ACR logo

Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Chiarelli AM, Edwards SA, Sheppard AJ, et al. Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50-69. Eur J Cancer Prev. 2012;21(6):499-506. Observational-Dx 1,848 breast cancers diagnosed among women To examine the benefit of mammography screening on breast cancer mortality. Women with symptomatic detected [odds ratio (OR)=7.48, 95% confidence interval (CI)=5.38-10.38] and interval cancers (OR=2.20, 95% CI=1.56-3.10) were more often diagnosed at stage III-IV versus I than women with rescreen-detected cancers. After adjusting for tumour size, women with symptomatic cancers had tumours of higher grade (OR=1.50, 95% CI=1.05-2.15) and mitotic score (OR=1.69, 95% CI=1.15-2.49) and women with interval cancers had tumours of higher mitotic score (OR=1.52, 95% CI=1.01-2.28) compared with women diagnosed at screening. 3
2. Lehman CD, Lee AY, Lee CI. Imaging management of palpable breast abnormalities. [Review]. AJR Am J Roentgenol. 203(5):1142-53, 2014 Nov. Review/Other-Dx 48 studies To discuss the evidence informing current management guidelines for the care of patients with palpable breast abnormalities. Ultrasound is a highly effective imaging tool for guiding effective evaluation of women with palpable breast abnormalities and should be used for all women with suspicious findings at clinical breast examination. The exception is cases in which mammography shows a clearly benign correlate or a normal, fatty area of breast tissue in the location of the palpable finding. Breast ultrasound should be the primary imaging tool for women with palpable lumps who are pregnant, lactating, or younger than 30 years. For women 40 years old and older, mammography, followed in most cases by ultrasound, is recommended. For women 30-39 years old, ultrasound or mammography may be performed first at the discretion of the radiologist or referring provider. There is little to no role for breast MRI or other advanced imaging technologies in the routine diagnostic evaluation of palpable breast abnormalities. 4
3. Ma I, Dueck A, Gray R, et al. Clinical and self breast examination remain important in the era of modern screening. Ann Surg Oncol. 19(5):1484-90, 2012 May. Observational-Dx 782 patients To review the methods of detecting newly diagnosed breast neoplasms at our institution. We identified 782 patients. Patients aged <50 years were more likely to present with palpable disease (P < 0.001). Overall, 75% of patients had a mammogram within 24 months. There was a higher incidence of Tis tumors and lower incidence of T1 tumors if patients had mammography performed within 12 months versus 13-24 months (P < 0.01); tumor size, hormonal status, and lymph node (LN) status were comparable between these two groups. Patients diagnosed by SBE/CBE who had mammography performed within 12 months versus 13-24 months did not differ statistically according to tumor characteristics. In the screened cohort (mammography within 24 months), the majority of patients (64%) were diagnosed by mammography. Cancers detected by SBE/CBE were larger tumors (2.4 vs. 1.3 cm), higher grade, more frequently ER- (29 vs. 16%), triple-negative (21 vs. 10%), and lymph node-positive (39 vs. 18%; all P </= 0.01). There were no statistically significant differences in tumor size, T stage, or hormonal status in patients who had analog versus digital mammography. 3
4. Salzman B, Collins E, Hersh L. Common Breast Problems. [Review]. American Family Physician. 99(8):505-514, 2019 04 15. Review/Other-Dx N/A To present information regarding common breast problems. No results stated in abstract. 4
5. Boyd NF, Sutherland HJ, Fish EB, Hiraki GY, Lickley HL, Maurer VE. Prospective evaluation of physical examination of the breast. Am J Surg. 1981; 142(3):331-334. Observational-Dx 100 patients Prospective evaluation of physical examination of the breast. Reliability of physical examination was evaluated by determining the extent of agreement among four experienced breast surgeons who examined the same patients. Diagnostic accuracy of surgeons was very similar, and most disagreements concerned the findings in patients who did not have breast cancer. Breast examination carried out by more than one surgeon may reduce the frequency with which biopsy is performed in patients who do not have breast cancer. 3
6. Rosner D, Blaird D. What ultrasonography can tell in breast masses that mammography and physical examination cannot. J Surg Oncol. 1985; 28(4):308-313. Observational-Dx 400 patients Prospective study to examine the capability of US to provide additional information to the physical and mammographic examination for therapeutic decision. Breast cancers were accurately diagnosed in 73% (88/120) by US and 84% (98/116) by mammography (P>0.10). Major limitation of US was in the diagnosis of minimal breast cancer (23%, 5/21) due to its inability to visualize microcalcifications. Study validates the importance of US in the diagnosis and therapeutic decision of cystic and fibrocystic masses but cannot substitute mammography in early detection of breast carcinoma. 3
7. Dennis MA, Parker SH, Klaus AJ, Stavros AT, Kaske TI, Clark SB. Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump. Radiology 2001; 219(1):186-191. Observational-Dx 600 lumps in 486 women To review the authors' experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens were benign (negative predictive value, 100%). Results of this retrospective study suggest that breast biopsy may be avoided in women with palpable abnormalities when both US and mammography depict normal tissue at the lump site. 3
8. Moy L, Slanetz PJ, Moore R, et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Radiology. 2002; 225(1):176-181. Observational-Dx 829 patients Retrospective study to determine the number of patients who received diagnosis of breast cancer after having an area of clinical concern and combined negative mammographic and US findings. 374/829 women had follow-up information. 233 had negative imaging findings with more than 2 years of follow-up. 6 (2.6%) of 233 had a diagnosis of breast cancer in the area of the palpable abnormality. A negative mammographic and US finding of a palpable abnormality does not exclude breast cancer, but the likelihood of breast cancer is low, approximately 2.6%-2.7%. It may be higher if the breast tissues are dense and lower if they are predominantly fatty. 3
