Breast Pain

Variant: 1 Female with clinically insignificant breast pain (nonfocal [greater than one quadrant], diffuse, or cyclical) without other suspicious clinical finding. Any age. Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis diagnostic	Usually Not Appropriate	☢☢
Mammography diagnostic	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 2 Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Appropriate	O
Digital breast tomosynthesis diagnostic	Usually Not Appropriate	☢☢
Mammography diagnostic	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 3 Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Appropriate	O
Digital breast tomosynthesis diagnostic	Usually Appropriate	☢☢
Mammography diagnostic	Usually Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 4 Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Appropriate	O
Digital breast tomosynthesis diagnostic	Usually Appropriate	☢☢
Mammography diagnostic	Usually Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Panel Members

Summary of Literature Review

Introduction/Background

Special Imaging Considerations

Discussion of Procedures by Variant

Variant 1: Female with clinically insignificant breast pain (nonfocal [greater than one quadrant], diffuse, or cyclical) without other suspicious clinical finding. Any age. Initial imaging.

Variant 1: Female with clinically insignificant breast pain (nonfocal [greater than one quadrant], diffuse, or cyclical) without other suspicious clinical finding. Any age. Initial imaging.
A. Mammography

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
A. Mammography

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
B. DBT

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
C. US Breast

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
D. MRI Breast

Variant 2: Female with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
E. Sestamibi MBI

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
A. Mammography

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
B. DBT

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
C. US Breast

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
D. MRI Breast

Variant 3: Female with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
E. Sestamibi MBI

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
A. Mammography

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
B. DBT

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
C. US Breast

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
D. MRI Breast

Variant 4: Female with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
E. Sestamibi MBI

Summary of Recommendations

Summary of Evidence

Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate	4, 5, or 6	The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)	5	The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate	1, 2, or 3	The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.

Relative Radiation Level Information

References

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Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.