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Breast Imaging During Pregnancy
Variant: 1
Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Digital breast tomosynthesis screening | Usually Appropriate | ☢☢ |
| Mammography screening | Usually Appropriate | ☢☢ |
| US breast | May Be Appropriate | O |
| Mammography with IV contrast | Usually Not Appropriate | ☢☢ |
| MRI breast without and with IV contrast | Usually Not Appropriate | O |
| MRI breast without and with IV contrast abbreviated | Usually Not Appropriate | O |
| MRI breast without IV contrast | Usually Not Appropriate | O |
| MRI breast without IV contrast abbreviated | Usually Not Appropriate | O |
| Sestamibi MBI | Usually Not Appropriate | ☢☢☢ |
Variant: 2
Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US breast | May Be Appropriate | O |
| Digital breast tomosynthesis screening | Usually Not Appropriate | ☢☢ |
| Mammography screening | Usually Not Appropriate | ☢☢ |
| Mammography with IV contrast | Usually Not Appropriate | ☢☢ |
| MRI breast without and with IV contrast | Usually Not Appropriate | O |
| MRI breast without and with IV contrast abbreviated | Usually Not Appropriate | O |
| MRI breast without IV contrast | Usually Not Appropriate | O |
| MRI breast without IV contrast abbreviated | Usually Not Appropriate | O |
| Sestamibi MBI | Usually Not Appropriate | ☢☢☢ |
Variant: 3
Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Digital breast tomosynthesis screening | Usually Appropriate | ☢☢ |
| Mammography screening | Usually Appropriate | ☢☢ |
| US breast | May Be Appropriate | O |
| Mammography with IV contrast | Usually Not Appropriate | ☢☢ |
| MRI breast without and with IV contrast | Usually Not Appropriate | O |
| MRI breast without and with IV contrast abbreviated | Usually Not Appropriate | O |
| MRI breast without IV contrast | Usually Not Appropriate | O |
| MRI breast without IV contrast abbreviated | Usually Not Appropriate | O |
| Sestamibi MBI | Usually Not Appropriate | ☢☢☢ |
Variant: 4
Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. 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 | ☢☢ |
| Mammography with IV contrast | 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: 5
Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US breast | Usually Appropriate | O |
| Digital breast tomosynthesis diagnostic | Usually Appropriate | ☢☢ |
| Mammography diagnostic | Usually Appropriate | ☢☢ |
| Mammography with IV contrast | 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: 6
Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. 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 | ☢☢ |
| Mammography with IV contrast | 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: 7
Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US breast | Usually Appropriate | O |
| Digital breast tomosynthesis diagnostic | Usually Appropriate | ☢☢ |
| Mammography diagnostic | Usually Appropriate | ☢☢ |
| Mammography with IV contrast | 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: 8
Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US axilla | Usually Appropriate | O |
| US breast | Usually Appropriate | O |
| Digital breast tomosynthesis diagnostic | Usually Appropriate | ☢☢ |
| Mammography diagnostic | Usually Appropriate | ☢☢ |
| Mammography with IV contrast | 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: 9
Pregnant female. Breast infection or abscess suspected. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US breast | Usually Appropriate | O |
| Digital breast tomosynthesis diagnostic | May Be Appropriate | ☢☢ |
| Mammography diagnostic | May Be Appropriate | ☢☢ |
| Mammography with IV contrast | 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: 10
Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US breast | Usually Appropriate | O |
| US axilla | Usually Not Appropriate | O |
| Digital breast tomosynthesis diagnostic | Usually Not Appropriate | ☢☢ |
| Mammography diagnostic | Usually Not Appropriate | ☢☢ |
| Mammography with IV contrast | Usually Not Appropriate | ☢☢ |
| Image-guided core biopsy breast | Usually Not Appropriate | Varies |
| Image-guided fine needle aspiration breast | Usually Not Appropriate | Varies |
| 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: 11
Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US axilla | Usually Appropriate | O |
| US breast | Usually Appropriate | O |
| Digital breast tomosynthesis diagnostic | Usually Appropriate | ☢☢ |
| Mammography diagnostic | Usually Appropriate | ☢☢ |
| Image-guided core biopsy breast | Usually Appropriate | Varies |
| Image-guided fine needle aspiration breast | May Be Appropriate | Varies |
| Mammography with IV contrast | 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 | ☢☢☢ |
Panel Members
Lonie R. Salkowski, MD, PhD, MSa; Alana A. Lewin, MDb; Susan P. Weinstein, MDc; Stacey Bartell, MDd; Meredith L. Birsner, MDe; Virginia Borges, MDf; Elizabeth H. Dibble, MDg; Katerina Dodelzon, MDh; Basak E. Dogan, MDi; Claudia Kasales, MD, MHAj; Jean M. Kunjummen, DOk; Cherie M. Kuzmiak, DOl; Andrea Merrill, MDm; Chirag Parghi, MD, MBAn; Lisa V. Paulis, MDo; Richard E. Sharpe Jr., MD, MBAp; Priscilla J. Slanetz, MD, MPHq.
Summary of Literature Review
Introduction/Background
Initial Imaging Definition
Discussion of Procedures by Variant
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
A. Digital breast tomosynthesis screening
A. Digital breast tomosynthesis screening
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
B. Mammography screening
B. Mammography screening
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
E. MRI breast without and with IV contrast abbreviated
E. MRI breast without and with IV contrast abbreviated
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
F. MRI breast without IV contrast
F. MRI breast without IV contrast
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
G. MRI breast without IV contrast abbreviated
G. MRI breast without IV contrast abbreviated
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
H. Sestamibi MBI
H. Sestamibi MBI
Variant 1: Pregnant female. Age 40 years or older. Breast cancer screening. Any risk.
