American College of Radiology
ACR Appropriateness Criteria®

Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer

Variant 1: Initial determination of tumor size and extent within the breast prior to neoadjuvant chemotherapy. Initial imaging examination.
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
MRI breast without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
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
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 2 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
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Imaging of the breast after initiation or completion of neoadjuvant chemotherapy. Initial imaging examination.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI breast without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 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
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 2 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
FDG-PEM Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Known breast cancer. Axillary evaluation prior to neoadjuvant chemotherapy. Initial imaging examination.
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
MRI breast without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 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
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
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 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
Variant 4: Known breast cancer. Axillary evaluation after completion of neoadjuvant chemotherapy, axilla not previously evaluated. Initial imaging examination.
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] 8 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 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
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 2 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
Variant 5: Known breast cancer with clinical suspicion of metastatic disease. Staging or assessment of response to neoadjuvant chemotherapy. Initial imaging examination.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Tc-99m bone scan whole body Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually appropriate ☢☢☢☢ 10-30 mSv 9 n/a 0 0 0 0 0 0 0 0 0
CT chest abdomen pelvis with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv 8 n/a 0 0 0 0 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv 7 n/a 0 0 0 0 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 1 n/a 0 0 0 0 0 0 0 0 0
MRI chest abdomen pelvis 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
MRI chest abdomen pelvis 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
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.