Variant 1: 55-year-old woman with mammographically detected 2.0-cm comedo, high nuclear grade DCIS, ER-positive. Surgically excised, multiple foci of DCIS in lateral and medial specimen close to excision margin (≤1.0 mm).

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 2: 50-year-old woman with extensive pleomorphic microcalcifications in more than one quadrant on mammography. Area too large to excise with cosmetically acceptable outcome. Core biopsies demonstrate DCIS involving more than one quadrant.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 3: 78-year-old woman with mammographically detected 1-cm, low nuclear grade DCIS, ER-positive. Surgically excised with 5-mm negative margins. Excellent performance status, no comorbidities. Plans to take a hormonal agent for 5 years.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 4: 41-year-old premenopausal woman with mammographically detected 0.9-cm, intermediate nuclear grade, comedo DCIS, ER negative. Surgically excised with widely negative margins.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 5: 49-year-old premenopausal woman with mammographically detected 1-cm high-grade, comedo DCIS with single focus microinvasion, ER-positive. Surgically excised with widely negative margins (>5 mm).

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 6: 60-year-old woman with new microcalcifications on screening mammography. Stereotactic core biopsy shows pure pleomorphic LCIS, ER/PR negative.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 7: 41-year-old premenopausal woman with mammographically detected 0.9-cm, high nuclear grade DCIS, plus comedo necrosis, ER negative. Surgically excised. Assume final margins >1 cm, patient wants partial breast irradiation.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 8: 58-year-old postmenopausal woman with mammographically detected 1.9-cm, intermediate nuclear grade solid DCIS, ER positive. Surgically excised. Assume final margins >1 cm, patient wants partial breast irradiation.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

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.

Appropriateness Criteria