9. Shetty MK, Shah YP. Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast. J Ultrasound Med. 2002; 21(11):1211-1216; quiz 1217-1219. Observational-Dx 172 patients; 186 palpable abnormalities Prospective study to evaluate the value of combined negative sonographic and mammographic findings in patients with palpable breast abnormalities. Twelve patients underwent biopsy; benign histologic diagnoses were reported in all 12 (12 [6.9%] of 172). In the remaining 160 patients who were followed, there was no interval development of breast cancer at the site of the palpable abnormality. The NPV of combined negative mammographic and sonographic findings in a patient with a palpable abnormality of the breast was 100%. Findings suggest that in a patient with a palpable abnormality of the breast, the NPV of combined normal sonographic and mammographic findings is very high and is therefore reassuring to the patient. 3
10. Chan CH, Coopey SB, Freer PE, Hughes KS. False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Res Treat 2015;153:699-702. Observational-Dx 1212 patients To review data regarding the use of combined mammography and ultrasound for patients with palpable breast masses. The false-negative rate of CRUM was 2.4 % (2/81). Since 69 % (428/617) of BI-RADS 1-2 patients without tissue diagnosis had follow-up imaging and/or clinical exam (median: 27 months, range: 2-62 months) and none developed cancers, the cancer rate and negative predictive value of a palpable breast mass of BI-RADS 1-2 were estimated to be 0.3 % (2/682) and 99.7 %. 2
11. Brandt KR, Craig DA, Hoskins TL, et al. Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol 2013;200:291-8. Observational-Dx 146 women To evaluate digital breast tomosynthesis (DBT) as an alternative to conventional diagnostic mammography in the workup of noncalcified findings recalled from screening mammography in a simulated clinical setting that incorporated comparison mammograms and breast ultrasound results. Agreement between DBT and diagnostic mammography BI-RADS categories was excellent for readers 1 and 2 (kappa = 0.91 and kappa = 0.84) and good for reader 3 (kappa = 0.68). For readers 1, 2, and 3, sensitivity and specificity of DBT for breast abnormalities were 100%, 100%, and 88% and 94%, 93%, and 89%, respectively. The clinical workup averaged three diagnostic views per abnormality and ultrasound was requested in 49% of the cases. DBT was adequate mammographic evaluation for 93-99% of the findings and ultrasound was requested in 33-55% of the cases. 2
12. Noroozian M, Hadjiiski L, Rahnama-Moghadam S, et al. Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology. 2012;262(1):61-68. Observational-Dx 67 women To determine if digital breast tomosynthesis (DBT) performs comparably to mammographic spot views (MSVs) in characterizing breast masses as benign or malignant. Mean mass visibility ratings were slightly better with DBT (range, 3.2-4.4) than with MSV (range, 3.8-4.8) for all four readers, with one reader's improvement achieving statistical significance (P = .001). The A(z) ranged 0.89-0.93 for DBT and 0.88-0.93 for MSV (P >/= .23). The A(z)((0.90)) ranged 0.36-0.52 for DBT and 0.25-0.40 for MSV (P >/= .20). The readers characterized seven additional malignant masses as BI-RADS 4 or 5 with DBT than with MSV, at a cost of five false-positive biopsy recommendations, with a mean of 1.8 true-positive (range, 0-3) and 1.3 false-positive (range, -1 to 4) assessments per reader. 2
13. Waldherr C, Cerny P, Altermatt HJ, et al. Value of one-view breast tomosynthesis versus two-view mammography in diagnostic workup of women with clinical signs and symptoms and in women recalled from screening. AJR Am J Roentgenol 2013;200:226-31. Observational-Dx 144 women To compare the diagnostic value of one-view digital breast tomosynthesis versus two-view full-field digital mammography (FFDM) alone, and versus a combined reading of both modalities. Eighty-six of the 144 patients were found to have breast cancer. The BI-RADS categories for one-view digital breast tomosynthesis were significantly better than those for two-view FFDM (p < 0.001) and were equal to those of the combined reading in both women admitted for diagnostic workup and women recalled from screening. The sensitivity and negative predictive values of digital breast tomosynthesis were superior to those of FFDM in fatty and dense breasts overall and in women admitted for diagnostic workup and in women recalled from screening. Only 11% of digital breast tomosynthesis examinations required additional imaging, compared with 23% of FFDMs. 3
14. Zuley ML, Guo B, Catullo VJ, et al. Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images. Radiology 2014;271:664-71. Observational-Dx 123 patients To assess interpretation performance and radiation dose when two-dimensional synthesized mammography (SM) images versus standard full-field digital mammography (FFDM) images are used alone or in combination with digital breast tomosynthesis images. Probability of malignancy-based mean AUCs for SM and FFDM images alone was 0.894 and 0.889, respectively (difference, -0.005; 95% confidence interval [CI]: -0.062, 0.054; P = .85). Mean AUC for SM with tomosynthesis and FFDM with tomosynthesis was 0.916 and 0.939, respectively (difference, 0.023; 95% CI: -0.011, 0.057; P = .19). In terms of the reader-specific AUCs, five readers performed better with SM alone versus FFDM alone, and all eight readers performed better with combined FFDM and tomosynthesis (absolute differences from 0.003 to 0.052). Similar results were obtained by using a nonparametric analysis of forced BI-RADS ratings 3
15. Hawley JR, Kang-Chapman JK, Bonnet SE, Kerger AL, Taylor CR, Erdal BS. Diagnostic Accuracy of Digital Breast Tomosynthesis in the Evaluation of Palpable Breast Abnormalities. Acad Radiol. 25(3):297-304, 2018 Mar. Observational-Dx 188 patients To evaluate combined 2D mammography, DBT, and ultrasound (US) at palpable sites. A total of 229 sites in 188 patients were included, with 50 biopsies performed identifying 18 cancers. All 18 cancers were identified on 2D and US, whereas 17 cancers were identified on DBT. Cancer detection sensitivities for 2D, DBT, and US were 100.0%, 94.4%, and 100.0%. The negative predictive value, when combined with US, was 100% for both. The sensitivity and the specificity for both benign and malignant findings with 2D and DBT were 70.5% versus 75.4% (P = 0.07) and 95.3% versus 99.1% (P = 0.125). Palpable findings not identified by 2D and DBT were smaller than those identified (11.5 +/- 8.3 mm vs 23.9 +/- 12.8 mm, P < 0.001). Patients with dense breasts were more likely to have mammographically occult findings than patients with nondense breasts (27.4% vs 8.3%). 3