I. US breast
I. US breast
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
A. Digital breast tomosynthesis screening
A. Digital breast tomosynthesis screening
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
B. Mammography screening
B. Mammography screening
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
E. MRI breast without and with IV contrast abbreviated
E. MRI breast without and with IV contrast abbreviated
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
F. MRI breast without IV contrast
F. MRI breast without IV contrast
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
G. MRI breast without IV contrast abbreviated
G. MRI breast without IV contrast abbreviated
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
H. Sestamibi MBI
H. Sestamibi MBI
Variant 2: Pregnant female. Age less than 25 years. Breast cancer screening. Higher-than-average risk.
I. US breast
I. US breast
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
A. Digital breast tomosynthesis screening
A. Digital breast tomosynthesis screening
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
B. Mammography screening
B. Mammography screening
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
E. MRI breast without and with IV contrast abbreviated
E. MRI breast without and with IV contrast abbreviated
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
F. MRI breast without IV contrast
F. MRI breast without IV contrast
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
G. MRI breast without IV contrast abbreviated
G. MRI breast without IV contrast abbreviated
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
H. Sestamibi MBI
H. Sestamibi MBI
Variant 3: Pregnant female. Age 25 years or older. Breast cancer screening. Higher-than-average risk.
I. US breast
I. US breast
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 4: Pregnant female. Age less than 30 years. Focal pain or palpable breast mass. Initial imaging.
G. US breast
G. US breast
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 5: Pregnant female. Age 30 years or older. Focal pain or palpable breast mass. Initial imaging.
G. US breast
G. US breast
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 6: Pregnant female. Age less than 30 years. Clinically suspicious nipple discharge. Initial imaging.
G. US breast
G. US breast
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 7: Pregnant female. Age 30 years or older. Clinically suspicious nipple discharge. Initial imaging.
G. US breast
G. US breast
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
G. US axilla
G. US axilla
Variant 8: Pregnant female. Newly diagnosed breast cancer. Locoregional staging.
H. US breast
H. US breast
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
B. Mammography diagnostic
B. Mammography diagnostic
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
C. Mammography with IV contrast
C. Mammography with IV contrast
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
D. MRI breast without and with IV contrast
D. MRI breast without and with IV contrast
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
E. MRI breast without IV contrast
E. MRI breast without IV contrast
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
F. Sestamibi MBI
F. Sestamibi MBI
Variant 9: Pregnant female. Breast infection or abscess suspected. Initial imaging.
G. US breast
G. US breast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
B. Image-guided core biopsy breast
B. Image-guided core biopsy breast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
C. Image-guided fine needle aspiration breast
C. Image-guided fine needle aspiration breast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
D. Mammography diagnostic
D. Mammography diagnostic
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
E. Mammography with IV contrast
E. Mammography with IV contrast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
F. MRI breast without and with IV contrast
F. MRI breast without and with IV contrast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
G. MRI breast without IV contrast
G. MRI breast without IV contrast
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
H. Sestamibi MBI
H. Sestamibi MBI
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
I. US axilla
I. US axilla
Variant 10: Pregnant female. Palpable breast mass. US findings are probably benign. Next imaging study.
J. US breast
J. US breast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
A. Digital breast tomosynthesis diagnostic
A. Digital breast tomosynthesis diagnostic
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
B. Image-guided core biopsy breast
B. Image-guided core biopsy breast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
C. Image-guided fine needle aspiration breast
C. Image-guided fine needle aspiration breast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
D. Mammography diagnostic
D. Mammography diagnostic
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
E. Mammography with IV contrast
E. Mammography with IV contrast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
F. MRI breast without and with IV contrast
F. MRI breast without and with IV contrast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
G. MRI breast without IV contrast
G. MRI breast without IV contrast
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
H. Sestamibi MBI
H. Sestamibi MBI
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
I. US axilla
I. US axilla
Variant 11: Pregnant female. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy. Next imaging study.
J. US breast
J. US breast
Summary of Highlights
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.
Safety Considerations in Pregnant Patients
Gender Equality and Inclusivity Clause
The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.
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
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.
|
Relative Radiation Level Designations |
||
|
Relative Radiation Level* |
Adult Effective Dose Estimate Range |
Pediatric Effective Dose Estimate Range |
|
O |
0 mSv |
0 mSv |
|
☢ |
<0.1 mSv |
<0.03 mSv |
|
☢☢ |
0.1-1 mSv |
0.03-0.3 mSv |
|
☢☢☢ |
1-10 mSv |
0.3-3 mSv |
|
☢☢☢☢ |
10-30 mSv |
3-10 mSv |
|
☢☢☢☢☢ |
30-100 mSv |
10-30 mSv |
|
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.” |
||
References
| 1. | Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging. 2013;4(5):527-538. | |
| 2. | Kieturakis AJ, Wahab RA, Vijapura C, Mahoney MC. Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. AJR Am J Roentgenol. 2021 Jun;216(6):1462-1475. | |
| 3. | Peterson MS, Gegios AR, Elezaby MA, et al. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics. 2023 Oct;43(10):e230014. | |
| 4. | Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Cherel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014;95(4):435-441. | |
| 5. | Kalogerakos K, Sofoudis C, Tzonis P, Koutsouradis P, Katsoulis G. Breast cancer and pregnancy; overview of international bibliography. [Review]. Journal of B.U.On.. 18(2):308-13, 2013 Apr-Jun. | |
| 6. | Wang B, Yang Y, Jiang Z, et al. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer. Thoracic Cancer. 10(5):1060-1068, 2019 05. | |
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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