. But, as you will find out later, there are very real risks of annual examinations, “false positives” and questionable treatments.

Potential risks

In 2002, Cochran, a British non-profit organization, conducted an analysis to examine mammography data and found that general screening can be harmful, as it often leads to overdiagnosis and over-treatment. She also found that many advertising groups and websites supporting mammography accept industry sponsorship without restriction. This leads some organizations to talk about the possibilities of mammography without mentioning its disadvantages.A similar problem arises when it comes to treating cancer naturally, rather than more aggressive methods.

Reasons why mammography can increase your risk of cancer:

1. Overdiagnosis and over-treatment

Ductal carcinoma in situ (DCIS) is a type of cancer cell present in 10% of all women and in 15-60% of women over 40. DCIS means that abnormal cells have been found in the breast ducts, but they have not spread outside of them. into other fabrics.PCIS itself is not life-threatening, but its presence increases the risk of developing invasive breast cancer in the future.

But, according to Dr. Michael Cohen, “PSIC can be present in a woman’s body all her life and not affect the surrounding tissues … We cannot distinguish those cells that will spread from those that will not.”

This fact creates some problems for doctors, because if a mammogram confirms the presence of PCIS in women, they cannot say for sure how to respond and treat the disease as effectively as possible.Many invasive and dangerous measures can be taken to treat abnormal cells even when the PCIS is not progressing. Often, after its detection, the patient is recommended to start treatment with surgery, radiation, hormonal or chemotherapy in order to stop the development of oncology.

Since the introduction of mammography in the 1970s, the detection rate of PCIS has increased dramatically. The US National Cancer Institute reported that in 2004, the incidence of PCIS was 32.5% per 100,000 women.For comparison, in 1975 the figure was 5.8% per 100,000. It is believed that radiation and pressure during mammography procedures provoke an increase in the incidence. But even if this is not the case, there is a real problem of over-treatment of PCIS and the occurrence of adverse side effects.

2. Increased exposure

A mammogram exposes the body to a higher dose of radiation than a chest x-ray. There is an opinion that ionizing radiation leads to cell mutation, and mechanical action promotes the spread of tumor cells (as during a biopsy).

In addition to the low reliability of mammograms in young women (premenopausal), patients under 40 are much more sensitive to radiation. The organization for the fight against breast cancer has found that “radiation during mammography in women under 40, and probably in women before menopause in general, can increase the risk of developing cancer.” She also claims that radiation is even more dangerous for a pregnant woman than chemotherapy!

The risk of developing breast cancer increases by 1% with each additional unit of radiation.The Department of Epidemiology and Radiology at the University Medical Center Groningen in the Netherlands found that among women with a predisposition to cancer, the risk of developing cancer was 1.5 times higher in those who were exposed to a low dose of radiation. If patients under the age of 20 were exposed to it, or the procedure was performed 5 or more times, then the likelihood of breast cancer may increase 2.5 times!

A study published by Harvard Medical School also suggests that for every Gray (unit of absorbed dose of ionizing radiation), the risk of heart disease in women increases by 7.4%.

3. Stress and Anxiety

Many are not worried about the fact that cancer cells are present in the body of every person in one way or another. Our immune system is able to effectively fight them if it is not deficient in nutrients or too much toxins. We used to think that cancerous or mutated cells are not normal and should be cause for concern, but this is not always the case. As we mentioned above, overdiagnosis and over-treatment can do more harm than good.

Surprisingly, an increased concern for our own health can negatively affect our body. Clinical studies that have been conducted over the past 30 years have shown a strong link between “chronic stress, depression and social isolation with the development of cancer.” There is speculation that excessive stress levels when a person thinks they have cancer can cause them to lose hope and succumb to illness.

Don’t underestimate the impact of anxiety, stress, and despair; Research shows that optimism and a positive outlook can literally increase your chances of recovery.Dr. Joseph Mercola agrees and argues that “the very thought that you might have breast cancer when you really don’t have it focuses your mind on fear and disease. This may be enough to trigger the development of the disease in the body. Thus, a false positive mammogram or unnecessary biopsy can be dangerous. ”

FDA FDA Regulation Regarding the Accuracy of Mammography:

In March 2019, FDA published the following: “As part of the protection of women’s health, we propose to change the surveillance policy for the use of mammography, based on a number of advances in this area, including the use of digital 3D equipment, and taking into account the density of the patient’s breast for effective result… This recommendation will help patients continue to benefit from modern technology with more careful monitoring in this area. ”

The 2019 FDA amendments aim to:

• Improving the relationship and communication in medical decision making between the patient and the doctor. The new wording in the conclusions of mammograms will be able to more easily inform patients about the risks (such as breast tightening and others), affecting the development of breast cancer.
• Providing patients and healthcare facilities with more complete information on breast density. “Dense” breasts are those with a higher proportion of fibroglandular tissue compared to adipose. Statistics show that in the United States, more than half of women over 40 have firm breasts.
• For a more detailed explanation of how breast density can affect the accuracy of a mammogram. Dense breasts can hide signs of breast cancer and reduce the sensitivity of the mammography device.Dense tissue in this case does not allow specialists to see signs of cancer, which makes the mammogram less reliable. In this case, patients with dense breasts should discuss the risks with a specialist and talk about other methods of diagnosis and treatment, based on each specific situation.
• Providing physicians with information on three additional risk categories for breast cancer, including “biopsy-proven malignancy.”
• the establishment of new rules for mammography, taking into account the information that is provided to patients.So, before carrying out the procedure, it is necessary to notify the patient if the diagnosis does not meet the quality standards FDA . In this case, patients will be able to independently decide whether they should use any other diagnostic methods in addition to mammography.

Proven risks of mammography

• Mammography is associated with a lot of unnecessary procedures, excitement and waste. A large Swedish study found that 726 out of 60,000 women were referred to an oncologist for treatment after undergoing mammography.Moreover, about 70% of these women did not have cancer! The number of false positives in women under the age of 50 is very high (about 86%).
• Another study by Cochran Nordic Center involving 800,00 women showed no statistically significant reduction in breast cancer mortality in the first 9 years of a mammographic screening program.
• Magazine “ The Lancet ” states that mammography is not a reliable diagnostic method for women at a young age.5% of patients who underwent mammography were referred to an oncologist; studies have shown that 20 to 93% of these cases were “false positive.” How can the number of misdiagnoses be so high? Perhaps this is due to an erroneous reading of the diagnostic results due to the high density of the breasts.
• Another study by members of the Radiological Society of North America found that about a third of women who had annual mammograms between the ages of 40 and 49 had at least one false positive result.At the same time, 62% of women do not even consider the possibility of a false positive result during the examination.
• A 13-year study in Canada involving 39,405 women concluded that mammography screening did not reduce the absolute incidence of breast cancer or mortality from breast cancer compared with physical examination.

Effective alternative to

Thermography is a new, non-invasive technology that does not use radiation or compression to diagnose breast cancer.Breast density also does not affect the result of the thermogram, which means it is reliable in young women as well. This is a simple and painless method that is suitable even for pregnant women, it is cheaper than mammography, but no less (and sometimes even more) effective.