16. Bansal GJ, Young P. Digital breast tomosynthesis within a symptomatic "one-stop breast clinic" for characterization of subtle findings. British Journal of Radiology. 88(1053):20140855, 2015 Sep. Observational-Dx 103 symptomatic patients To evaluate the diagnostic accuracy of combination of full-field digital mammography [two dimension (2D)] and digital breast tomosynthesis [DBT, three dimension (3D)] by comparing the combination with 2D imaging in a symptomatic setting. M3 lesions were reduced from 91 (85.8%) to 18 (16.9%) with the combination imaging. The mean AUC +/- 95% confidence interval for 2D images alone was 0.721 (0.662-0.905) and for combined 2D and 3D images was 0.901 (0.765-1.00). The difference in AUCs between the two modalities was 0.180. 2
17. Skaane P, Gullien R, Bjorndal H, et al. Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol. 53(5):524-9, 2012 Jun 01. Observational-Dx 129 women To compare digital mammography and DBT in a side-by-side feature analysis for cancer conspicuity, and to assess whether there is a potential additional value of DBT to standard state-of-the-art conventional imaging work-up with respect to detection of additional malignancies. State-of-the-art conventional imaging resulted in needle biopsy of 45 breasts, of which 20 lesions were benign and a total of 25 cancers were diagnosed. The remaining 84 women were dismissed with a normal/definitely benign finding and without indication for needle biopsy. The subsequent DBT interpretation found suspicious findings in four of these 84 women, and these four women had to be called back for repeated work-up with knowledge of the tomosynthesis findings. These delayed work-ups resulted in two cancers (increasing the cancer detection by 8%) and two false-positive findings. The side-by-side feature analysis showed higher conspicuity scores for tomosynthesis compared to conventional 2D for cancers presenting as spiculated masses and distortions. 2
18. Ciatto S, Houssami N. Breast imaging and needle biopsy in women with clinically evident breast cancer: does combined imaging change overall diagnostic sensitivity? Breast. 2007;16(4):382-386. Observational-Dx 1000 women with clinically evident (clinically presenting and/or clinically palpable) breast cancer. To quantify the incremental gain in sensitivity for the diagnosis of palpable breast cancer, using single versus combined imaging, where needle biopsy is mandatory clinical practice in the diagnostic pathway. Sensitivity--true positive rate for cancer detection--of different test combinations (with the number of cases missed in 1000 subjects given in parentheses) is: mammography and ultrasound 97.9% (21); mammography with needle biopsy 99.5% (5); ultrasound with needle biopsy 99.5% (5); combined imaging with needle biopsy 99.6% (4). Using only one imaging test (irrespective of whether that is mammography or ultrasound) in combination with needle biopsy provides the same sensitivity, with an incremental gain in sensitivity of 0.1% where combined imaging is included into the diagnostic pathway. This is largely due to needle biopsy identifying most cancers missed on single imaging thus negating the effect of additional imaging on overall sensitivity. 3
19. Murphy IG, Dillon MF, Doherty AO, et al. Analysis of patients with false negative mammography and symptomatic breast carcinoma. J Surg Oncol. 2007; 96(6):457-463. Observational-Dx 124 patients had false-negative preoperative mammograms and 1241 patients had abnormal preoperative mammograms To analyze the characteristics of symptomatic patients with false-negative mammograms. Following retrospective review, 42% of false-negative mammograms were re-categorised as suspicious. The most commonly misinterpreted lesion was architectural distortion/asymmetrical density. Adjuvant US, where performed (n = 27), raised the level of suspicion in 93% of cases. Patients with false-negative mammograms were more likely to be younger (P < 0.0001), present with nipple discharge (P = 0.002) and have smaller tumours (P < 0.0001). Their tumours were more frequently located outside the upper outer quadrant (P = 0.002). False-negative mammography led to a delay in diagnosis of >2 months in 12 patients. Symptomatic patients with false-negative mammograms often demonstrate definite abnormalities on imaging, the most common of which is architectural distortion/asymmetrical density. Those at particular risk were younger patients, those with nipple discharge, and patients with lesions located outside the upper outer quadrant 4
20. Shetty MK, Shah YP, Sharman RS. Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast. J Ultrasound Med. 2003; 22(3):263-268; quiz 269-270. Observational-Dx 411 consecutive cases of palpable abnormalities of the breast To evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of the breast. 165 (40.1%) of 411 palpable abnormalities had a benign assessment; 97 (58.7%) of the 165 benign lesions were visible on both mammography and sonography; 66 (40%) of 165 benign lesions were mammographically occult and identified at sonographic evaluation. In 60 (14.6%) of the 411 cases, imaging evaluation resulted in a suspicious assessment; 49 (81.7%) of the 60 lesions categorized as suspicious underwent biopsy; 14 (28.5%) of 49 lesions were histologically proved to be carcinoma. Nineteen (31.6%) of the 60 lesions categorized as suspicious were mammographically occult and identified only on sonography; 14 (73.7%) of these 19 lesions underwent biopsy; 12 (63.1%) of 19 were benign, and 2 (10.5%) were malignant. One hundred eighty-six (45.2%) of the 411 palpable abnormalities had negative imaging assessment findings; 12 patients with negative imaging findings underwent biopsy, and all had benign findings. The sensitivity (14 of 14) and negative predictive value (186 of 186) for a combined mammographic and sonographic assessment were 100%; the specificity was 80.1% (186 of 232). Cancer was diagnosed in 14 (3.4%) of 411 women who underwent combined imaging for palpable abnormalities of the breast. Combined mammographic and sonographic assessment was shown to be very helpful in identifying benign as well as malignant lesions causing palpable abnormalities of the breast. 3
