TY - JOUR
T1 - ACR Appropriateness Criteria® Palpable Breast Masses
T2 - 2022 Update
AU - Expert Panel on Breast Imaging
AU - Klein, Katherine A.
AU - Kocher, Maddi
AU - Lourenco, Ana P.
AU - Niell, Bethany L.
AU - Bennett, Debbie L.
AU - Chetlen, Alison
AU - Freer, Phoebe
AU - Ivansco, Lillian K.
AU - Jochelson, Maxine S.
AU - Kremer, Mallory E.
AU - Malak, Sharp F.
AU - McCrary, Marion
AU - Mehta, Tejas S.
AU - Neal, Colleen H.
AU - Porpiglia, Andrea
AU - Ulaner, Gary A.
AU - Moy, Linda
N1 - Funding Information:
Dr. Bennett reports Payments or honoraria from Honorarium for CME conference at Washington University in St. Louis. Dr. Chetlen reports Payment for expert testimony from Consulting fee for medical malpractice case expert review in 2021 and 2022. No testimony provided, rather a chart and image review only. Dr. Freer reports Grants or contracts from Predictors of Relapse and Response to Therapy, a Double Blinded Study, (Brian Welms, Cindy Matsen) NCI/NIH; Payments or honoraria from UpToDate $500 approx; Leadership roles as Huntsman Steering Committee on Community Outreach and Engagement, Radiographics Committee, breast subpanel, ACR Appropriateness Criteria, SBI Screening Leadership. Dr. Ivansco reports Support for meetings from Employer provides CME fund for academic conferences; Leadership roles as Assistant Chief, Department of Radiology, The Southeast Permanente Medical Group, Chief, Breast Imaging, Kaiser Permanente Georgia. Dr. Lourenco reports Leadership roles as Society of Breast Imaging CME & SAM Committee Chair. Dr. Malak reports Leadership roles as National Mammography Quality Assurance Advisory Committee Member. Dr. Mehta reports Payments or honoraria from UpToDate "Ultrasound of Pregnancy of Unknown Location"; Leadership roles as Society of Breast Imaging - CoChair of Inclusion Diversity, Equity Alliance, Tufts University School of Medicine Board of Advisors. Dr. Moy reports Grants or contracts from Siemens Research Grant, Gordon and Betty Moore Foundation, Mary Kay Foundation and Google; Consulting fees from Lunit Insight, Inc.), ICAD), (Guerbet;Support for meetings from British Society of Breast Radiology, European Society of Breast Imaging; Leadership roles as Board member of ISMRM and Society of Breast Imaging; Stock in Lunit. Dr. Niell reports Grants or contracts from Grant funding from the NIH/NCI and the Florida Health Bankhead-Coley Cancer Research Program; Payments or honoraria from University of Wisconsin Grand Rounds and resident lecture, NIH CTIS grant study section; Support for meetings from NIH/NCI grants; Leadership roles as Section Chief of Breast Imaging at Moffitt Cancer Center, Chair of ACR Appropriateness Criteria breast imaging panel, Chair of the ACR breast imaging GR committee. Dr. Porpiglia reports Support for meetings from Fox Chase Cancer Center reimbursed travel to the Society of Surgical Oncology annual conference. Dr. Ulaner reports Leadership roles as Past President, American College of Nuclear Medicine. Board of Directors, Society of Nuclear Medicine and Molecular Imaging. Dr. Lourenco and Dr Neal are partners; and the other authors are non-partner/non-partnership track/employees.