A thermograph measures the level of infrared radiation and converts it into an image. With its help, doctors can detect cancerous tumors at an early stage and choose the most effective method of treatment for the patient.

In any case, the best treatment is prevention.Eat healthy foods rich in cancer-fighting nutrients, exercise, avoid stress, and limit the effects of toxins on your body. This way you can minimize the risk of developing any disease.

Take care of yourself and your loved ones,
buy only healthy products!

Changes that do not make themselves felt until recently

02/18/2021 11:17:00

Changes that do not make themselves felt until the last

Today’s women spend a lot of money and time on manicures, haircuts and hair dyeing, glue eyelashes, paint eyebrows and much more that nature has not completed.Many are accustomed to visiting their craftswomen over and over again and drawing patterns on nails for hours, not finding time to visit a doctor at least once every six months to simply, quickly and often even check their women’s health for free.

Since November 2020, a modern mammography apparatus has been operating in the Teplo-Ogarevskaya polyclinic, which makes it possible to obtain highly accurate results according to the BI-RADS international breast imaging interpretation and logging system. In addition to obtaining accurate results, the system allows you to standardize examination results, bring them to a unified terminology, indicate a further action plan, and monitor the course of the disease.An expensive digital device has ample opportunities for long-term data archiving for the purpose of their subsequent comparison and accessibility for doctors not only of the district hospital, but also of other medical institutions.

– The result of screening mammography is documented in a standardized protocol. The terminology used in the description of the results should be clear and not tolerant of ambiguity. This is the main task of the BIRADS system. The protocols for describing mammography of the mammary glands should be set out structurally, according to a clear standard and obey certain description criteria, according to which conclusions and recommendations will be made.This is especially important in the sense that other specialized doctors can get acquainted with the results of the examination, – says ultrasound diagnostics doctor Alla Roenko. – It’s no secret that breast cancer has become a natural disease that affects many women, especially over 45 years old (according to WHO). By the order of the Ministry of Health on medical examination of the population, mammography is strictly indicated once every two years for all women from 40 to 75 years old. The procedure takes 15 minutes for each breast.The examination can be carried out more often for medical reasons, which can be identified by a gynecologist or mammologist.

For a competent approach to monitoring her health, a woman should visit a gynecologist every six months, who, as part of a clinical examination, will palpate the mammary glands. If the doctor doesn’t raise any concerns, it’s okay. But at the same time, every six months, every woman should also undergo an ultrasound of the mammary glands. The radiation load from ultrasound is not as great as with mammography, so it is allowed to do it so often.

– In less than 4 months of work, 126 heat-warmed women were examined on our mammography machine. One of them was diagnosed with an oncological disease at an early stage, – continues Alla Aleksandrovna. – Be attentive to your body and do not forget to examine and feel yourself on your own. Make it a rule to visit your doctor regularly and remember: bad things don’t hurt.

Lyudmila Grishina

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Glossary of Terms, Union Clinic

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Sexual abstinence – sexual abstinence, forced or conscious decrease in sexual activity below the individual need.In healthy married men of young and middle age, the period of forced sexual intercourse is easily tolerated, however, premature ejaculation, sexual difficulties when resuming regular sexual activity due to a violation of its previous rhythm, which is restored slowly and gradually, are possible.

Sexual aversion is one of the most severe sexual dysfunctions, a condition opposite to libido (sexual desire). It manifests itself in the inhibition of any sexual manifestations, which leads to disruption of the functioning of the partner couple and the occurrence of sexual dysfunction.

Adenoma of the prostate gland – benign hyperplasia (increase in volume) of the glandular tissue of the prostate gland. According to statistics, it prevails in patients over the age of 50. It is characterized by disorders of urination, dysfunctions of the bladder and kidneys, and sexual dysfunctions. In the initial stages of the disease, an asymptomatic course is possible, the final stages are manifested by severe pain syndrome, the inability to urinate independently, and the development of renal failure.

Azoospermia – the absence of sperm in the ejaculate. It is one of the causes of infertility in men.

Akinospermia – complete immobility of living spermatozoa in the sperm and their inability to fertilize.

Acne (acne) is a deep skin lesion associated with hereditary predisposition, perverted hormone levels in the body, and other external and internal influences.The patients have a feeling of inferiority, depression, shyness, irritability. The disease is accompanied by inflammatory changes around acne (acne) with possible regional lymph node involvement. The most severe complication is pyoderma – skin lesions with the formation of multiple purulent foci, fever, weight loss and appetite.

Alibidemia – lack of sexual desire. The reasons are mental disorders, endocrine disorders, drug intoxication, sleeping pills, etc.drugs, urological or gynecological diseases.

Allergic contact dermatitis – itchy blistering rash on the skin in places of contact with allergens. When combing, infection is possible with the subsequent spread of the inflammatory process in the skin. Against the background of allergic dermatitis, allergic edema of the mucous membranes of internal organs often develops (for example, Quincke’s edema – edema of the respiratory tract) with the development of a severe clinical picture.

Allergy to drugs – a type of adverse reactions to taking medications, on the part of the skin manifested by itching, rashes, urticaria, areas of redness, blistering, etc. The most formidable complication is the development of toxic epidermal necrolysis – rejection of large areas of skin (from 20 to 100%), sometimes incompatible with life.

Algodismenorrhea is a cyclic pathological process consisting of pain in the lower abdomen, which may be accompanied by nausea, vomiting, headache, lack of appetite, fever, fainting, etc.vegetative manifestations during menstruation. Hypersensitivity to certain hormones during the menstrual cycle, genital endometriosis, or pelvic inflammatory disease may be the cause.

Aldosteronism syndrome (hyperaldosteronism, Connes syndrome) – caused by a tumor of the adrenal cortex, consists of 3 groups of symptoms:

1) neuromuscular,
2) renal,
3) arterial hypertension.
Severe weakness, attacks of muscle weakness up to paralysis are observed, convulsions are possible. Hypertension is a constant symptom of hyperaldosteronism, it causes changes in the retina of the eye, changes in the heart with impaired cardiac functions.

Amenorrhea – pathological absence of menstruation in women for 6 months or more. The cause of the disease can be a brain tumor, psychosis, inflammatory diseases of the ovaries, uterus, malformations of the genital organs, diseases of the adrenal glands, thyroid gland, nutritional disorders.

Anal fissure – longitudinal (along the bowel axis) defect of the mucous membrane with clear edges and bottom. Cracks are always located at the entrance to the rectum, mainly along the back wall. The length of the fissure is approximately 1 cm. The fissure manifests itself as severe pain that occurs during or after defecation, spasm of the anal sphincter, and bleeding. In chronic course, the edges of the wound thicken, thicken, which prevents its healing. Long-term presence of an inflammatory focus can lead to severe complications – fistulas, paraproctitis (purulent inflammation of soft tissues around the rectum), malignancy of the process.