21. Leung SE, Ben-Nachum I, Kornecki A. New Palpable Breast Lump With Recent Negative Mammogram: Is Repeat Mammography Necessary?. AJR Am J Roentgenol. 207(1):200-4, 2016 Jul. Observational-Dx 612 patients To determine the utility of repeat mammography, compared with targeted ultrasound and previous mammogram, in the assessment of an interval palpable breast lump found within 1 year after a negative mammogram study. A total of 618 palpable lumps in 612 women (mean [+/- SD] age, 55.9 +/- 11.2 years) were included in this study. In 314 of 618 cases (50.8%), a sonographic finding or mammographic change, or both was detected in the region of the palpable lump. Ultrasound detected a finding in 311 cases (50.3%), whereas repeat mammography detected a change in only 80 (12.9%) cases (p < 0.001). Of the 314 cases with imaging findings, 234 findings (74.5%) were detected by ultrasound alone. Repeat mammography identified a more prominent focal asymmetry in the palpable region in three cases with no sonographic correlate; none had malignancy. Eighty lesions were biopsied, and 48 (60.0%) of them were positive for malignancy. The repeat mammogram findings were unchanged for 10 of these lesions. 3
22. Linden OE, Hayward JH, Price ER, Kelil T, Joe BN, Lee AY. Utility of Diagnostic Mammography as the Primary Imaging Modality for Palpable Lumps in Women With Almost Entirely Fatty Breasts. AJR Am J Roentgenol. 214(4):938-944, 2020 04. Observational-Dx 323 patients To assess the performance of diagnostic mammography alone for evaluation of palpable symptoms in women with almost entirely fatty breast composition. Of these, 294 (91%) had undergone targeted ultrasound. At mammography, 240 (74%) had no correlate to the palpable lump; 38 (12%), a benign correlate; and 45 (14%), a suspicious correlate. Three cases had incidental suspicious mammographic findings, for a total of 48 positive mammography cases. Twenty-seven (8%) cases were malignant. Mammography alone detected all but one cancer, which was detected by ultrasound. In retrospect, the woman from whom this single false-negative mammogram was obtained did not have almost entirely fatty breast density. Mammography alone yielded a negative predictive value of 99.6%, percentage of diagnostic examinations recommended for biopsy that resulted in a tissue diagnosis of malignancy within 1 year of 54%, sensitivity of 96%, and specificity of 93%. Adjunct ultrasound contributed to 11 false-positives but also identified benign correlates in eight cases with no mammographic finding. 3
23. Amitai Y, Menes TS, Weinstein I, Filyavich A, Yakobson I, Golan O. What is the yield of breast MRI in the assessment of palpable breast findings?. Clin Radiol. 72(11):930-935, 2017 Nov. Observational-Dx 7,782 patients To examine the contribution of magnetic resonance imaging (MRI) to characterise palpable breast masses after conventional imaging was found to be non-contributory. Investigation of palpable breast finding was the clinical indication for 167 of 7,782 (2%) examinations. Thirty-two (19%) women in the study had positive MRI findings. Most (20, 63%) findings corresponded to the palpable area, resulting in three carcinomas being diagnosed. Only one carcinoma required MRI-guided biopsy for diagnosis. Eighteen women with negative MRI underwent ultrasound-guided biopsy from the palpable area, which resulted in a diagnosis of one carcinoma. One carcinoma was incidentally detected in another location. Within the present population, the sensitivity for detecting malignancy was 80%, specificity 78%, negative predictive value 99%, and positive predictive value 13%. 3
24. Olsen ML, Morton MJ, Stan DL, Pruthi S. Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative? J Womens Health (Larchmt) 2012;21:1149-54. Observational-Dx 77 studies To examine the use and utility of breast MRI in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies. Seventy-seven studies were included, comprising 1.3% of all breast MRI studies performed at our institution during the study period (2005-2011). Twenty-two patients underwent biopsy, and 55 were followed clinically without biopsy. Approximately half (27 of 55) of the patients without biopsy were lost to follow-up after negative MRI, and the rest had no evidence of cancer on imaging or clinical examination at 1 year. Of the 22 patients who underwent biopsy, 2 were diagnosed with cancer, both with positive MRI studies. Sensitivity of MRI when compared to tissue diagnosis was 100%, and specificity was 70%. Positive and negative predictive values were 25% and 100%, respectively. 3
25. Yau EJ, Gutierrez RL, DeMartini WB, Eby PR, Peacock S, Lehman CD. The utility of breast MRI as a problem-solving tool. Breast J. 17(3):273-80, 2011 May-Jun. Observational-Dx 3001 consecutive breast MR examinations Records of breast MR examinations were reviewed to identify all those performed for the clinical indication of problem solving. Details of clinical presentation, mammography and US findings, follow-up recommendations, and pathology outcomes were recorded. 36 biopsies were performed based on MRI findings and 14 cancers were diagnosed. Biopsy was indicated for 11 of 14 (79%) cancers based on suspicious mammographic or US findings identified prior to MRI. One incidental cancer was detected by MRI alone in a patient at high risk for breast cancer, and two cancers were detected in patients with suspicious nipple discharge and negative mammogram and US. A single false-negative MRI occurred in a patient whose evaluation for a palpable lump prompted biopsy. Problem-solving breast MRI rarely identifies otherwise occult cancer and can be falsely negative in patients with suspicious findings on mammogram and US. Until the benefits and risks of problem-solving MRI are clarified, it should be used judiciously. 3
