Follow Up of Abnormal Clinical and Imaging Findings of the Breast: Five Self-Study Modules for Primary Care Clinicians

 

Glossary of Terms

Absolute risk: refers to the number or proportion of individuals in a population who will (or will not) develop cancer during a specified period of time when exposed to a particular agent

Adenoma: a benign epithelial tumor that forms glands

Adenosis: a benign proliferation of glandular acini within a lobule

Aneuploid: having an abnormal amount of DNA per cell. Aneuploid DNA content is commonly found in carcinomas and, in particular, it is seen in carcinomas of higher nuclear grade. Of itself, it does not impact outcome.

Apocrine metaplasia: a benign change frequently occurring in cysts in which the epithelia of ducts and lobules change to a cell type similar to those of apocrine sweat glands

Apoptosis (also called programmed cell death): type of cell death in which a series of molecular steps in a cell leads to its death. This is the body's normal way of getting rid of unneeded or abnormal cells. The process of apoptosis may be blocked in cancer cells.

Atypical ductal hyperplasia (ADH): a proliferation of cells confined to the ductal-lobular space which has some but not all of the features of ductal carcinoma in situ and is characterized by a population of evenly spaced uniform cells with monotonous hyperchromatic nuclei which form the rigid geometric structures similar to ductal carcinoma in situ (DCIS), but only involves part of the membrane-bound ductal-lobular space. This finding indicates a moderately increased risk of invasive breast cancer, which is 5 times above that of the general population.

Atypical/indeterminate: probably benign, but a definitive diagnosis cannot be provided due to either technical difficulties such as limited cellularity or poor preservation, or due to the inherent nature of certain breast lesions such as papilloma vs papillary carcinoma, fibroadenoma vs phyllodes tumors, proliferative lesions with atypia vs in situ or low-grade infiltrating carcinomas

Atypical lobular hyperplasia (ALH): a proliferation of cells confined to the ductal-lobular space which has some but not all of the features of lobular carcinoma in situ and is characterized by a population of bland, round cells which are evenly spaced and often of smaller size than those seen in ADH or DCIS. These cells resemble those of lobular carcinoma in situ, but they do not completely fill and distend the glandular acinus, thus leaving intercellular spaces, or they involve less than half of the multiple acini in a lobular unit. This finding indicates a moderately increased risk of invasive breast cancer, which is 5 times above that of the general population.

Benign: no evidence of malignancy; includes fibrocystic change without atypia, fibroadenoma, pregnancy- or treatment-associated changes, and infectious and inflammatory conditions

Biopsy: a surgical procedure that removes tissue tissue samples for examination under a microscope. The biopsies can include minimally interventional techniques such as core biopsy or larger core procedures guided by mammography or ultrasound, such as bard gun or vacuum-assisted core biopsies. Biopsies can also refer to open incisional biopsies or excisional biopsies.

Breast self-examination (BSE): a technique in which a woman performs a methodical examination, including a visual examination, on her own breasts to detect visible and/or palpable changes. Breast self-examination has not been shown to improve survival among women with breast cancer.

Calcifications (see also Microcalcifications): refers to a number of distinct types of calcium phosphate or calcium oxalate deposits in benign and malignant breast epithelium and in periductal stroma. Microcalcifications can be psammomatous, indeterminate, dystrophic, or large coarse tumoral calcifications. Microcalcifications do not necessarily indicate a malignant process.

Carcinoma in situ: a malignant epithelial tumor, in the breast limited to the duct system and ductolobular units, and incapable at this stage of invading beyond the duct wall into the adjacent parenchyma

Clinical breast examination (CBE): a physical breast examination performed by a licensed medical professional, including a doctor of medicine (MD), doctor of osteopathic medicine (DO), doctor of naturopathic medicine (ND), physician assistant (PA), nurse practitioner (NP), certified-nurse midwife (CNM), etc.

Comedo: a term that refers to the gross appearance of certain duct carcinomas in situ in which central areas of necrotic tumor cells accumulate. These were initially seen to resemble comedones of the skin, hence the term. At present, comedo frequently is used as an adjective to describe certain types of duct carcinoma in situ in which areas of necrosis occur.

CAD (computer-aided detection): The mammogram image is scanned with a laser beam and converted into a digital signal to indicate changes on a mammogram that may need extra evaluation by the radiologist.

Computerized axial tomography scan (CAT scan): a procedure in which multiple x-rays are taken of all or part of the body to produce an image of internal organs.

Concordance: agreement in the types of data that occur in natural pairs. For breast diagnostic work-up, all test and procedure results are in agreement with one another.