Anal itching – a pathological condition characterized by persistent itching in the anus. The disease is characterized by a persistent course. It can be primary (true) and secondary, accompanying many diseases (hemorrhoids, anal fissure, helminthic invasions, inflammation of the sigmoid and rectum, constipation, diarrhea, inflammation of the genital organs, fungal skin lesions, etc.). In addition, anal itching can be one of the early signs of latent diabetes.Acute anal itching begins suddenly, the skin is changed by hypertrophy of the perianal folds, scratching. With chronic itching, the onset is slow, the skin is dry, thinned, scratching marks look like thin abrasions. Anal itching is always dangerous by the development of perianal purulent-inflammatory processes and inflammatory changes in the sigmoid and rectum.

Androphobia – man-hatred, fear of men. Caused by various psychological trauma.

Anococcygeal pain syndrome – pain in the sacrococcygeal region and in the anal and rectum.The reasons are still not fully understood. The pathology of the nervous apparatus of the sacrococcygeal plexus, the consequences of acute or chronic trauma with the development of a fibrous process in the pelvic tissue with the development of myositis or muscle contracture plays a role. Pain can be pronounced, last for years, radiate to the perineum, buttocks, thighs. For the treatment of anococcygeal pain syndrome, an integrated approach is required.

Anorgasmia – Difficulty reaching orgasm.A common condition in women. There are primary (women who have never experienced an orgasm suffer) and secondary (characteristic of those women who were previously capable of orgasm, but now no longer experience it for a number of reasons). The most common among secondary anorgasmia are symptomatic anorgasmia (manifestation of any underlying disease) and psychogenic (inhibition of sexual functions by mental factors). The consequences of anorgasmia can be the development of stagnant processes in the small pelvis and the formation of urogynecological pathology, psychological problems, problems of partnerships, etc.

Nervous anorexia is a psychogenic disease characterized by lack of appetite, progressive loss of body weight. Secondary causes are dysfunctions of the endocrine system (thyroid disease, ovarian dysfunction, polycystic ovary disease, decreased adrenal cortex function). It occurs in both women and men, who are prone to stressful situations, nervous shocks and worries for a long time.

Anejaculatory phenomenon is a type of ejaculation disorder.The extreme manifestation of delayed ejaculation or its complete absence. The most probable causes are urological diseases, inhibition of sexual functions by mental factors, intoxication. The absence of ejaculation causes stagnation in the small pelvis with the subsequent development or aggravation of urological diseases.

Apoplexy of the ovary – hemorrhage in the ovary, accompanied by its rupture and bleeding into the abdominal cavity. It occurs against the background of a previous inflammatory process.Lifting weights and violent intercourse play a provoking role. It is manifested by severe pain syndrome and signs of internal bleeding.

Aspermia – the absence of sperm in the semen. One of the causes of male infertility.

Asthenozoospermia – a decrease in the number of motile forms, as well as the speed of movement of sperm in the semen (more than 30%). One of the causes of male infertility.

Ataxia-telangiectasia is a severe genetically determined disease of cells of the central nervous system with characteristic changes – telangiectasias (spider veins) on the skin of the trunk, auricles, conjunctiva of the eye and other mucous membranes.

B

Bacterial infections – purulent-inflammatory lesions of the skin and hair follicles caused by various bacterial flora (the most common are staphylococcal and streptococcal infections). Manifested by the formation of boils, carbuncles, vesicles with serous or purulent contents, inflammation of the hair follicle bulb, inflammatory cellulite, etc. May be accompanied by the formation of glued honey-yellow crusts.One of the types of cellulite caused by hemolytic streptococcus is erysipelas. Skin lesions are accompanied by malaise, fever, headache. Purulent areas of the skin can become necrotic; if a large amount of infectious agents enter the blood, bacteremia develops, which can be fatal.

Bacterial vaginosis – inflammatory changes in the vagina, accompanied by discharge from the genital tract.Bacterial vaginosis makes up from 30 to 80% in the structure of inflammatory diseases of the genital organs in women and is detected in 24% of practically healthy women during examination for the purpose of prophylaxis. Bacterial vaginosis is one of the causes of severe pathology of the female genital organs and complications of pregnancy and childbirth.

Bartholinitis – inflammation of the large gland of the vestibule. The causative agents are various microbes: staphylococci, gonococci, etc.It is manifested by swelling, pain in the vaginal area. In the case of recurrent bartholinitis, extirpation (removal) of the gland is indicated.

Beli is a symptom of gynecological diseases associated with a change in the secretion of the genital organs. The reasons may be inflammatory processes, tumors of various localization. An admixture of pus usually indicates an inflammatory process, blood – the development of a malignant tumor.

Infertility – the absence of pregnancy for 2 years or more in a woman who has a regular sex life and does not use contraception.The incidence of infertile marriages is 10-15%. In 60% of cases, infertility is caused by disorders in a woman’s body, in 40% – in a man’s body. The most common cause of infertility in a woman is anatomical and functional changes in the genitals: infantilism; inflammation of the disease of the fallopian tubes, ovaries, uterus, vagina; dysfunction of the ovaries and pituitary gland, adrenal glands, thyroid gland; tumors of the uterus; endometriosis; ovarian tumors. An important cause of secondary infertility is abortion.

Bisexuality – the presence of sexual attraction to persons of both sexes. The reasons are varied. For most, this is an experiment that allows you to add a spicy addition to sexual relations while maintaining the main type of behavior. For others, it is a deliberate choice that allows them to take part in any kind of sexual activity without restriction.

Painful intercourse (dyspareunia) – observed in both women and men. Pain can appear at the beginning of intercourse, in the middle of coitus, during orgasm, or after intercourse has ended.The pain can be felt in the form of burning, tingling, cramps. It can be external, felt in the vagina or penis, deep in the pelvic region, in the abdomen. The reasons are divided into psychogenic, organic (the presence of diseases of the genitourinary organs) and infectious and inflammatory. Dyspareunias interfere with a full sexual life, causing stagnant processes in the small pelvis, psychological problems.

Warts – growths on the epidermis (surface layer of the skin) or mucous membranes caused by the human papillomavirus.May appear on the skin of the limbs, palms, soles, scalp, mucous membranes of the mouth, larynx, genitals and rectum. They tend to grow over large areas of the skin or mucous membranes. When warts are traumatized, it is possible to introduce an infection with the development of inflammation. They cause a pronounced cosmetic defect that greatly disturbs patients. The most formidable complication is malignancy (malignancy) of the process with the development and progression of malignant tumors.

B

Vaginismus – involuntary convulsive contraction of the muscles of the vagina and pelvic floor caused by fear of sexual intercourse or gynecological examination. With vaginismus, it becomes impossible to have a full sexual intercourse. A distinction is made between the phobic form (fear of intercourse) and the hysterical form of vaginismus (the patient’s conscious or unconscious unwillingness to have sex with this partner). The phenomena of vaginismus can last for years.Prolonged vaginismus in a wife often leads to a weakening of the husband’s potency due to the development of a neurosis of expectation of failure and the frequent occurrence of congestion in the prostate gland.

Vaginitis – inflammation of the vaginal mucosa. The causative agents are: streptococci and staphylococci, Escherichia, Trichomonas, mushrooms. In acute inflammation, complaints of a feeling of heaviness in the vagina, burning, itching in the external genital area. Predisposing factors – general diseases, ovarian hypofunction, involutional processes in old age.