26. Durfee SM, Selland DL, Smith DN, Lester SC, Kaelin CM, Meyer JE. Sonographic Evaluation of Clinically Palpable Breast Cancers Invisible on Mammography. Breast J. 2000;6(4):247-251. Observational-Dx 298 women To determine the utility of sonography in the evaluation of palpable breast cancers invisible on mammography. During the study period 298 women presented with a palpable breast cancer for imaging at our institution. Of these, 38 cancers (12.8%) were not seen on mammography. In 32 patients where no mammographic abnormality was found, ultrasound was able to detect a mass corresponding to the area of clinical concern. Histologic tumor types included 30 invasive ductal carcinomas, 5 ductal carcinomas in situ, and 3 invasive lobular carcinomas. Mammographic density was mild with scattered fibroglandular densities in 2 (5%), heterogeneously dense in 12 (32%), and extremely dense in 24 (63%). Thirty-one masses (97%) were hypoechoic and 1 (3%) was echogenic. Lesion margins were irregular in 23 (72%), lobulated in 5 (16%), and well-circumscribed in 4 (12%). In this group of patients the combination of mammography and ultrasound of the mass demonstrated 99% of the palpable cancers 3
27. Garg S, Mohan H, Bal A, Attri AK, Kochhar S. A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions. Diagn Cytopathol. 35(11):681-9, 2007 Nov. Observational-Dx 50 patients To compare value of needle core biopsy and fine-needle aspiration cytology (FNAC) in the evaluation of palpable and mammographically detected suspicious breast lesions. Sensitivity and specificity of mammography for malignant diagnosis was 84.37% and 83.33%, respectively. Sensitivity and specificity of FNAC for malignant diagnosis was 78.15% and 94.44%, respectively, and of needle core biopsy was 96.5% and 100%, respectively. Needle core biopsy is superior to FNAC in the diagnosis of breast lesions in terms of sensitivity, specificity, correct histological categorization of the lesions and tumor grading. 3
28. Schrading S, Distelmaier M, Dirrichs T, et al. Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology. 2015;274(3):654-662. Observational-Dx 205 patients To use digital breast tomosynthesis (DBT)–guided vacuum-assisted biopsy (VAB) to sample target lesions identified at full-field digital screening mammography and compare clinical performance with that of prone stereotactic (PS) VAB. Technical success was achieved in 51 of 51 lesions (100%) with DBT VAB versus 154 of 165 lesions (93%) with PS VAB. In one of 11 lesions in which PS VAB failed, DBT VAB was performed successfully. Mean time to complete VAB was 13 minutes +/- 3.7 for DBT VAB versus 29 minutes +/- 10.1 for PS VAB (P < .0001). Reidentifying and targeting lesions during PS VAB took longer than it did during DBT VAB (P < .0001). Tissue sampling took about the same time for PS VAB and DBT VAB (P = .067). Significantly more "low-contrast" (ie, uncalcified) target lesions were biopsied with DBT VAB (13 of 51 lesions) versus PS VAB (nine of 165 lesions) (P < .0002). No major complications were observed with either system. One patient who underwent DBT VAB in the sitting position and one patient who underwent PS VAB developed self-limiting vasovagal reactions. 3
29. Viala J, Gignier P, Perret B, et al. Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J. 2013;19(1):4-9. Review/Other-Dx 118 stereotactic vacuum assisted biopsies To describe our operating process and to report results of 118 stereotactic vacuum-assisted biopsies performed on a digital breast 3D-tomosynthesis system. A total of 106 patients had a lesion, six had two lesions. Sixty-one lesions were clusters of micro-calcifications, 54 were masses and three were architectural distortions. Patients were in lateral decubitus position to allow shortest skin-target approach (or sitting). Specific compression paddle, adapted on the system, performed, and graduated, allowing localization in X-Y. Tomosynthesis views define the depth of lesion. Graduated Coaxial localization kit determines the beginning of the biopsy window. Biopsies were performed with an ATEC-Suros, 9 Gauge handpiece. All biopsies, except one, have reached the lesions. Five hemorrhages were incurred in the process, but no interruption was needed. Eight breast hematomas, were all spontaneously resolved. One was an infection. About 40% of patients had a skin ecchymosis. Processing is fast, easy, and requires lower irradiation dose than with classical stereotactic biopsies. Histology analysis reported 45 benign clusters of micro-calcifications, 16 malignant clusters of micro-calcifications, 24 benign masses, and 33 malignant masses. Of 13 malignant lesions, digital 2D-mammography failed to detect eight lesions and underestimated the classification of five lesions. 4
30. American College of Radiology. ACR Practice Parameter for the Performance of Ultrasound-Guided Percutaneous Breast Interventional Procedures . Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-GuidedBreast.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
31. Ly A, Ono JC, Hughes KS, Pitman MB, Balassanian R. Fine-Needle Aspiration Biopsy of Palpable Breast Masses: Patterns of Clinical Use and Patient Experience. J. Natl. Compr. Cancer Netw.. 14(5):527-36, 2016 05. Review/Other-Dx N/A To compare patient wait times and utilization patterns for palpable breast mass diagnosis and treatment with regard to biopsy method. Patients diagnosed by FNA biopsy received their biopsy diagnosis more than 8 days sooner than those diagnosed by core biopsy. Most FNA biopsies occurred the same day the patient clinically presented. Time to treatment did not differ significantly between groups. Both biopsy methods demonstrated comparable diagnostic accuracy. Breast masses diagnosed by FNA biopsy had Breast Imaging Reporting and Data System (BI-RADS) scores ranging from 1 through 5, whereas nearly all core biopsy cases had a BI-RADS score of 4 or greater. All patient groups were demographically comparable and presented with similar breast mass sizes. 4
32. American College of Radiology. ACR Practice Parameter for Performing and Interpreting Magnetic Resonance Imaging (MRI). Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/MRI.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
33. Harvey JA. Sonography of palpable breast masses. Semin Ultrasound CT MR. 2006; 27(4):284-297. Review/Other-Dx N/A Review usefulness of US in the evaluation of palpable breast masses. US is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The NPV of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative. 4
