American College of Radiology
ACR Appropriateness Criteria®

Breast Pain

Variant 1: Woman 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 SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually not appropriate Limited 3 ☢☢ 0.1-1mSv 1 1 9 0 2 2 2 0 0 1 0
References Study Quality
32 (10794575) 4
14 (9831579) 4
34 (22331398) 3
8 (27916596) 4
33 (28567103) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
US breast Usually not appropriate Limited 3 O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
References Study Quality
35 (25931836) 3
8 (27916596) 4
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus 1 ☢☢ 0.1-1mSv 1 1 10 0 2 1 3 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv 1 1 15 0 1 0 0 0 0 0 0
Variant 2: Woman with clinically significant breast pain (focal and noncyclical). Age less than 30. Initial imaging.
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 Limited 3 O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 2 4 3 4
References Study Quality
14 (9831579) 4
12 (12008815) 3
37 (21098212) 3
11 (24011215) 3
35 (25931836) 3
9 (27746121) 3
Mammography diagnostic Usually not appropriate Limited 3 ☢☢ 0.1-1mSv 1 1 10 2 2 0 0 0 2 0 0
References Study Quality
36 (7268931) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 1 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 1 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus 1 ☢☢ 0.1-1mSv 1 1 11 2 2 1 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv 1 1 15 0 1 0 0 0 0 0 0
Variant 3: Woman with clinically significant breast pain (focal and noncyclical). Age 30 to 39. Initial imaging.
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 Limited 1 ☢☢ 0.1-1mSv 9 9 0 0 0 1 1 0 3 3 8
References Study Quality
39 (23175484) 2
10 (3371473) 4
9 (27746121) 3
Digital breast tomosynthesis diagnostic Usually appropriate Strong 3 07 ☢☢ 0.1-1mSv 9 9 0 0 0 0 2 0 1 3 10
References Study Quality
41 (29429017) 2
40 (29494322) 2
30 (23255766) 3
29 (23620367) 2
28 (23345348) 2
39 (23175484) 2
US breast Usually appropriate Limited 3 O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 8 0 5
References Study Quality
14 (9831579) 4
12 (12008815) 3
11 (24011215) 3
9 (27746121) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 1 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 1 0 0 0
Tc-99m sestamibi MBI Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv 1 1 15 0 0 1 0 0 0 0 0
Variant 4: Woman with clinically significant breast pain (focal and noncyclical). Age greater than or equal to 40. Initial imaging.
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 Limited 3 ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 4 1 11
References Study Quality
38 (16174154) 3
11 (24011215) 3
9 (27746121) 3
Digital breast tomosynthesis diagnostic Usually appropriate Strong 3 07 ☢☢ 0.1-1mSv 9 9 0 0 0 1 0 0 5 1 9
References Study Quality
30 (23255766) 3
29 (23620367) 2
28 (23345348) 2
US breast Usually appropriate Limited 3 O 0 mSv O 0 mSv [ped] 7 7 0 1 0 1 1 4 6 1 2
References Study Quality
14 (9831579) 4
12 (12008815) 3
11 (24011215) 3
9 (27746121) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 0 0 1
Tc-99m sestamibi MBI Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv 1 1 14 0 1 0 0 1 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.