Authors: Kirby Bland. Imprint: Saunders. Published Date: 31st July Page Count: Free Shipping Free global shipping No minimum order. Features multidisciplinary advice from experts in surgery, radiation and medical oncology, pathology, molecular biology, pharmacokinetics, and genetics for a well-rounded perspective to enhance patient outcomes. Includes more than 1, figures and tables that offer high quality depictions of surgery and treatment procedures. Offers step-by-step guidance through both text and clinical boxes that makes the material relevant to everyday practice. Provides cross-referencing between chapters, as well as references to carefully selected journal articles, that makes further research easier.
If you wish to place a tax exempt order please contact us. Such a unit should perform at least mammograms per annum, employ a trained radiologist reporting at least mammograms a year, have specialist cytological and histopathological support services, organise regular multidisciplinary review meetings, monitor data and feedback results and also keep formal records of assessment processes and outcomes. Its specialist multidisciplinary team will have access to more sophisticated imaging equipment and nonoperative diagnostic techniques than are available in a diagnostic breast imaging unit.
Sampling techniques may include fine needle aspirate cytology, core biopsy or vacuum-assisted biopsy. If image-guided sampling is carried out, a representative image showing accuracy of needle placement must be obtained. Units must record basic data on diagnosis, pathology, primary treatment and clinical outcomes. Regular minuted audit meetings should take place and a nominated person held responsible for production of annual performance and audit figures.
The unit must have written and agreed protocols for the diagnosis and management of cancer at all stages. Population breast screening programmes should ideally be based within or closely associated with a specialised breast unit and share the services of trained expert personnel. A minimum size for a breast unit is necessary from the point of view of expertise of specialist staff, arrangement of frequent clinics, provision of equipment and cost-effectiveness. The breast unit must have an identified clinical director of breast services and each member of the core team must have a specialist training in breast cancer.
Two or more nominated breast surgeons must be available, each personally carrying out primary surgery on at least 50 newly diagnosed cancers per year and attending at least one diagnostic clinic per week. There must be at least two nominated, fully trained and experienced radiologists able to carry out all aspects of breast imaging, tissue sampling and localisation procedures under image control. Radiographers must fulfil all training and working practice recommendations and mammograms should not be carried out by any other personnel without such specialist training.
There should be a lead pathologist, specialised in breast disease and adhering to European performance quality standards and guidelines, also taking part in any available quality assurance schemes. They should be members of the core team and participate in case management and audit meetings. Patient support must be provided by specialist breast care nurses or appropriately psychologically, professionally trained persons with expertise in breast cancer.
At least two such persons are needed per unit. They must be available to counsel, offer practical advice and emotional support. Adjuvant therapies such as radiotherapy or cytotoxic therapy may be given at separate clinics or hospitals to the breast unit but such treatment must be supervised by the main breast unit and all decisions made by the unit's multidisciplinary team.
Clear written or oral information must be available to women from the unit, which should also provide written information concerning local outpatient support groups and advocacy organisations. All work of the breast unit should be carried out or directly supervised by specialists specifically trained in breast disease.
This is more efficient and cost-effective than allowing unsupervised management by junior or nonspecifically trained staff. The surgeon is a member of the multidisciplinary team and should always personally assess and examine a woman before accepting her for surgery. The lead surgeon should ensure that important activities and decisions are not delegated to unsupervised trainees.
Unique Challenges for Young Women
Management of cases coming to surgery from screening programmes should be carried out only by surgeons with specialist knowledge and expertise, having undergone specific formal multidisciplinary programme training which include courses in communication and counselling. Specified target figures must be observed for successful removal of mammographic abnormalities and definitive surgical treatment of those cases following a clear malignant diagnosis at the first operation.
Unnecessary surgical excision and benign biopsy rate should be minimised. Accurate marking procedures must be available to the surgeon in order to improve postoperative cosmesis for those women having an impalpable lesions. Its aim is to allow full excision of the tumour with uniform margins. A full report of the localisation procedure and relevant images must be provided by the radiologist for the surgeon in the operating theatre. Specimen radiography is essential for lesions such as microcalcification visible on X-ray to confirm excision in theatre, before skin closure.