34. Kaiser JS, Helvie MA, Blacklaw RL, Roubidoux MA. Palpable breast thickening: role of mammography and US in cancer detection. Radiology. 2002; 223(3):839-844. Observational-Dx 103 consecutive women (123 breasts) To determine the frequency of breast carcinoma and ascertain the diagnostic yield of mammography and breast US in the detection of breast carcinoma in women with palpable breast thickening. Six (5%) of 123 cases had a diagnosis of breast carcinoma; five (83%) of the six had invasive carcinoma. Mammography was performed in all cases, US in 77 (63%) cases. Mammographic sensitivity for invasive cancer detection was 60% (three of five cases), specificity was 94% (102 of 108 cases), and NPV was 97% (102 of 105 cases). Sensitivity of US alone was 100% (two of two cases), specificity was 96% (65 of 68 cases), and NPV was 100% (65 of 65 cases). The combined NPV of mammography and US was 100%. Patients with prior biopsies at the site of palpable thickening accounted for most false-negative mammograms. Median time to initiate follow-up of patients in whom biopsy was not performed was 14 months. Breast cancer was discovered in 5% of women with palpable breast thickening. Women with negative mammograms and US scans are at low risk for cancer but should be followed up at short-term intervals with clinical examination and imaging if biopsy is not elected by their surgeon or clinician. 3
35. American College of Radiology. ACR Practice Parameter for the Performance of a Breast Ultrasound Examination. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-Breast.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
36. Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 2013;269(3):701-712. Review/Other-Dx 2662 participants To prospectively validate predefined breast ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) category 3 criteria in a multicenter setting in an elevated-risk population. Of 2662 participants, 519 (19.5%) had 745 BI-RADS category 3 lesions (25.5% of 2916 US lesions other than simple cysts), with a median size of 7 mm (range, 2-135 mm). The number of new BI-RADS category 3 lesions decreased with year 2-3 screening, but the percentage of new BI-RADS category 3 lesions was stable at 26.4% (506 of 1920 lesions), 23.6% (142 of 601 lesions), and 24.6% (97 of 395 lesions), respectively. Of 745 BI-RADS category 3 lesions, 124 (16.6%) were ultimately sampled for biopsy. Six malignancies (0.8% of BI-RADS category 3 lesions; 95% confidence interval [CI]: 0.3%, 1.7%) occurred in five (1.0%) of 519 participants: Five malignancies were invasive (median size, 10 mm; size range, 2-18 mm), and one was node positive. When the analysis is limited to lesions with at least 2-year follow-up or biopsy, the malignancy rate among BI-RADS category 3 lesions is 0.9% (95% CI: 0.3%, 2.0%). Three malignant BI-RADS category 3 lesions were sampled for biopsy because of a suspicious change at follow-up (two N0 lesions, one each at 6- and 12-month follow-up; one N1 lesion at 24-month follow-up), one was sampled for biopsy because of an upgrade after additional mammography (NX), one was found at mastectomy for another cancer (N0), and one was found at prophylactic contralateral mastectomy in the same patient (NX). 4
37. American College of Radiology. ACR Practice Parameter for the Performance of Stereotactic/Tomosynthesis-Guided Breast Interventional Procedures. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Stereo-Breast.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
38. Gumus H, Gumus M, Mills P, et al. Clinically palpable breast abnormalities with normal imaging: is clinically guided biopsy still required? Clin Radiol. 2012;67(5):437-440. Observational-Dx 251 patients To determine the need for a fine-needle or core biopsy in patients with clinically palpable breast abnormalities who have negative mammographic and sonographic findings. Three (1.2%) of the 251 CGBs were reported as malignant; two (0.8%) of which were invasive. Forty-six (18.3%) of the 251 cases were regarded as clinically suspicious or malignant while the remaining 215 examinations were categorized as benign or probably benign. All three malignancies were in the clinically suspicious or malignant group. 3
39. Harvey JA, Nicholson BT, Lorusso AP, Cohen MA, Bovbjerg VE. Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR. 2009; 193(6):1723-1730. Observational-Dx 320 women with 375 masses To evaluate the feasibility of short-term follow-up of palpable masses that have benign imaging features. Lesions were evaluated with mammography and US (n = 186) or US alone (n = 189). Masses were typically identified only with US (n = 258, 68.8%); were oval (n = 275, 73.3%), of equal density to normal breast tissue on mammograms (n = 95 on 117 mammograms, 81.2%), and hypoechoic (n = 336 in 372 US examinations, 90.3%); and were prospectively believed to be fibroadenoma (n = 304, 81.1%). Eightyfive lesions (22.7%) were biopsied soon after evaluation, and one 1.5-mm ductal carcinoma in situ was diagnosed. At follow-up (mean, 2.7 years), 26 lesions (6.9%) had grown. 24 of the 26 lesions were biopsied, and no cancer was diagnosed. The overall cancer prevalence was similar for palpable (0.3%) and nonpalpable (1.6%) masses. The cost of short-term follow-up was less than that of biopsy. Short-term follow-up is a reasonable alternative to biopsy of palpable breast lesions with benign imaging features, particularly for young women with probable fibroadenoma. 3
40. Lehman CD, Lee CI, Loving VA, Portillo MS, Peacock S, DeMartini WB. Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012 Nov. Observational-Dx 1208 cases in 954 patients To determine the accuracy and value of breast ultrasound for primary imaging evaluation of women 30-39 years of age who present with focal breast signs or symptoms. Outcomes were benign in 1185 of 1208 (98.1%) and malignant in 23 of 1208 (1.9%) cases. Sensitivities for ultrasound and mammography were 95.7% and 60.9%, respectively. Specificities for ultrasound and mammography were 89.2% and 94.4%, respectively. NPV was 99.9% for ultrasound and 99.2% for mammography. PPV was 13.2% for ultrasound and 18.4% for mammography. Mammography detected one additional malignancy in an asymptomatic area in a 32-year-old woman who was subsequently found to have a BRCA2 gene mutation. 3
41. Ciatto S, Bravetti P, Bonardi R, Rosselli del Turco M. The role of mammography in women under 30. Radiol Med. 1990; 80(5):676-678. Observational-Dx 305 patients To determine the appropriate use of mammography in younger women with a solid palpable mass. Mammography missed 5/18 cancers (28%) and is not recommended in women under 30 except for preoperative cases with a strong suspicion of cancer. 3