Funding Information:
Dr. Bennett reports Payments or honoraria from Honorarium for CME conference at Washington University in St. Louis. Dr. Chetlen reports Payment for expert testimony from Consulting fee for medical malpractice case expert review in 2021 and 2022. No testimony provided, rather a chart and image review only. Dr. Freer reports Grants or contracts from Predictors of Relapse and Response to Therapy, a Double Blinded Study, (Brian Welms, Cindy Matsen) NCI/NIH; Payments or honoraria from UpToDate $500 approx; Leadership roles as Huntsman Steering Committee on Community Outreach and Engagement, Radiographics Committee, breast subpanel, ACR Appropriateness Criteria, SBI Screening Leadership. Dr. Ivansco reports Support for meetings from Employer provides CME fund for academic conferences; Leadership roles as Assistant Chief, Department of Radiology, The Southeast Permanente Medical Group, Chief, Breast Imaging, Kaiser Permanente Georgia. Dr. Lourenco reports Leadership roles as Society of Breast Imaging CME & SAM Committee Chair. Dr. Malak reports Leadership roles as National Mammography Quality Assurance Advisory Committee Member. Dr. Mehta reports Payments or honoraria from UpToDate "Ultrasound of Pregnancy of Unknown Location"; Leadership roles as Society of Breast Imaging - CoChair of Inclusion Diversity, Equity Alliance, Tufts University School of Medicine Board of Advisors. Dr. Moy reports Grants or contracts from Siemens Research Grant, Gordon and Betty Moore Foundation, Mary Kay Foundation and Google; Consulting fees from Lunit Insight, Inc.), ICAD), (Guerbet;Support for meetings from British Society of Breast Radiology, European Society of Breast Imaging; Leadership roles as Board member of ISMRM and Society of Breast Imaging; Stock in Lunit. Dr. Niell reports Grants or contracts from Grant funding from the NIH/NCI and the Florida Health Bankhead-Coley Cancer Research Program; Payments or honoraria from University of Wisconsin Grand Rounds and resident lecture, NIH CTIS grant study section; Support for meetings from NIH/NCI grants; Leadership roles as Section Chief of Breast Imaging at Moffitt Cancer Center, Chair of ACR Appropriateness Criteria breast imaging panel, Chair of the ACR breast imaging GR committee. Dr. Porpiglia reports Support for meetings from Fox Chase Cancer Center reimbursed travel to the Society of Surgical Oncology annual conference. Dr. Ulaner reports Leadership roles as Past President, American College of Nuclear Medicine. Board of Directors, Society of Nuclear Medicine and Molecular Imaging. Dr. Lourenco and Dr Neal are partners; and the other authors are non-partner/non-partnership track/employees.
Publisher Copyright:
© 2023 American College of Radiology
PY - 2023/5
Y1 - 2023/5
N2 - Palpable masses in women are the most common symptom associated with breast cancer. This document reviews and evaluates the current evidence for imaging recommendations of palpable masses in women less than 30 to over 40 years of age. There is also a review of several different scenarios and recommendations after initial imaging. Ultrasound is usually the appropriate initial imaging for women under 30 years of age. If ultrasound findings are suspicious or highly suggestive of malignancy (BIRADS 4 or 5), it is usually appropriate to continue with diagnostic tomosynthesis or mammography with image-guided biopsy. No further imaging is recommended if the ultrasound is benign or negative. The patient under 30 years of age with a probably benign ultrasound may undergo further imaging; however, the clinical scenario plays a role in the decision to biopsy. For women between 30 to 39 years of age, ultrasound, diagnostic mammography, tomosynthesis, and ultrasound are usually appropriate. Diagnostic mammography and tomosynthesis are the appropriate initial imaging for women 40 years of age or older, as ultrasound may be appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy. If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
AB - Palpable masses in women are the most common symptom associated with breast cancer. This document reviews and evaluates the current evidence for imaging recommendations of palpable masses in women less than 30 to over 40 years of age. There is also a review of several different scenarios and recommendations after initial imaging. Ultrasound is usually the appropriate initial imaging for women under 30 years of age. If ultrasound findings are suspicious or highly suggestive of malignancy (BIRADS 4 or 5), it is usually appropriate to continue with diagnostic tomosynthesis or mammography with image-guided biopsy. No further imaging is recommended if the ultrasound is benign or negative. The patient under 30 years of age with a probably benign ultrasound may undergo further imaging; however, the clinical scenario plays a role in the decision to biopsy. For women between 30 to 39 years of age, ultrasound, diagnostic mammography, tomosynthesis, and ultrasound are usually appropriate. Diagnostic mammography and tomosynthesis are the appropriate initial imaging for women 40 years of age or older, as ultrasound may be appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy. If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
KW - AUC
KW - Appropriate Use Criteria
KW - Appropriateness Criteria
KW - breast cancer
KW - digital breast tomosynthesis
KW - mammography
KW - palpable breast mass
KW - ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85160046483&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2023.02.013
DO - 10.1016/j.jacr.2023.02.013
M3 - Article
C2 - 37236740
AN - SCOPUS:85160046483
SN - 1546-1440
VL - 20
SP - S146-S163
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 5
ER -