Vasculitis – inflammation of blood vessels, can accompany various systemic diseases (rheumatoid arthritis, ulcerative colitis, multiple myeloma, systemic lupus erythematosus, etc.) or accompany allergic and infectious processes (hepatitis B, acute respiratory infections, streptococcal infection, etc. ), malignant tumors. The clinic depends on the main process and the localization of the inflammation of the blood vessels. For example, if the carotid and temporal arteries are affected, complete loss of vision is possible.With damage to the vessels of the liver, kidneys, heart, gastrointestinal tract, peripheral nervous system, the clinical picture of vasculitis is manifested by a violation of the function of the corresponding organ.

Vesicular viral eruptions – vesicular eruptions on the skin or mucous membranes caused by various viruses, including the herpes simplex virus. They are contagious (infectious) diseases. The classic manifestation is grouped vesicles on a red background, open vesicles crusty, accompanied by soreness or itching.Suppression of the immune system is noted, so the rash spreads, covering new surfaces, fever is possible. When a secondary pathogenic flora is attached, purulent skin lesions develop.

Vesicular-bullous dermatoses – limited lesions of the skin and mucous membranes, manifested by the development of vesicles (vesicles) up to 5 mm in diameter and blisters (bulls) over 5 mm. The reasons are varied, including infections (bacterial, viral and fungal), external agents (allergic contact dermatitis, bites, burns, radiation, photodrug reactions), inflammatory dermatoses, genetic defects.Large surfaces of the skin or mucous membranes can be affected, patients are worried about soreness and itching in places where blisters develop. Perhaps the addition of purulent skin lesions with severe intoxication, fever.

Victorianism – restrictions related to sexual ethics, religious morality and educational moments. The spouse maintains complete immobility and absolute equanimity during intercourse with the spouse. Victorianism hinders the development of full-fledged sexual relations in the family, the long-term existence of marital relations.

Herpes simplex virus – see vesicular viral eruptions.

Viral exanthema – any skin rash associated only with a viral infection. Most often appears with measles, rubella, herpes, intestinal viruses, chickenpox, etc. The spread of the rash can be in the form of spots and nodules, blisters, redness, etc. Treatment of the underlying disease is always indicated.

Human papillomavirus – seewarts .

Age-related decrease in sexuality – extinction of sexual manifestations due to changes in age characteristics. The presence of concomitant chronic diseases can aggravate the processes of decreasing sexuality.

Pubic louse is a parasitic infection with a characteristic localization of the process in the pubic region. It can also be found on short hairs in the occiput, torso, eyebrows, eyelashes and armpits.The most common route of infection is through sexual contact. Bites cause itching, discomfort, scratching is dangerous by introducing a secondary infection into the wound.

Vulvitis – inflammation of the external genital organs, often combined with vaginitis. It occurs as a result of mechanical, chemical influences and the development of infection. It is manifested by pain and itching in the genital area.

D

Gamophobia – one of the varieties of phobias (fears) – fear of marriage.Associated with psychological and psychosexual problems.

Hemangioma is a benign vascular tumor that can develop at any age and anywhere in the body. It has various sizes and shapes. On the skin, hemangiomas are raised formations of red, dark blue or cherry color. Sometimes there is a reverse development of the hemangioma. At this site, hypopigmentation, excess skin, fibrous fat deposits or scars develop. The most formidable complication of hemangiomas are violations of vital functions (vision, breathing, nutrition, defecation or urination), ulceration followed by bleeding and the development of infection, heart failure, etc.

Hemorrhoids is one of the most common diseases in proctology. It is an expansion of the natural vascular cavernous bodies and cavernous veins located in the final section of the rectum. It is accompanied by a pain symptom, hemorrhoidal bleeding, prolapse of hemorrhoids. Typically, a little bleeding occurs during or immediately after a bowel movement (bowel movement). The color of the blood is usually scarlet, but dark blood is possible, sometimes with clots.Regular bleeding quickly leads to anemia (anemia). The prolapse of internal hemorrhoids often develops gradually. Initially appears during bowel movements, after a while when straining, lifting weights, coughing, sneezing. In the first stages, the nodes are easily adjusted, in the future they are constantly located outside the anal canal (outside). At any stage, thrombosis and necrosis of the hemorrhoid is possible with the development of a severe clinical picture.

Purulent hydroadenitis is a chronic pyoinflammatory disease with frequent relapses (repetitions) affecting the sweat glands.The disease is characterized by inflammatory nodules, abscesses, scars on areas of the skin with sweat glands, mainly in the armpits, as well as on the scrotum and, less often, in the perineum, on the buttocks, neck and scalp. It is dangerous with the development of fistulas and generalization (spread) of the infectious process.

Ginatresia – vaginal infection. It can be congenital and acquired as a result of inflammation, as a result of trauma, the use of cauterizing agents and radioactive drugs.

Gynecomastia syndrome – breast enlargement in men (unilateral, bilateral). It is associated with an excess amount of female sex hormones in the body. It occurs at any age, can develop against the background of thyroid gland diseases, when taking hormonal drugs, liver diseases, in the presence of hormonally active adrenal tumors. The course of the disease may be asymptomatic or painful. The process can turn into malignant forms.

Gynecophobia – manifestation of obsession – fear of women.The reasons are mental disorders, psychological trauma.

Epidermolytic hyperkeratosis – hereditary skin disease. It manifests itself from birth in the form of erosions, blisters or warty growths throughout the body with predominant localization on the flexor surfaces. It may be accompanied by an unpleasant odor, complicated by a purulent process.

Hyperprolactinemia is a complex neuroendocrine pathology with an increase in the level of prolactin in the blood.It occurs against the background of a pituitary adenoma, dysfunction of the thyroid gland, dysfunction of the adrenal cortex, taking certain medications. The condition is accompanied by headaches, menstrual irregularities in women, discharge from the mammary (in women) and mammary (in men) glands, infertility.

Hypersexuality ( sexomania or nymphomania in women and satyriasis in men) – a pathological increase in libido and an increase in the ability to experience orgasm (prolonged wave-like debilitating orgasms).The causes of hypersexuality are different. One of them is disruption of the endocrine (hormonal) glands as a result of trauma, neuroinfections, brain or adrenal tumors.

Hypersublimation – persistent suppression of sexual manifestations and interests by motivations and activities of a sports, creative, industrial or other nature.

Lanuginous hypertrichosis is an acquired disease characterized by excessive growth of vellus hair.Typically, the process begins on the face and ears, sometimes involving the entire surface of the skin where hair grows. A frequent companion of the disease is inflammation of the mucous membrane of the tongue. If the medicinal causes of lanuginous hypertrichosis are excluded, then there is a high probability of the presence of cancer of the internal organs – tumors of the lungs, gastrointestinal tract, etc.

Hypovitaminosis A – Vitamin A deficiency. First of all, it affects the skin and eyes. The skin reaction manifests itself as a rash and scaly hair follicles, initially on the skin of the upper arms and legs.Ultimately, the process spreads to the torso, back, abdomen, buttocks, and neck. Visual disturbances include night blindness and xerophthalmia (overgrowth of cells in the cornea). In severe cases, keratomalacia (softening of the cornea) occurs.