42. Feig SA. Breast masses. Mammographic and sonographic evaluation. Radiol Clin North Am 1992; 30(1):67-92. Review/Other-Dx N/A To review the role of mammography and US in the evaluation of breast masses. Characteristics that may allow a benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. For palpable breast masses, selection of mammography or US as the primary imaging modality will depend on patient’s age and risk factors. 4
43. Harris VJ, Jackson VP. Indications for breast imaging in women under age 35 years. Radiology. 1989; 172(2):445-448. Observational-Dx 625 patients Correlated patient histories with mammographic and/or sonographic findings and biopsy or follow-up results for patients to determine appropriate indications for breast imaging in younger women. Important indications: palpable mass and suspected abscess. Imaging helpful in 4/15 suspected abscesses. In patients with palpable masses, 6 cancers were found. No other significant indications. Women with low yield indications should be followed clinically and not referred for imaging.Of the 335 studies performed for evaluation of a palpable mass, 184 (55%) were normal, 28 (8%) were compatible with benign disease, and 123 (37%) were suggestive of malignancy. Biopsies were performed in 73 patients; the findings were benign in 67 cases, and carcinoma was found in six. Imaging studies were considered helpful in four of the 15 cases of suspected abscess, in that the studies established the presence and extent of an abscess. Studies in 275 women were performed for a variety of other indications. The findings were normal in 239 (87%) studies, benign in 21 (8%), and suggestive of malignancy in 15 (5%); there were no known carcinomas in any of the patients. Women with the "low-yield" indications identified in this study should be followed up clinically rather than referred for imaging studies 3
44. Williams SM, Kaplan PA, Petersen JC, Lieberman RP. Mammography in women under age 30: is there clinical benefit? Radiology 1986; 161(1):49-51. Observational-Dx 76 patients; 2 observers Retrospective study to determine the utility of mammography in women less than 30 years of age referred for mammography. 55% had a palpable mass. In this group, no mass seen by mammography in 74%. But 14% had a definite lesion found by other means. No cancers were found. US may be best initial approach with mammography reserved for preoperative cases. 4
45. Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The relationship of mammographic density and age: implications for breast cancer screening. AJR Am J Roentgenol. 2012;198(3):W292-295. Review/Other-Dx 7007 screening mammograms To examine the relationship between age and breast density, particularly focusing on postmenopausal women. A total of 7007 screening mammograms were performed. The median age of our cohort was 57 years. Within each subgroup categorized by decade of age, there was a normal distribution among the categories of breast density. There was a significant inverse relationship between age and breast density (p < 0.001). Seventy-four percent of patients between 40 and 49 years old had dense breasts. This percentage decreased to 57% of women in their 50s. However, 44% of women in their 60s and 36% of women in their 70s had dense breasts as characterized on their screening mammograms. 4
46. Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003;138(3):168-175. Observational-Dx 329,495 women To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography. Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages. 3
47. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30. Review/Other-Dx N/A Estimates on the numbers of new cancer cases and deaths that will occur in the United States in the current year. Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Overall cancer incidence trends (13 oldest SEER registries) are stable in women, but declining by 3.1% per year in men (from 2009-2012), much of which is because of recent rapid declines in prostate cancer diagnoses. The cancer death rate has dropped by 23% since 1991, translating to more than 1.7 million deaths averted through 2012. Despite this progress, death rates are increasing for cancers of the liver, pancreas, and uterine corpus, and cancer is now the leading cause of death in 21 states, primarily due to exceptionally large reductions in death from heart disease. Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death because of the dramatic therapeutic advances against leukemia. Accelerating progress against cancer requires both increased national investment in cancer research and the application of existing cancer control knowledge across all segments of the population. 4
48. Lee WK, Chung J, Cha ES, Lee JE, Kim JH. Digital breast tomosynthesis and breast ultrasound: Additional roles in dense breasts with category 0 at conventional digital mammography. Eur J Radiol. 85(1):291-296, 2016 Jan. Observational-Dx 108 patients To compare the diagnostic performances of digital breast tomosynthesis (DBT) and ultrasound for the dense breasts with category 0 at conventional digital mammography. Among 108 lesions, 17 (15.7%) were malignant and 91 (84.3%) were benign. Sensitivity was 100% for both ultrasound (17/17) and DBT (17/17) and negative predictive value was also 100% for both ultrasound (49/49) and DBT (74/74). Specificity and positive predictive value for ultrasound were 53.9% (49/91) and 28.8% (17/59), respectively. Specificity and positive predictive value for DBT were 81.3% (74/91) and 50% (17/34), respectively. DBT showed higher diagnostic accuracy than that of breast ultrasound (DBT: 84.3%, 91/108; ultrasound: 61.1%, 66/108; p<0.001). The benign biopsy rate of DBT (50%, 17/34) was lower than that of ultrasound (71.2%, 42/59). 2
