Abstract
BUPA's mammography quality assurance programme comprises an annual audit visit to 31 hospital-based screening centres by one of a team of three quality assurance mammographers. Clinical competence and mammographic film quality are assessed and technical quality control data are also collected. Monitoring of overall image quality is also addressed by a 'quarterly' test object film. A patient dose survey has been undertaken with exposure and breast thickness data collected from all sites. The standard of mammography across screening centres is good and well within NHSBSP standards. Reject rates are less than 3% and are personalised to each radiographer, enabling feedback and learning. Continuing professional development is in place and sites have evidence of a system of peer review. Quality control checks are undertaken according to recommended standards and records are kept. The mean glandular dose for a lateral oblique film across all centres was 1.7 mGy, well below the recommended national reference dose level. Mean doses at individual hospitals ranged from approximately 1.1 mGy to 2.3 mGy. Image quality scores using the Leeds TORMAM are generally satisfactory and typical of elsewhere, with only a few films having scores less than optimum and driving a move to higher contrast film/screens at these sites.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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