Hypothalamic syndrome – a pathology accompanied by obesity, arterial hypertension, menstrual irregularities and fertility, thermoregulation, etc. The reasons are neuroinfection, intoxication, and cranial trauma.Over time, obesity progresses, arterial hypertension is accompanied by crises, persistent ovarian dysfunction and infertility develop. With the development of the disease in adolescence, growth disorders (lagging or accelerated growth) are possible.

Hypothalamic syndrome of puberty – functional or organic lesions of the hypothalamic-pituitary system in adolescents, accompanied by obesity, changes in the activity of both the nervous and endocrine systems.Acceleration of growth and sexual development, polycystic ovary disease, arterial hypertension, headaches, signs of decreased thyroid function are observed.

Hypothyroidism syndrome – a decrease in the functional activity of the thyroid gland with insufficient secretion of hormones. Metabolic processes are disrupted, lethargy, loss of interest in the environment, weight gain, constipation, chilliness, drowsiness, and slowness increase. In children, growth retardation, mental development is noted.In severe cases, edema develops, the work of the cardiovascular system is disrupted.

Deep trichophytosis – damage to the scalp (scalp lichen, ringworm) caused by a fungal pathogen. It manifests itself as inflammatory plaques, abscesses, sometimes accompanied by an increase in regional lymph nodes and fever. In some patients, residual scarring and persistent baldness are observed.

Deep mycoses – certain fungal infections that can penetrate deep into the skin and cause damage to the skin, nails, mucous membranes, lymph nodes and internal organs.Clinical manifestations on the skin are varied, depending on the type of pathogen. The most formidable complications are the drift of a fungal infection through the blood vessels to the tissues of the joints, bones, eyes, meninges, etc.

Homosexuality – Sexual attraction to people of the same sex. One of the theories of homosexuality is based on the principles of behavioral psychology, which states that a person’s sexual orientation is formed depending on the general psychological mood, as well as under the influence of punishing children for sexual manifestations.Homosexuals often experience internal conflicts, a third of them seriously think about stopping their sexual activity. Most homosexuals experience manifestations of homophobia – feelings of hostility and fear from other people.

Gonorrhea is a disease of the urogenital tract caused by gonococcus, which has a tropism for the mucous membranes covered with columnar epithelium. The disease is caused by a pathogenic microorganism and is sexually transmitted, leading to infertility.

Gonorrheal urethritis – damage to the mucous membrane of the urethra. Complaints of pain and pain when urinating.

Gonorrheal endocervicitis – damage to the mucous membrane of the cervical canal. Complaints of slight pain in the lower abdomen, mucopurulent leucorrhoea.

Gonorrheal proctitis – damage to the rectal mucosa. It is observed when infected discharge from the genital tract flows. It is manifested by a burning sensation in the rectum and an urge to defecate.

Gonorrheal endometritis – damage to the mucous membrane of the body of the uterus. The ascent of infection is facilitated by menstruation, abortion, childbirth, intrauterine interventions. The acute stage is accompanied by pain in the lower abdomen, low-grade fever, and serous-purulent discharge.

Genital herpes is a sexually transmitted infection. The causative agent is the herpes simplex virus 2. Asymptomatic viral shedding can occur in the following cases: rashes are located in places inaccessible to patients due to their anatomical location, lesions are misinterpreted by a doctor or patient (eg, candidiasis, cracks).

Fungal lesions of the feet – interdigital or plantar infection with characteristic inflammation. It is peeling, maceration, cracks or redness in the interdigital folds. Damage to the feet according to the “moccasin” type is manifested in the form of diffuse hyperkeratosis (excessive keratinization) and desquamation in the area of ​​the soles of the foot. This form of infection is usually accompanied by nail damage. The inflammatory type of infection is manifested by the rash of blisters on the arch or lateral surfaces of the foot.Blisters and cracks in the foot interfere with normal walking, causing pain. It is always possible to attach a secondary infection with the development of purulent-inflammatory complications.

D

Deactualization syndrome – pushing back the sexual-erotic motivation of behavior to the background due to various diseases or pathological conditions (skin diseases, emphysema, blindness, amputation of limbs, etc.).

Dermatitis – inflammation of the skin, manifested by outlined redness with itching.The lesions pass through 3 stages: acute (with the manifestation of a vascular reaction), subacute (with the formation of crusts and scales in the affected area) and chronic (with a pronounced thickening of the outer skin). Depending on the stage of the disease, skin manifestations can occur in the form of spots, vesicles, plaques, edema, crusts, scales, cracks, etc. The most common forms are contact (allergic or from irritation), atopic, pompholyx (imbalance in the water balance of the skin), seborrheic, autosensitive, etc.Any areas of the skin are affected, the disease often takes on chronic forms with periodic exacerbations.

Dermatomycosis is a fungal infection of the skin with a favorite localization on the scalp. At the same time, hair loss has even limited contours, the skin of the scalp flakes off.

Diabetes mellitus – a chronic increase in blood sugar levels, which develops as a result of the influence of many factors, including genetic ones.The first signs are thirst, frequent urination, and changes in body weight. In the future, the pathology of the retina of the eye develops with deterioration of vision, impaired renal function, damage to the nervous and cardiovascular systems. The most formidable are acute complications of diabetes mellitus – various types of coma.

Dysgamy – disharmony in the relationship between spouses according to one of the leading marital factors or their combination, when the forces that destroy the union prevail over the forces that unite.It is possible to distinguish sexual and personal disharmony, when the basis of the conflict lies in the structure of the personality of one of the partners. Dysgamia is the main cause of divorce.

Dysplasia of the cervix, vagina is a precancerous condition, which means a change in the epithelium (mucous membrane) of the cervix and vagina of various origins. It can occur both on the unchanged cervix and in concomitant diseases (infectious and inflammatory processes, including sexually transmitted diseases, traumatic injuries, etc.)etc.). It does not have a clear clinical picture, most often it is asymptomatic. With severe dysplasia, surgical treatment is indicated (in order to avoid the development of malignant oncology) and constant dispensary observation.

E

Eunuchoidism is an endocrine disease characterized by dysfunction of the gonads, underdevelopment of the genitals, skeletal imbalance and obesity. The disease is based on decreased secretion of sex hormones. The clinical picture depends on the age at which the disease began.Libido is often absent or weakly expressed. Eunuchoidism, as a rule, is not accompanied by mental disorders, with the exception of timidity, shyness, and sometimes instability of mood.

F

Misogyny is a hateful attitude not towards a specific woman, but towards women in general. A misogynist will never fall in love with a woman, will not create a family, will not become the father of his children. There are two main reasons. The first is improper family upbringing, when parents, protecting their child from possible troubles associated with a woman, orient him towards a negative attitude towards the female sex in general.The second is homosexuality, sometimes hidden.