49. Skaane P, Bandos AI, Eben EB, et al. Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology. 271(3):655-63, 2014 Jun. Experimental-Tx 24,901 examinations To compare the performance of two versions of reconstructed two-dimensional (2D) images in combination with digital breast tomosynthesis (DBT) versus the performance of standard full-field digital mammography (FFDM) plus DBT. Cancer detection rates were 8.0, 7.4, 7.8, and 7.7 per 1000 screening examinations for FFDM plus DBT in period 1, initial reconstructed 2D images plus DBT in period 1, FFDM plus DBT in period 2, and current reconstructed 2D images plus DBT in period 2, respectively. False-positive scores were 5.3%, 4.6%, 4.6%, and 4.5%, respectively. Corresponding reader-adjusted paired comparisons of false-positive scores revealed significant differences for period 1 (P = .012) but not for period 2 (ratio = 0.99; 95% confidence interval: 0.88, 1.11; P = .85) 1
50. Liew PL, Liu TJ, Hsieh MC, et al. Rapid staining and immediate interpretation of fine-needle aspiration cytology for palpable breast lesions: diagnostic accuracy, mammographic, ultrasonographic and histopathologic correlations. Acta Cytol. 2011; 55(1):30-37. Observational-Dx 408 FNAC specimens from 400 patients To investigate the role and turn around time of rapid staining and immediate interpretation of fine-needle aspiration cytology (FNAC) for women with palpable breast lesions. Of the 408 specimens, 243 (59.6%) were interpreted as benign, 37 (9.0%) atypical, 22 (5.4%) suspicious, 68 (16.7%) malignant, and 38 (9.3%) unsatisfactory. 132 of 408 (32.4%) had subsequent surgical procedures; the sensitivity, specificity, PPV, NPV, and accuracy were 88.5, 100, 100, 81.9 and 92.4%, respectively. The average turn around time was 8.6 min. Mammographic results were available in 242 (59.3%) cases, with 112 (46.3%) undergoing surgical excision. In correlation with mammography and surgical pathology, the false-positive rate, false-negative rate, sensitivity, specificity and accuracy were 1.9, 10.5, 98.1, 89.5 and 95.8%, respectively. Rapid FNAC interpretation is a useful, effective diagnostic method for palpable breast lesions in the healthcare environment. 3
51. Rosa M, Mohammadi A, Masood S. The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions. Diagn Cytopathol. 2012; 40(1):26-34. Observational-Dx 1,583 cases; malignant diagnosis in 357 cases. To assess the diagnostic accuracy of FNAB in palpable breast lesions, the authors reviewed their experience during an 8-year-period and compared fine needle aspiration results with follow-up surgical specimens. 139 cases were classified as atypical/ suspicious, 135 cases had insufficient cells for establishing a diagnosis, and 952 were categorized as negative. A total of 408 follow-up surgical specimens were available for comparison with cytologic results. There were 19 false-negative, and no false-positive results were found. The majority of false-negative results were secondary to sampling errors. In 93% of the malignant cases, there was enough material obtained in cytological specimens to perform prognostic/predictive factors studies.The data proves that FNAB is a reliable method for the initial evaluation and diagnosis of palpable masses of the breast. In addition, it also has the ability of providing necessary prognostic/predictive information, particularly for patients that may undergo neoadjuvant therapy. 3
52. Yue D, Swinson C, Ravichandran D. Triple assessment is not necessary in most young women referred with breast symptoms. Ann R Coll Surg Engl. 2015;97(6):466-468. Observational-Dx 955 females aged under 25 years To see whether CB/FNA could be avoided in young women with benign findings on CE and imaging. The most common presenting complaint was a lump, followed by pain and nipple discharge. CE was normal or revealed benign findings in all except 15 patients, in whom it was indeterminate. Ultrasonography was performed in 692 patients (72%) and was normal (n=289) or benign (n=382) in all except 21 patients, in whom it was indeterminate. In six patients, both were indeterminate. A total of 317 patients (35%) had triple assessment: FNA in 106, CB in 239 and both in 9 cases. No cancers were diagnosed. 3
53. Osako T, Iwase T, Takahashi K, et al. Diagnostic mammography and ultrasonography for palpable and nonpalpable breast cancer in women aged 30 to 39 years. Breast Cancer. 2007; 14(3):255-259. Observational-Dx 165 patients To investigate the relationship between the tumor size of breast cancer by palpation and the sensitivity of mammography (MMG) and US, and which modality can detect nonpalpable breast cancer in women aged 30 to 39 years. Of 165 patients, 147 patients (89%) showed mammographically dense breasts. Of 165 cancers, 14 (8%) were Tnp, 40 (24%) were T1p, 82 (50%) were T2p, and 29 (18%) were T3p. The sensitivity of MMG was 57% (8 of 14) for Tnp, 78% (31 of 40) for T1p, 90% (74 of 82) for T2p, and 97% (28 of 29) for T3p. The sensitivity of US was 43% (6 of 14) for Tnp and 100% for palpable cancers. Of 14 nonpalpable cancers, 4 (29%), 4 (29%), and 2 (14%) could be detected by only MMG, bloody nipple discharge, and US, respectively. The sensitivity of MMG depends on the tumor size and on palpation in this age range. MMG fails to detect relatively large palpable cancers. On the other hand, US can detect all palpable cancers. However, the sensitivity of US declines for nonpalpable cancers. For the detection of nonpalpable cancers, MMG, US, and nipple discharge are complementary modalities. 4
54. Brown AL, Phillips J, Slanetz PJ, et al. Clinical Value of Mammography in the Evaluation of Palpable Breast Lumps in Women 30 Years Old and Older. AJR Am J Roentgenol. 209(4):935-942, 2017 Oct. Observational-Dx 861 patients To determine whether mammography adds clinical value in the diagnostic imaging workup of women 30 years old and older who present with palpable breast lumps. The study cohort included 861 patients presenting with 935 palpable lumps. Imaging correlates were reported for 568 of 935 (60.7%) lumps, and imaging findings were negative in 367 of 935 (39.3%). Of the 935 palpable lumps, 858 (91.8%) were benign and 77 (8.2%) were malignant. Mammography added clinical value in the evaluation of 27 of 77 (35.0%) malignant lumps by better delineating extent of disease and in the evaluation of 26 of 858 benign lumps (3.0%) by confirming benignity. Fifty-two of 861 (6.0%) patients had incidental findings that led to a recommendation for biopsy. Twenty-nine of the 52 findings were originally seen with mammography and 23 with ultrasound. Mammography also depicted seven incidental malignancies in nonpalpable areas, and ultrasound depicted one incidental malignancy. 3
55. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
No of Rows: 55