Core needle biopsy: removal of a tissue specimen using a needle; the specimen is examined under a microscope to determine whether cancer cells are present. The patient is given a local anesthetic before a core biopsy is done.

Cribriform: type of DCIS in which the cells filling the duct have “punched out” areas

Cumulative lifetime risk: a statistically derived number that is based on the assumption that all women live to be a certain age

Cyst: a fluid-filled structure that is benign if it has no internal echoes, and has a smooth wall with no internal masses through enhancement on ultrasound

Cystosarcoma phyllodes: unusual type of breast tumor that includes connective tissue in the breast

Cytologist: one who specializes in studying cells

Density: a radiographic term to describe the ratio of glandular to fatty/fibrous tissue. Dense tissue is more glandular and lowers the observable differences in tissue thickness.

Diagnostic workup: any of the follow-up procedures used to establish a final diagnosis (eg, additional mammogram views such as special views, spot compression or magnification techniques; ultrasound, fine-needle aspiration, core needle biopsy, magnetic resonance imaging, or consultation with a breast specialist or surgeon)

Differentiation: in cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated cells resemble normal cells and grow at a slower rate than undifferentiated cells, which lack the structure of normal cells and grow at a more rapid rate

Digital mammography: an x-ray mammography system that produces digital images using a computer receptor in contrast to images produced on radiographic film

Discordant: for diagnostic workup, all test and procedure results are not in agreement, hence further evaluation needs to be done

Ductal carcinoma in situ, comedo type: distended ducts and lobules lined by an increased number of large cells with pleomorphic nuclei of high grade and which contain central necrotic debris that grossly resembles the center of a comedone and which can calcify and can appear mammographically as coarsely granular or "casting" calcifications outlining the involved duct. The size of this type of DCIS is frequently underestimated mammographically and can be quite extensive.

Ductal carcinoma in situ, non-comedo type: includes those forms of DCIS that are classified as micropapillary, cribriform solid, or clinging and are characterized by distension of the involved ducts and lobules by smaller, uniform, monotonous cells which do not have the high nuclear grade typical of the cells of comedo-type DCIS. There is no central necrosis, and the abnormal cells often create rigid geometric spaces and bridges within the involved duct/lobule. This type can also appear as microcalcifications by mammography, though less frequently than the comedo-type, and usually appears as fine granular calcifications.

Duct ectasia (cysts): a dilatation of medium to large ducts lined by flattened cells, filled with amorphous debris, and associated with periductal inflammation

Ductal lavage: a relatively new technique being studied as a potential additional measure for breast cancer risk assessment and management; currently being used in the evaluation of high-risk patients

Ductography (see also Galactography): radiography of the mammary ducts after injection of a radiopaque substance into the duct system

Epithelial hyperplasia: an increased proliferation of cells lining the ductal-lobular unit, thus distending the glandular space. The cells are variable in appearance; maintain their polarity, and form irregular, slit-like spaces.

Excisional biopsy: surgical procedure designed to remove an entire tumor or mass, which is then studied under a microscope to determine whether cancer cells are present.

False-positive result: an initial positive test result that is truly negative after further evaluation

False-negative result: an initial negative test result that is truly positive after further evaluation

Fat necrosis: area of dead fatty tissue usually following some form of trauma or surgery; a cause of lumps and calcifications on mammogram

Fibroadenoma: a focal well-circumscribed growth of glands and stroma in which proliferating stroma surrounds the growing glands and often compresses and distorts them.

Fibrocystic change: a benign condition representing focal, nonuniform changes in the breast tissue

Fibrosis: increased collagen deposition within the breast stroma

Fine-needle aspiration (FNA): biopsy technique used to evaluate palpable masses by placing a small-gauge needle into a lesion and extracting cells

Galactocele: milk cyst sometimes found in a nursing mother's breast

Galactography (see Ductography): radiography of the mammary ducts after injection of a radiopaque substance into the duct system

Genetic risk counseling and testing: a method to determine an individual's risk of disease that passes genetically (such as some breast cancers) by examining the history and genetic material (blood cells) in the family

Grade (see also Differentiation): describes how closely a cancer resembles normal tissue of the same type, and the cancer's probable rate of growth

Gynecomastia: swollen breast tissue in a man or boy

HER-2/neu: an oncogene found in some breast and ovarian cancer patients associated with a poor prognosis

Histology: study of tissue removed by biopsy or other surgery to determine whether it is cancer. Histology looks at cytology and the overall structure of the tissue to determine whether cancer is present.