Z

Sexually transmitted diseases (STDs) – inflammatory diseases of the genitourinary system in men and women. Includes chlamydia, ureaplasmosis, mycoplasmosis, gardnerellosis, gonorrhea, trichomoniasis, viral diseases (herpes, cytomegalovirus). Depending on the main localization of the inflammatory focus, the clinic of diseases is diverse – urethritis, prostatitis, cystitis, adnexitis, endometritis, colpitis, vaginitis, etc.The most common consequences are chronic inflammatory processes of the genitourinary organs (sluggish or with frequent exacerbations), all kinds of sexual disorders, infertility.

Constipation – slow, difficult or systematic inadequate emptying of the intestines, occurring less often than 48-72 hours. Normally, bowel movements occur from 2 times a day to 1 time in two days. The causes of constipation are numerous, among the complications are intoxication of the body, colitis (inflammation of the intestinal mucosa), atony and paresis of the large intestine.

Diffuse toxic goiter – a disease of the thyroid gland with an obligatory increase in the gland tissue in volume and an increased content of thyroid hormones in the blood. It is manifested by increased excitability, tearfulness, sleep disturbances, palpitations, increased sweating, fever, trembling of the limbs, frequent stools, weight loss, muscle weakness, bulging. The pulse is quickened even at rest and during sleep. In severe cases, atrial fibrillation, liver damage, and depletion of the body develop.Against the background of diffuse toxic goiter, the development of hormone-dependent thyroid tumors is possible.

Endemic goiter – an increase in the volume of the thyroid gland in areas with insufficient content of iodine and other trace elements in soil, water, food. The hormonal function of the thyroid gland can be increased, decreased or not changed, therefore the clinical picture of the disease is varied. Changes in the normal tissue of the thyroid gland are always a prerequisite for the development of tumor processes.

AND

Heartburn – one of the symptoms of diseases of the digestive system, a burning sensation behind the sternum or in the epigastric region, often extending up to the pharynx, due to the throwing of gastric contents into the esophagus.

Impotence – the inability of a man to perform a full sexual intercourse (a close concept is erectile dysfunction).

Ischemia – a decrease in the blood supply to an area of ​​the body, organ or tissue due to a weakening or cessation of arterial blood flow.Cardiac ischemia.

90,000 The Government of the Sverdlovsk Region and Sberbank agreed on cooperation in the field of digital transformation of the region

02.12.

The Government of the Sverdlovsk Region and Sberbank have drawn up a roadmap for cooperation for 2020-2021. The document was signed by First Deputy Prime Minister Alexei Orlov and the manager of the Sverdlovsk branch of Sberbank Vladislav Shilenko.

“A significant increase in joint work this year is associated with the deep integration of the activities of Sberbank of Russia into the implementation of programs to support entrepreneurship in the context of the 2020 pandemic.The prepared roadmap will update our basic areas of cooperation, will give an opportunity to hold events taking into account the modern challenges of the regional economy development related to digitalization, and to fulfill the strategic tasks set by the Governor of the Sverdlovsk Region Yevgeny Kuyvashev, ”said Alexey Orlov.

Among the priority areas of joint work, the parties noted the further digitalization of the region, public-private partnerships, expanding the scope of artificial intelligence technologies in healthcare, increasing the availability of non-cash payments, developing transport acquiring, as well as financing projects timed to coincide with the World Student Games in 2023.A separate area of ​​cooperation is associated with the promotion of the region’s financial market and the services sector – these are measures to develop bond instruments, increase the financial literacy of residents of the Sverdlovsk region.

“The roadmap provides for cooperation both in traditional banking areas of activity – lending, financing infrastructure projects, development of payment services – and outside the financial market, because the companies of the Sberbank ecosystem today are present in almost all digital industries.The unique IT solutions that we offer are aimed at high-quality digital transformation of the region and business, ”said Vladislav Shilenko, Sverdlovsk branch manager of Sberbank.

We are talking, in particular, about digital technologies that will modernize healthcare infrastructure. One of them is Voice 2 Med, a voice filling service for medical records. Examining the patient, the doctor dictates information into a special microphone, which is instantly deciphered and automatically transferred to the information system of the medical institution.The voice assistant recognizes 98% of speech and medical terms using the provided medical dictionaries. This saves the doctor’s time, which can be spent on treatment, and not on filling out documents.

Another progressive technology from the Sberbank ecosystem is already being used in four medical institutions of the Sverdlovsk Region – this is a model for detecting lung pathology, including pneumonia in COVID-19, based on a neural network. When conducting research, the neural network itself determines the volume and proportion of the affected areas.Sberbank is ready to provide software for such research to other medical organizations in the region. In addition to CT of the lungs, the model can be used to diagnose cerebral strokes and mammography.

The signed document will contribute to the implementation of a number of national projects on the territory of the Sverdlovsk Region: Digital Economy, Small and Medium Business and Support for Individual Entrepreneurial Initiative, Healthcare and others.

Date of publication: 02.12.

Product name
Complex (apparatus) X-ray mammography (mammography) digital
No. Functional, technical, quality, performance characteristics (if necessary), their standard indicators, requirements, symbols and terminology related to technical and quality characteristics Indicators of product conformity (min., max, unchanged values) Manufacturer’s standard specification (if any)
rev. Qty
1. Requirements for the main operational characteristics of the mammograph set 1
1.1 The device must be designed for mammographic examination of the breast with a specified diagnosis and mammographic screening Compliance 1.2 Digital technology for X-ray imaging Availability 1.3 Working field size, not less than, mm 240×180 1.4 Spatial resolution limit, not less than pairs of lines / mm 7 1.5 Image pixel size, not less, microns 70 1.6 Number of image elements, not less than, thousand 2.8 x 3.7 1.7 Software synthesized number of elements in the image, not less, thousand 3.8 x 5.2 1.8 Threshold contrast, not more,% ¹ 2 1.9 Dynamic range, not less, times 100 1.10 Exposure variation range manual or automatic presence 1.11 Exposure duration variation range with 0.1 s steps, not less, s¹ 0.1 – 8.0 1.12 Anode voltage variation range (manual mode), not less, kV¹ from 28 to 40 1.13 Duration of continuous operation, at least, hours¹ 6 1.14 Power consumption of the complex (single-phase network, 220V, 50Hz) – no more, W¹ 600 2. Compression / decompression system of the mammary gland 2.1 Multi-stage setting of the limiting compression force with a step, no more than, kgf¹ 0, 1 2.2 Programmed pressure limiter 2.3 Compression force variation range, not m

In accordance with paragraph 1 of the Decree of the Government of the Russian Federation of December 24, 2013 …



In accordance with paragraph 1 of the Decree of the Government of the Russian Federation of December 24, 2013 No.No. 1224 “On the establishment of a ban and restrictions on the admission of goods originating from foreign states for the purpose of purchasing goods, works (services) for the needs of the country’s defense and state security”, a ban is established on the admission of products originating from foreign states for the purpose of making purchases products for the needs of the country’s defense and state security. The country of origin of the products is the Russian Federation.

90,000 When B-Mode has problems

By Michel Rose (AMC), Application Specialist, Toshiba Medical

Have you ever heard something like this from a patient: “Would it really be great if it was all in color?”

