Variant 1: Female. New palpable, unilateral, axillary lump. Initial imaging of the axilla.
Variant 2: Female. New palpable, bilateral, axillary lump. Initial imaging of the axilla.
Variant 3: Female. Newly diagnosed breast cancer, 2 cm or less, with clinical node-negative. Initial imaging of the axilla following diagnostic mammography or DBT.
Variant 4: Female. Newly diagnosed breast cancer, 2 cm or less, with clinical node-positive. Initial imaging of the axilla following diagnostic mammography or DBT.
Variant 5: Female. Newly diagnosed breast cancer, greater than 2 cm, with clinical node-negative. Initial imaging of the axilla following diagnostic mammography or DBT.
Variant 6: Female. Newly diagnosed breast cancer, greater than 2 cm, with clinical node-positive. Initial imaging of the axilla following diagnostic mammography or DBT (prior to treatment).
Variant 7: Female. Breast cancer, greater than 2 cm in size, at mid-treatment of neoadjuvant chemotherapy, with initial clinical node-negative disease but now presenting with new palpable axillary lump. Imaging of the axilla at mid-treatment.
Variant 8: Female. Breast cancer, greater than 2 cm in size, clinical node-negative. Imaging of the axilla after completion of neoadjuvant chemotherapy.
Variant 9: Female. Breast cancer, greater than 2 cm in size, clinical node-positive. Imaging of the axilla after completion of neoadjuvant chemotherapy and prior to surgery.
Variant 10: Female. Newly diagnosed locally recurrent breast cancer. Initial imaging of the axilla following diagnostic mammography or DBT.
Variant 11: Female. Suspicious axillary node on mammography or ultrasound. Next imaging study.
Variant 12: Female. Suspicious axillary node on any other imaging modality (excluding mammography and ultrasound). Next imaging study.
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.