Hormonal therapy: treatment of postmenopausal women with synthetic hormones

Hormone receptor test: a test used to measure the amount of certain proteins, called hormone receptors, in breast cancer tissue. A high level means that the hormones (attached to the protein) probably help the cancer grow.

Hyperplasia: excessive growth of cells

Imaging: a technology that produces a picture of the inside of the body. Examples of imaging techniques include mammogram, ultrasound, computed axial tomography, magnetic resonance imaging, and x-ray.

Incidence: as it pertains to breast cancer in women, the number of women who get breast cancer among a defined number of women in the population during a given time period

Infiltrating ductal carcinoma: the most common type of invasive breast cancer, accounting for as many as 75%-80% of all breast cancers, sometimes also referred to as carcinoma of no special type. These tumors can vary microscopically in their degree of tubule formation, mitotic rate, and nuclear pleomorphism, and grading these features can give a clue to prognosis. There are several types of ductal carcinoma, all of which are associated with an improved survival rate compared with those of no special type

Infiltrating lobular carcinoma: characterized histologically by small cells that frequently contain a cytoplasmic vacuole, classically arranged in a single-file "Indian-file" arrangement. The stroma is densely sclerotic, giving this tumor a rock-hard feeling to palpation and making the cells difficult to remove by fine-needle aspiration. This tumor has an intermediate prognosis in its classic form (variants do exist), and has an increased incidence of multifocality and bilaterality.

Inflammatory breast cancer: a rare type of breast cancer in which cancer cells invade the lymphatic channels of the skin, causing a redness and firmness of the breast

In situ: the cancer cells are contained within the duct or lobule and have not infiltrated (ie, non-invasive) below the basement membrane of the epithelium

Intraductal papilloma: benign tumor that projects like a finger from the lining of the duct

Invasive (infiltrating) cancer/carcinoma: cancer that has spread beyond the layer of tissue in which it developed

Linguini sign: linear artifact created on magnetic resonance imaging or ultrasound examination by the envelope of a disrupted breast implant

Lobular carcinoma in situ (LCIS): characterized microscopically by distention of at least half of the acini in a lobular unit by a very round uniform population of small cells, which may have clear cytoplasm or nuclear vacuoles. This is usually an incidental finding in breast tissue removed for another indication, frequently multifocal and bilateral, and rarely causes clinical findings or changes on a mammogram. This finding indicates an increased risk of invasive breast cancer, which is 10 times above that of the general population.

Lobular neoplasia: a term used to represent the spectrum of changes that can occur, including atypical lobular hyperplasia and lobular carcinoma in situ. Some pathologists may prefer the term lobular neoplasia due to controversies surrounding criteria for differential diagnosis of atypical lobular hyperplasia and lobular carcinoma in situ.

Localized breast cancer: cancer that is confined to the breast

Lumpectomy: operation to remove a breast tumor and a small margin of normal surrounding tissue, usually followed by radiation. Lumpectomy may be the first and only surgical excision of a breast lesion with proper preoperative diagnosis and workup.

Lymphedema: swelling in the arm caused by excess fluid that collects after lymph nodes and vessels have been surgically removed or treated by radiation

Macrocalcifications: tiny deposits of calcium in the breast detected on a mammogram. A cluster of these small specks of calcium most likely represents benign changes in the breast due to the normal aging process. They may also be diagnostic for early-stage DCIS.

Magnetic resonance imaging (MRI): an imaging technique that uses a powerful magnet to transmit radio waves through the body. The images appear on a computer screen as well as on film.

Malignant: diagnostic of malignancy; should be further characterized by specifying the type of neoplasm, such as ductal or lobular carcinoma, in situ or invasive.

Malignant phyllodes tumor: formerly called cystosarcoma phyllodes; characterized by a proliferation of glands and malignant stroma with more than 10 mitoses per high-power field, which may resemble fibrosarcoma or have heterologous elements such as malignant bone cartilage, skeletal muscle, or fat. Unlike carcinomas, these metastasize hematogenously and can spread along nerves.

Mammogram: a low-dose x-ray technique especially designed to detect breast cancer

Mammotome®: a minimally invasive alternative to open surgical biopsy, which uses a unique vacuum-assisted technique to provide tissue samples

Margins: the edge of the tissue removed during biopsy, partial mastectomy, or mastectomy. For optimal control of cancer, the margin of tissue should not have cancer

Mastalgia: pain in the breast(s)

Medullary carcinoma: characterized histologically by syncytial sheets of large, extremely pleomorphic cells with a prominent lymphoid infiltrate; usually well circumscribed with little fibrous reaction; can feel deceptively soft and benign

Microcalcifications: tiny deposits of calcium in the breast detected on a mammogram. A cluster of these small specks of calcium may indicate that an early-stage cancer is present.