Indeed, the B-mode lacks that brilliance of color, which is in the Doppler.We ourselves are to blame, we love doppler. How often do you hear, “Have you used color?” The last time you asked, “How often do you use anti-aliasing?” And every time I look at how other doctors perform an ultrasound scan, I see how diagnosticians scan at different angles, at different patient positions, in different acoustic windows and with different degrees of pressure from the transducer. Image adjustment is carried out, images are signed, marked with markers, enlarged.How much needs to be done in order to get these undervalued grayish dots. And so they remain until you try to explain to someone the reason why you did all these manipulations before pressing the “Print” button, and you yourself understand this. B-mode lacks the polish of Doppler, but that’s what most of us do.

Probe manipulation is a fine art and is best learned in a hands-on environment. Patient and transducer positions, pressure, and acoustic window selection are extremely important for high image quality and vary from patient to patient.However, these aspects of visualization are better left for training, since I have no goal to talk about them here. What I want to describe is how to use the tuning controllers on your unit to get the 2D B-mode image that “suits you best”.

All setting controllers can be divided into pre- and post-processing. All functions, the adjustment of which requires rescanning, refer to preprocessing, and those that you can change while working with a “frozen” image – postprocessing.This simple classification is relevant, but each vendor differentiates between pre- and post-processing differently. So I decided to list them rather than group them. I have also tried to stick to standard terminology and nomenclature, but if you cannot relate the description to the controller on your instrument, you should consult your applicator.

Preset

This sounds obvious, but choosing the right preset is extremely important. The presets are tuned to give you a starting point with the best averaged settings.Initial depth, gain, focal position (as well as Doppler settings) are set according to how most ultrasound doctors set them when starting this type of study. This means that the abdominal preset is for pancreas and the renal preset is for full bladder studies. Choosing the right preset gives you a head start, but you’ll have to tweak the settings as you move on to other organs. Rice. 1 and Fig. 2 show the difference in renal imaging when renal and gynecological presets are applied.When scanning many parts of the body in one scan, keep in mind the original purpose of the preset you selected. Maternal renal scans as part of obstetric examination are common practice. If you are still unsatisfied with the image quality of the mother’s kidneys, check which preset you are using. After all, the obstetric preset is set to a low MI (Mechanical Index), which means that the acoustic output is significantly reduced. And if you used this particular preset when examining the mother’s kidneys, there will be times when you will not have enough penetration of the ultrasound beam, especially if the patient is technically difficult in one way or another.The solution to this problem may be to increase the acoustic power output, but changing the preset itself is also simple, and most likely more effective.

Sensor selection

This selection occurs at the same time as the preset selection. You should be familiar with the sensors you are working with. Consider whether the transducer frequency, shape (convex or linear) and surface are suitable for the area you will be scanning.The resolution advantages of high frequency sensors are lost if you cannot conveniently position it in the area of ​​interest.

Gain

There are three gain controllers. Overall gain is the level of gain applied to the entire image. DGC (Depth Gain Compensation) – compensation of gain in depth or TGC (Time Gain Compensation) – compensation of gain in time, this is the gain applied in relation to the depth of the image.Usually, the TGC decreases by passing through areas of low echogenicity, such as the bladder or vitreous humor of the eye. It is important to look at this situation from the other side. The next time you scan an eye or other objects that have areas of reduced echo. do not reduce the TGC in the eye area or similar structure. Leave the TGC curve straight and then reduce it after passing through the vitreous area. Thus, low-amplitude signals from hemorrhage, etc. will be determined more easily without compensation by signals behind them.A similar effect is demonstrated in Fig. 3 and Fig. 4. AGC (Automatic Gain Control) – automatic gain control, often built by the manufacturer’s gain curve. It can be used to adjust the contrast resolution. Use it when examining areas containing strong reflectors or tissue other than typical reflectors, such as abnormal liver tissue. The difference in images when changing the AGC level is shown in Fig. 5 and Fig. 6.

Focus

The focus controller allows you to change the beam width and therefore the lateral resolution.Increasing the number of focal zones will narrow the beam profile and also decrease the temporal resolution. You will have to experiment with your instrument to find out which settings are right for you. Correctly adjusting the depth of focus is more important than having multiple focuses. In Fig. 7 demonstrates the use of multiple focal zones, and Fig. 8 the same image using one focal area. The focus adjustment used by most manufacturers does not affect the transmitted beam width, but changes its effective beam width without changing the frame rate.

Sound power

Determined by the amplitude of crystal vibration, low acoustic power results in reduced penetration and incomplete recording of reflected signals. But, maximum power is not always necessary or advisable. Remember the ALARA (As Low As Reasonably Achievable) principle and obstetric presets – reducing acoustic power reduces patient exposure.While gain cannot compensate for insufficient power, lowering power may be more effective than lowering gain, as it also reduces the intensity of reverb artifacts. I have long been a supporter of acoustic power reduction when examining superficial gallbladders. Rice. 9 and Fig. 10 show the differences in images obtained at different acoustic power levels.

Dynamic range

Dynamic Range controls the display of signals, from the weakest to the highest amplitude that can be displayed.Decreasing the dynamic range will increase the contrast of your image, but will reduce the display of low-amplitude signals typical of noise (especially when examining overweight or obese patients). Therefore, optimal balance is important. Setting the dynamic range too low can result in the loss of diagnostically valuable information. The effect of changing the dynamic range is shown in Fig. 11-13.

Frame averaging

Also known as Temporal Anti-Aliasing, Frame Correlation, and Persistence.When using this function, the value of each pixel displayed in the image is calculated from the average data of a specified number of previous frames. The higher the frame averaging value, the more previous frames are used to calculate the pixel value. Frame averaging improves signal-to-noise ratio, but also has a smoothing effect and while the actual number of frames per minute does not change, applying pixel averaging means that the effective number of frames per minute is reduced.A high value of frame averaging is preferable for examining superficially located organs and the musculoskeletal system. Areas with shifting tissues, such as the heart, including the fetal heart, are best scanned with a low frame averaging level set. Moreover, I recommend using a low level of frame averaging for conducting research with mobile children or adults with hyperventilation and unwillingness to cooperate with a doctor! Rice. 14 is an example of an image using the minimum frame averaging level, and Fig.15 at the maximum level, notice how the hepatic vein edges are displayed better after increasing the frame averaging value.

Post-processing

A variety of post-processing curves can be used to change the contrast resolution of an image. A portion of your gray scale can be extended, usually by compressing the gray scale in another part of the processor curve.Typically, when set for “brighter white” compression, the post-processing curves can be modified to highlight formations or other areas of interest. Unfortunately, each manufacturer sets its own curves and their values, so you have to experiment (at least there is no need to re-scan) or ask for help from the applicator. In Fig. Figures 16-18 show the effect of changing the post-processing curves.

2D Mapping

Color shadows are used to display the amplitude of the echo.Similar to post-processing curves, 2D mapping is designed to enhance contrast resolution. Its scope also includes fetal heart and gynecological examinations (or responding to patient comments about color). I also find 26 mapping useful when conducting research in poorly lit environments such as hospital wards. Rice. 19 and 20 show the results of 2D mapping.