Such images must also be available to the pathology department. The surgeon must ensure that women receive information on treatment options and be aware that breast-conserving surgery is the treatment of choice for the majority of small screen-detected cancers.
Atlas of Differential Diagnosis in Breast Pathology
Where appropriate, patients should be offered a choice of treatment including immediate or delayed breast reconstruction should mastectomy be required. Surgeons undertaking axillary sentinel node procedures should receive specific training and validation. Mastectomy should be carried out in patients who do not satisfy criteria eligibility for breast-conserving treatment or in those patients who express a preference for it.
Patients with high risk factors for local recurrence should be offered adjuvant chest wall radiation treatment. Preoperative neo-adjuvant chemotherapy must be offered if appropriate in order to downstage large tumours to allow breast-conserving treatment. Patients with locally advanced breast cancer should be offered combined modality treatment to ensure lasting locoregional control.
Follow-up after treatment for breast cancer is mandatory for the measurement of outcomes, assessment of recurrences and screening for second primaries. The pathologist is a key member of the multidisciplinary team and must participate fully in pre- and postoperative case discussions. Operative and nonoperative specimens provide pathologists with particular problems that frequently arise with impalpable and complex lesions which are encountered in disproportionate frequency in screening programmes.
Accurate pathological diagnosis and the provision of prognostically important information are vital to ensure appropriate patient management as well as accurate programme monitoring and evaluation. A screening programme may in part be judged by the quality of its nonoperative diagnostic procedures which attempt to provide a definitive diagnosis of breast disease, allowing rapid referral for treatment, ideally in one procedure. Definitive nonoperative diagnosis of benign conditions also allows the avoidance of surgery and rapid return to routine recall.
Each one has specific and relative indications for use and written local protocols should be available clearly defining these indications. Details of the lesion and its radiological appearance, the localisation technique, specimen type, the presence or absence of histological calcification and the opinion of the pathologist should be expressed into one of the five main categories ranging from B1 normal tissue to B5 malignant.
Similar forms should be used for FNAC. The technique chosen for pathological examination of surgical excision specimens requires knowledge of the surgical method used and the anatomical boundaries of the resection. Lesions should be resected according to a defined protocol, any variation of which should be clearly indicated on the request form to the pathologist. In order to allow the use of predictive factors, fresh frozen tumour tissue will be increasingly used and the specimen should therefore be sent immediately to the pathology laboratory unfixed.
Once received in the laboratory, the entire surface of the specimen should be inked so that the lines of excision can be easily determined. Pathological examinations should be carried out on all lymph nodes received and the report should state the total number and the number containing metastases. Protocols for sentinel lymph node examination and specimen handling should be clearly agreed between the surgeon and pathologist. Standard histopathology reporting forms should be used and should record recognised prognostic data such as tumour size, disease extent, grade, type, lymph node status, vascular invasion, marginal status and receptor status.
Pathology laboratories must be involved in relevant QA schemes for both laboratory techniques and diagnostic accuracy. External quality assurance schemes should be used in countries where screening is established. Minimal delays must exist between taking a mammogram, film reading and the availability of the report, the provision of an assessment appointment for women with screen-detected abnormalities or a clinic appointment for women with substantial breast symptoms.
Women with symptoms and signs suggestive of breast cancer must be offered an appointment within 2 weeks. Communication of the diagnosis of likely breast cancer must never be given by post or over the telephone, but only verbally to the woman in the presence of a nurse counsellor. Clinicians and programmes should value data monitoring as an opportunity for permanent education and improvement and to demonstrate excellence.
Indicators should be derived from up-to-date and evidence-based guidelines or reflect clear consensus by professional experts and the public. Duplication of effort should be avoided as far as possible by including quality assurance criteria in routine reporting. Quality measures should be reproducible and clearly specified, and monitoring costs should be acceptable and results must be accessible to patients and advocacy organisations.