Mondor's disease: thrombosis of a vein in the breast

Mucinous (colloid) carcinoma: a well-differentiated form of ductal carcinoma that accounts for 2% of all breast cancers. It is more common in older women, usually well circumscribed, and is characterized by the production of abundant pools of mucin, making it deceptively soft and benign.

Oncogene: tumor genes present in the body. These can be activated by carcinogens and cause cells to grow uncontrollably.

Open surgical excisional biopsy: surgical removal of a breast lesion, considered the gold standard against which other diagnostic techniques are compared

Paget's disease: a metabolic bone disease that involves bone destruction and regrowth, which results in deformity

Papillary carcinoma: usually occurs in larger ducts, which can be cystically dilated, and resembles the frond-like branching structure of the benign papilloma, but is lined by atypical cells

Papillomas: benign frond- or finger-like growths with a fibrovascular core, always associated with epithelial hyperplasia of varying degrees. Papillomas can occur in large or small ducts and can be solitary or multiple.

Papillomatosis: multiple, small papillomas

Parenchyma: the essential or functional elements of an organ. In breast tissue, parenchyma refers to the glands that produce milk (lobes and ducts).

Pathologist: doctor who specializes in examining tissue and lab tests (eg, nuclear medicine).

Peau d'orange: orange-peel appearance of skin overlying the breast tissue due to dermal and/or lymphatic involvement by breast cancer

Poland's syndrome: a congenital condition in which there is no breast development on one side of the chest

Polymastia: literally means "many breasts"; refers to the existence of an extra breast or breasts

Positron emission tomography (PET): the PET scanning machine is used to detect how fast the body uses glucose. If glucose is being consumed faster in certain parts of the body, it may indicate the presence of a cancerous tumor by highlighting the area on imaging.

Preoperative needle (or wire) localization biopsy: a preoperative radiographic technique used to locate and target small lesions detected by mammography. A radiologist inserts a wire through a needle into the breast to mark nonpalpable lesions detected by mammography or ultrasound. The wire guides the surgeon to the lesion for tissue removal, and hence represents a combined radiography and surgical technique

Radial scar: a benign lesion that requires surgical excision if atypia is found on core biopsy. Any radial scar that is not removed creates a change in the parenchyma that makes internal screening very difficult.

Relative risk: a number used to compare the impact of different risk factors associated with the likelihood of developing breast cancer

Risk factor: any variable (eg, genetic, environmental, lifestyle) that increases a person's chance of developing disease

S-phase: the time during which an individual cell makes new DNA chromosomes in preparation for dividing into 2 cells. The higher the percentage of cells that are present in S-phase (as seen on laboratory testing), the more likely it is that the cancer is aggressive.

Scintimammography: a breast imaging technique that tracks radioactive tracers as they concentrate in cancer cells

Sclerosing adenosis: a benign proliferation of acini within a lobule associated with fibrosis and distortion of the lobule

Screening: the search for disease in an asymptomatic population at risk in hope of finding disease at a very early and more treatable phase. Screening tests for breast cancer include a clinical breast exam and mammography.

Sentinel lymph node procedure: the tumor site is injected with a blue dye and/or a radioisotope that flows to the sentinel node, usually the first location for the presence of cancer. This node is removed and examined closely by a pathologist. If there are no cancer cells in the sentinel node, no additional nodes are removed.

Staging: the method used to determine the extent of a cancer, especially whether it has spread from its original site to other parts of the body

Stereotactic core biopsy: a method using a series of computerized mammograms to identify an abnormality in 3 dimensions. This more accurately pinpoints a nonpalpable lesion in order to collect tissue for pathologic examination. This procedure offers an ability to sample (biopsy) suspicious clustered calcifications.

Suspicious/probably malignant: highly suggestive of malignancy, but a definitive diagnosis cannot be made due to either technical difficulties such as limited cellularity or poor preservation, or the inherent nature of certain breast lesions such as papilloma vs papillary carcinoma, fibroadenoma vs phyllodes tumors, proliferative lesions with atypia vs in situ or low-grade infiltrating carcinomas

Tubular carcinoma: the most well-differentiated form of ductal carcinoma, frequently presenting as small occult lesions discovered by screening mammography. Tubular carcinoma is usually curable and.derives its name from well-defined oval or round tubular structures formed by cells with little atypia.

Ultrasound: an imaging technique that uses high-frequency sound waves to produce an image of the internal structures of the breast.