Edge strengthening

Edge enhancement is used to improve the differentiation of signals on the screen.Increasing the edge enhancement will make the image “rough”. Rice. 21 and 22 show the differences between the images at different levels of edge enhancement.

Scan area / Field of view

A narrower field of view increases the number of frames, improves temporal and spatial resolution due to increased line density. If the narrowing of the field of view makes it difficult to inspect the area of ​​interest, then using the “dual” mode, the “narrowed” image will be displayed on one half of the screen, and the whole on the other.

Zoom

Increases spatial resolution, but can have a negative effect similar to that of narrowing the field of view, however this problem can be solved using the dual screen mode in the same way as when narrowing the field of view. Rice. 23 shows the effect of applying scaling to an image.

Harmonic (non-linear) image

At a workshop held for ASUM in September 2004, Professor Peter Burns pointed out that there are at least 22 names for harmonic imaging.Needless to say, but I’m not going to list them all! Despite the variety of names, there are fundamentally three harmonic imaging technologies: Tissue Harmonic, Pulse Subtraction, and Differential Harmonics. In a nutshell, an ultrasonic beam travels through tissues in the same way as a mechanical wave. Sound propagates faster during compression than refraction, and this is non-linear propagation and produces harmonics.The tissue harmonic emits the fundamental or fundamental frequency (f1) and takes on the harmonic (2f). Pulse subtraction harmonic uses two signals, phase-shifted 1800 to cancel the fundamental frequency (f 1) and adopts harmonic (2f).

Differential harmonic transmits two different frequencies, uses pulse subtraction to attenuate fundamental frequencies (f 1 and f2), and then receives harmonics of the lower frequency (2f) as well as the difference between the two transmitted frequencies (f2-f1).

Harmonic image has narrower beam width and lower amplitude, which improves lateral resolution and signal-to-noise ratio. You may note that lateral resolution is generally lower than axial, so the use of wideband transducers, with their ability to receive harmonic frequencies, improved our results in contrast and lateral resolution. “In clinical practice, the advances in abdominal and general imaging scanners are so great that most researchers are using tissue harmonics as the default.”

Harmonic image can be optimized using the same functions as normal image. Rice. 24 and 25 show the difference in image quality that can be achieved using a harmonic image.

Beam direction control

Electronic Linear Beam Control allows you to tilt the beam to achieve a tilt angle close to 900.This function is especially useful in cases where it is impossible to apply the fan-like technique, and it is also effective in reducing anisotropy artifacts when examining superficial organs, muscles and tendons or other regions in the study of which anisotropy occurs. In Fig. 26 shows a vein with open valves that was scanned using a linear probe, and Fig. 27 illustrates scanning using the beam direction control function used to better delineate the valve leaflet, since in this situation it is impossible to use the fan-like technique of the transducer, which leads to compression (squeezing) of the superficial vein.

Folded image

A web search will give you many different names for this technology: Compound Resolution Imaging, SieClear ™, SonoCT, and ApliPure are just a few of those described. The purpose of this technology is to provide the interface with specially directed beams from different directions, at different angles and, as a result, reduce the number of artifacts and smooth out signals from excessive reflectors (structures) located in a plane parallel to the sensor.This technology also enhances the boundaries of adjacent, and especially curved, or anisotropic structures. The level of the folded image can be controlled. But when artifacts carry valuable diagnostic information (as, for example, in the case of microcalcifications in the mammary gland), this function should be used within reasonable limits. Rice. 28 and 29 show the same image of the thyroid gland with and without this technology.

Keystone

Also known as ‘virtual convex’ – trapezoidal imaging allows scanning beyond its own surface with the probe and is best displayed on linear probes.The use of a trapezoidal image with high-frequency sensors allows you to obtain a high-quality image of the fetal kidneys, superficial organs (in full size), and the thyroid gland at its large size. I have also seen the successful use of trapezoidal imaging in expert obstetric research. Rice. 30 and 31 show the difference a keystone image can make in your image.

Expanded field of view [panoramic image)

Another technology with many names, including Panoramic, Logic view and SieScape®.Panoramic scanning is an idea familiar to those of us who have worked with static scanners and those who have digital cameras. Great technology for a coherent view, but the size of the image decreases as the length (surface) of the scan increases. The ROI where the measurements are taken can be separately displayed next to the panoramic scan. And yet, I would like to warn fans of panoramic scanning about the danger that lurks when measuring the length of objects, especially curved ones (such as, for example, the knee).In such situations, it is best to measure directly along the anatomical surface. Rice. 32 and 33 are examples of panoramic scanning.

Auto-optimization

You have bothered to finish reading up to this point, and now I’m going to tell you that you can forget almost everything you just read and use the autotune button on your device. Well, not quite. Auto-optimization features are also known as iSCAN, QuickScan nTEQ ™.YOU scan the ROI, hit the optimization button and let the machine optimize the image for you. Those who have been involved in X-ray diagnostics will probably remember that Automatic Exposure Control has both advantages and disadvantages, and so is the case with auto-optimization of the image during ultrasound examination. Your instrument will optimize the entire image on the screen. The advantage is that the instrument will correct not only the TGC but also the lateral gain, which means that the gain across the entire image will be corrected.

So far, everything is just fine, but think about what it means to correct the whole image. For example, we use the relative echogenicity of the liver and kidneys as a marker of the pathology of each organ. Using auto-optimization will improve the appearance of the image, but there is a danger of “masking” the pathology by smoothing the relative echo texture. You should also “notify” the instrument of the change in scanning conditions. If one of your little patients decides that he has not moved for too long, you suddenly find yourself scanning highly mobile tissues, and that this situation requires a decrease in frame averaging.

Auto-optimization is not that smart yet, and choosing the right presets is still extremely important. Rice. 34 and 35 show the difference in images with and without QuickScan (auto optimization).

Literature

1 Cosgrove D. Harmonic Imaging: tissues and microbubbles [lecture on the Internet]. Sardinia: Sardinian Mediterranean Imaging Research Group; date unknown [cited 2004 Feb 1]. Available from: www.smirg.org/lectu res / lecture_id2.ph p? sl = 1.

It is also recommended to read

1 Bums P. Advanced Applications and New Technology in Ultrasound. ASUM: 2004 Sep 8.

2 Gent R. Applied Physics and Technology of Diagnostic Ultrasound. Need to know the date of publication, the publisher and the place of publication. Copyright is 1997, ISBN 0 646 27601 8, Printed in Australia by Open book Publishers, Milner Publishing, 3 Milner Street, Prospect SA AUSTRALIA 5082

3 Ward B, Baker AC, Humphrey VF.Nonlinear propagation applied to the improvement of resolution in diagnostic medical ultrasound. J Acoust Soc Am. 1997 Jan; 101 (1): 143-54.

4 Website for GE Healthcare, http://www.gehealthcare.com/auen/

5 Website for Philips Medical Systems, www.medical.philips.com

6 Website for Siemens Medical, www.medical.siemens.com

7 Website for Toshiba Medical, www.medical.toshiba.com

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