ACR Appropriateness Criteria® on Nonpalpable Mammographic Findings (Excluding Calcifications)

• Published in: Journal of the American College of Radiology Vol. 7; no. 12; pp. 920 - 930
• Main Authors: Newell, Mary S., MD, Birdwell, Robyn L., MD, D'Orsi, Carl J., MD, Bassett, Lawrence W., MD, Mahoney, Mary C., MD, Bailey, Lisa, MD, Berg, Wendie A., MD, PhD, Harvey, Jennifer A., MD, Herman, Cheryl R., MD, Kaplan, Stuart S., MD, Liberman, Laura, MD, Mendelson, Ellen B., MD, Parikh, Jay R., MD, Rabinovitch, Rachel, MD, Rosen, Eric L., MD, Sutherland, M. Linda, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2010
• Subjects: Appropriateness Criteria; Biopsy - standards; breast imaging; breast MRI; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; breast ultrasound; Calcinosis - diagnosis; Diagnosis, Differential; Diagnostic Imaging - standards; Evidence-Based Medicine; Female; Guideline Adherence - standards; Humans; Magnetic Resonance Imaging - standards; mammography; Mammography - standards; Mass Screening - standards; Palpation; percutaneous breast biopsy; Practice Guidelines as Topic; Practice Patterns, Physicians; Radiation Dosage; Radiology; Societies, Medical; Ultrasonography, Mammary - standards; United States; United States; breast MRI; breast ultrasound; percutaneous breast biopsy; mammography; breast imaging; Appropriateness Criteria
• ISSN: 1546-1440; 1558-349X
• DOI: 10.1016/j.jacr.2010.07.006

Screening mammography can detect breast cancer before it becomes clinically apparent. However, the screening process identifies many false-positive findings for each cancer eventually confirmed. Additional tools are available to help differentiate spurious findings from real ones and to help determine when tissue sampling is required, when short-term follow-up will suffice, or whether the finding can be dismissed as benign. These tools include additional diagnostic mammographic views, breast ultrasound, breast MRI, and, when histologic evaluation is required, percutaneous biopsy. The imaging evaluation of a finding detected at screening mammography proceeds most efficiently, cost-effectively, and with minimization of radiation dose when approached in an evidence-based manner. The appropriateness of the above-referenced tools is presented here as they apply to a variety of findings often encountered on screening mammography; an algorithmic approach to workup of these potential scenarios is also included. The recommendations put forth represent a compilation of evidence-based data and expert opinion of the ACR Appropriateness Criteria® Expert Panel on Breast Imaging.