We are upgrading the repository! The content freeze has been extended to December 11, 2024, when we expect the new repository to become available. New submissions or changes to existing items will not be allowed until after the new website goes live. All content already published will remain publicly available for searching and downloading. Updates will be posted in the Website Upgrade 2024 FAQ in the sidebar Help menu. Reach out to escholarship@umassmed.edu with any questions.
ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Niell, Bethany LJochelson, Maxine S
Amir, Tali
Brown, Ann
Adamson, Megan
Baron, Paul
Bennett, Debbie L
Chetlen, Alison
Dayaratna, Sandra
Freer, Phoebe E
Ivansco, Lillian K
Klein, Katherine A
Malak, Sharp F
Mehta, Tejas S
Moy, Linda
Neal, Colleen H
Newell, Mary S
Richman, Ilana B
Schonberg, Mara
Small, William
Ulaner, Gary A
Slanetz, Priscilla J
UMass Chan Affiliations
RadiologyDocument Type
Journal ArticlePublication Date
2024-06-01Keywords
AUCAppropriateness Criteria
appropriate use criteria
breast MRI
breast cancer
breast cancer screening
digital breast tomosynthesis
female breast cancer screening
mammography
Metadata
Show full item recordAbstract
Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. 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.Source
Expert Panel on Breast Imaging; Niell BL, Jochelson MS, Amir T, Brown A, Adamson M, Baron P, Bennett DL, Chetlen A, Dayaratna S, Freer PE, Ivansco LK, Klein KA, Malak SF, Mehta TS, Moy L, Neal CH, Newell MS, Richman IB, Schonberg M, Small W Jr, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update. J Am Coll Radiol. 2024 Jun;21(6S):S126-S143. doi: 10.1016/j.jacr.2024.02.019. PMID: 38823941.DOI
10.1016/j.jacr.2024.02.019Permanent Link to this Item
http://hdl.handle.net/20.500.14038/53484PubMed ID
38823941Rights
Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.ae974a485f413a2113503eed53cd6c53
10.1016/j.jacr.2024.02.019
Scopus Count
Collections
Related items
Showing items related by title, author, creator and subject.
-
Apocrine Metaplasia Found at MR Biopsy: Is There Something to be LearnedGao, Yiming; Dialani, Vandana; DeBenedectis, Carolynn M; Johnson, Nicole; Brachtel, Elena; Slanetz, Priscilla (2017-07-01)The purpose of this study was to determine (a) the frequency of apocrine metaplasia (ApoM) found on MR core biopsy of suspicious findings, and (b) to determine if there are specific MR imaging features that might obviate the need for biopsy. This HIPAA-compliant retrospective study was performed under IRB exemption for quality assurance studies. Patient demographics, MR imaging features, and pathology were reviewed. Breast lesions which underwent MR-guided biopsy, yielding ApoM on pathology analysis were included. Retrospective review of MR imaging features of these lesions was performed by two radiologists blinded to pathology results except for the presence of ApoM. Imaging features on MR assessed included location, size, morphology, T1 and T2 signals, and enhancement kinetics. Full pathology results were subsequently reviewed during data analysis. The pathology slides and imaging was subsequently reviewed by two fellowship trained radiologists and a breast pathologist to categorize the finding of ApoM into target lesion (imaging corresponds to size of lesion on pathology) versus incidental lesion. Target lesion characteristics were assessed to determine specific MRI features of ApoM. Between January 2011 to November 2012, 155 distinct breast lesions suspicious for malignancy successfully underwent MR-guided biopsy. Of the 155 lesions biopsied, 123 (79%) were benign and 32 (21%) were malignant. Of the 123 benign biopsies, ApoM was found in 57 (46%), of which 35 (61%) had no associated atypia and 22 (39%) had associated atypia. Of the 32 malignant biopsies, three (9%) had associated ApoM (DCIS in two cases and DCIS/LCIS in one case). Of the 60 cases with ApoM, only 11 (18.3%) were target lesions and 49 were incidental lesions (81.7%). Of the 60 cases with ApoM, 35 (58%) were masses (average size 0.8 cm for both with or without atypia) and 25 (42%) were nonmass enhancement (NME) (average size 2.1 cm with and 1.0 cm without atypia). Only five (14%) of 35 masses demonstrated spiculated margins, of which four were associated with atypia (80%). Of 22 lesions with atypia or other high-risk lesion, 14 (64%) were masses, most commonly with irregular margins (64%). Of the 12 T2 hyperintense lesions, only two (1.7)% had associated atypia or high-risk lesion, and none were associated with malignancy. Of the 11 target lesions, seven were T2 hyperintense. Enhancement kinetics were variable: 30 (50%) showed mixed persistent and plateau kinetics, eight (13%) persistent delayed enhancement, 10 (17%) plateau kinetics, four (7%) washout kinetics, and eight (13%) were below threshold for kinetic analysis. ApoM is a common benign pathologic result at MR-guided core biopsy for both masses and NME accounting for 39% of all biopsy results in this series. Although there is considerable variability in imaging characteristics on MR, our results suggest biopsy may be safely obviated for lesions that are subcentimeter T2 hyperintense areas of NME and short term follow-up imaging may be a reasonable alternative for these lesions.
-
Benign Breast Cyst in a Young MaleAzimi, Nima; Azar, Azniv; Khan, Ashraf; DeBenedectis, Carolynn M (2019-06-03)Simple benign breast cysts are commonly diagnosed in female breasts and may present as palpable masses. However, they are extremely uncommon in the male breast and are rarely reported in the literature. Here, we report a case of a simple benign cyst of the breast in a relatively healthy 37-year-old man. The patient initially presented with a palpable 2-3 mm tender left breast lump. Further evaluation with mammography and ultrasound revealed a mass most consistent with a simple benign cyst. However, considering the rarity of breast cysts in males, the lesion was biopsied to rule out malignancy. Pathology results from ultrasound-guided core needle biopsy demonstrated fibro-adipose tissue with a benign cyst lined by foamy cells with apocrine features, consistent with a diagnosis of a benign epithelial cyst and concordant with the radiological findings. To our knowledge, this is the youngest case of a benign breast cyst in a male that has been reported in the literature. In this case report, we discuss the typical features and presentation of breast cysts in males, associated imaging findings on mammography and ultrasound, and the necessity for pathological confirmation with biopsy in this population.
-
Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured WomenGanguli, Ishani; Keating, Nancy l.; Thakore, Nitya; Lii, Joyce; Raza, Sughra; Pace, Lydia E. (2022-04-01)Importance: Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value. Objective: To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women. Design, Setting, and Participants: This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021. Exposures: Breast MRI vs mammography. Main Outcomes and Measures: Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test. Results: In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55). Conclusions and Relevance: In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.