Standard data reporting forms should be used in everyday practice. They should include essential items and appropriate coding. Computerised audit systems capable of calculating the great majority of recommended quality indicators have been developed within projects sponsored by the Europe against Cancer Programme of the European Commission.
This prototype web database and audit system on the basis of individual records are capable of calculating at a local or regional level a number of process and early impact indicators of breast cancer screening. It can support multicentre projects aimed at comparing performance parameters of screening programmes in Europe see also appd. SEED should contribute to the standardisation of screening evaluation in Europe by facilitating joint data collection and multicentre comparisons and by helping individual programmes to evaluate their own performance in a standard way.
QT—audit system on Quality of breast cancer diagnosis and Treatment. This is a Microsoft Access individual records database and is available in five languages. A web version is under construction. QT is kept updated with guidelines and allows recording of data on all women recalled for assessment in a screening programme or assessed for clinical suspicion. QT has been designed for and is being used by clinical breast units for monitoring diagnosis and treatment of breast lesions in symptomatic as well as asymptomatic women.
Furthermore, it can assist cancer registries for high-resolution population studies. One individual, i. The views expressed in the publication are those of the authors; the European Commission is not responsible for any use which may be made of the information contained therein. The authors declare no conflict of interests. Please note that the numbering of the indicators is not indicative of importance. For more complete information regarding definition and context, further reference should be made to the source of each parameter within the guideline text as listed. On occasions, we have had to accept that different disciplines and different Member States show some variation of priorities and target levels.
In all cases, we have attempted to list what we regard as the most widely used and generally appropriate professionally agreed levels for usage in a Pan-European setting. In any case, all targets should be constantly reviewed in the light of experience and revised accordingly with regard to results achieved and best clinical practice. Abbreviations used for reference to the European Guideline [ 2 ] chapters, e.
To assist in monitoring and comparing performance between and within screening programmes, this summary table of indicators includes recommendations on the minimum proportion of women for whom acceptable and recommended time periods should be observed. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Permissions Icon Permissions. Abstract Breast cancer is a major cause of suffering and death and is of significant concern to many women. Table 1. Target OD 2AT4. Spatial resolution 2AT4.
Teaching Atlas of Mammography 4th Edition – Mammography Education Inc. | Dr. Laszlo Tabar
Glandular dose—PMMA thickness at 4. Threshold contrast visibility 2AT4. Proportion of women with a radiographically acceptable screening examination 3. Proportion of women informed of procedure and timescale of receiving results 3. Proportion of women undergoing a technical repeat screening examination 1T32, 3. Absolute sensitivity of FNAC 5. Complete sensitivity of FNAC 5. Specificity of FNAC 5. Absolute sensitivity of core biopsy 5. Complete sensitivity of core biopsy 5.
Specificity of core biopsy 5. Proportion of localised impalpable lesions successfully excised at the first operation 4T2, 5. Proportion of image-guided FNAC procedures from lesions subsequently proven to be malignant, with an insufficient result 4T2, 5. Proportion of patients subsequently proven to have breast cancer with a preoperative FNAC or core biopsy at the diagnosis of cancer 7B.
Proportion of patients subsequently proven to have clinically occult breast cancer with a preoperative FNAC or core biopsy that is diagnostic for cancer 7B. Benign to malignant open surgical biopsy ratio in women at initial and subsequent examinations 1T32, 4T2, 5. Proportion of wires placed within 1 cm of an impalpable lesion before excision 4T2, 5.
Proportion of benign diagnostic biopsies on impalpable lesions weighing less than 30 grams 5. Proportion of patients where a repeat operation is needed after incomplete excision 7A. Open in new tab. Search ADS. European Commission. OJ C 68 E 18 March Office for Official Publications of the European Communities; — European Parliament.
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Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. Council of the European Unioin. All rights reserved. For Permissions, please email: journals. Issue Section:. Download all figures. View Metrics. Email alerts New issue alert. Advance article alerts.
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