American College of Radiology
ACR Appropriateness Criteria®

Palpable Breast Masses

Variant 1: Palpable breast mass. Woman 40 years of age or older, initial evaluation. (See Appendices 1A-1B for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 n/a 0 0 0 0 0 0 0 0 0
US breast May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Palpable breast mass. Woman 40 years of age or older, mammography findings suspicious for malignancy. Next examination to perform. (See Appendix 1A for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Mammography short interval follow-up Usually not appropriate ☢☢ 0.1-1mSv 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis short-interval follow-up Usually not appropriate ☢☢ 0.1-1mSv 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Palpable breast mass. Woman 40 years of age or older, mammography findings probably benign. Next examination to perform. (See Appendix 1A for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography short interval follow-up Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis short-interval follow-up Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Palpable breast mass. Woman 40 years of age or older, mammography findings benign (like lipoma) at site of palpable mass. Next examination to perform.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
Mammography short interval follow-up Usually not appropriate ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
US breast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis short-interval follow-up Usually not appropriate ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Palpable breast mass. Woman 40 years of age or older, mammography findings negative. Next examination to perform. (See Appendix 1B for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 6: Palpable breast mass. Woman younger than 30 years of age, initial evaluation. (See Appendices 2A-2B for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 7: Palpable breast mass. Woman younger than 30 years of age, US findings suspicious for malignancy. Next examination to perform. (See Appendix 2A for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided core biopsy breast Usually appropriate Varies Varies 9 n/a 0 0 0 0 0 0 0 0 0
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
US breast short interval follow-up Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 8: Palpable breast mass. Woman younger than 30 years of age, US findings probably benign. Next examination to perform. (See Appendix 2B for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast short interval follow-up Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 9: Palpable breast mass. Woman younger than 30 years of age, US findings benign (like simple cyst). Next examination to perform.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
US breast short interval follow-up Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 10: Palpable breast mass. Woman younger than 30 years of age, US findings negative. Next examination to perform.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
US breast short interval follow-up Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 11: Palpable breast mass. Women 30 to 39 years of age, initial evaluation. (See Appendix 3 for additional steps in the workup of these patients.)
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.