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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging. 2013;4(5):527-538. Review/Other-Dx N/A To review the imaging challenges of the breast during pregnancy and lactation. No results stated in abstract. 4
2. Kieturakis AJ, Wahab RA, Vijapura C, Mahoney MC. Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. [Review]. AJR. American Journal of Roentgenology. 216(6):1462-1475, 2021 06.AJR Am J Roentgenol. 216(6):1462-1475, 2021 06. Review/Other-Dx N/A To review the physiologic changes of the breast during pregnancy and lactation; the safety and utility of various imaging modalities; upto-date consensus on screening guidelines; recommendations for diagnostic evaluation of breast pain, palpable abnormalities, and nipple discharge; and recommendations regarding advanced modalities such as breast MRI. No results stated in abstract. 4
3. Peterson MS, Gegios AR, Elezaby MA, et al. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics. 43(10):e230014, 2023 10.Radiographics. 43(10):e230014, 2023 10. Review/Other-Dx N/A To review the normal physiologic changes of the breasts during pregnancy and lactation, discuss recommended screening and diagnostic guidelines, and describe imaging features of common benign and malignant entities. No results stated in abstract. 4
4. Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Cherel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014;95(4):435-441. Observational-Dx 113 patients of breast cancer To describe the main clinical, radiological and histological features, as well as the outcome of pregnancy-associated breast cancer (PABC), with a special emphasis on imaging and diagnostic difficulties. Mean age at diagnosis was 33.7 years. Most cancers (81.2%) were diagnosed after delivery. Intermediate or high family risk was frequent (27.5%). The most common mode of presentation was a palpable mass (89.7%). Mean time to diagnosis was 5.8 months. Sensitivity for mammography was 80.9% and for ultrasound 77%. Most prognostic factors were unfavourable: frequent lymph node involvement (51.8%), high-grade tumours, hormone receptor negativity (45.9%) and HER2 positivity (38.7%). Treatments generally included surgery (61.7% mastectomies), radiotherapy (96%) and chemotherapy (79.6%). Overall 5-year survival was 81.8%. 3
5. Kalogerakos K, Sofoudis C, Tzonis P, Koutsouradis P, Katsoulis G. Breast cancer and pregnancy; overview of international bibliography. [Review]. Journal of B.U.On.. 18(2):308-13, 2013 Apr-Jun. Review/Other-Dx N/A No abstract available. No abstract available. 4
6. Wang B, Yang Y, Jiang Z, et al. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer. Thoracic Cancer. 10(5):1060-1068, 2019 05. Observational-Dx 142 patients with PABC To evaluate the characteristics, diagnosis, prognosis, and effective treatment modalities of pregnancy-associated breast cancer (PABC). The median age at diagnosis was 30 years. All patients presented with a palpable mass in the breast. The sensitivity of ultrasound and mammography in PABC diagnosis was 86% and 83.3%, respectively, which increased to 91.3% when a combination of mammography and ultrasound was used. The median tumor size was 5.5 cm, and 63.1% of patients had associated axillary lymph node metastases. The proportions of ER negative, PR negative and HER2 positive were 45.7%, 45.7% and 30%, respectively. The five-year overall survival (OS) and disease-free survival (DFS) rates were 76.8% and 63.5%, respectively. According to univariate analysis, T stage, N stage, and HER2 status were significant prognostic factors for OS and DFS. The time interval between the onset of the first symptom and the first meeting with a health professional was also significant for OS. Multivariate analysis showed that T stage and HER2 status were independent prognostic risk factors for OS and DFS. 4
7. Vashi R, Hooley R, Butler R, Geisel J, Philpotts L. Breast imaging of the pregnant and lactating patient: imaging modalities and pregnancy-associated breast cancer. [Review]. AJR. American Journal of Roentgenology. 200(2):321-8, 2013 Feb. Review/Other-Dx N/A To review key clinical, histologic, and imaging features of expected physiologic changes within the breast and common benign breast disease in the pregnant and lactating patient. No results stated in abstract. 4
8. diFlorio-Alexander RM, Slanetz PJ, Moy L, et al. ACR Appropriateness Criteria R Breast Imaging of Pregnant and Lactating Women. Journal of the American College of Radiology. 15(11S):S263-S275, 2018 Nov.J. Am. Coll. Radiol.. 15(11S):S263-S275, 2018 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for breast imaging of pregnant and lactating women. No results stated in abstract. 4
9. Yang WT. Staging of breast cancer with ultrasound. [Review]. Seminars in Ultrasound, CT & MR. 32(4):331-41, 2011 Aug. Review/Other-Dx N/A To evaluate the staging of breast cancer using ultrasound. No results stated in abstract. 4
10. Langer A, Mohallem M, Berment H, et al. Breast lumps in pregnant women. Diagnostic and Interventional Imaging. 96(10):1077-87, 2015 Oct. Review/Other-Dx N/A To summarize the types of breast lumps identified in imaging findings. No results stated in abstract. 4
11. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media.  Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
12. Niell BL, Jochelson MS, Amir T, et al. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update. J Am Coll Radiol 2024;21:S126-S43. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for female breast cancer screening. No results stated in abstract. 4
13. Brown A, Lourenco AP, Niell BL, et al. ACR Appropriateness Criteria® Transgender Breast Cancer Screening. J Am Coll Radiol 2021;18:S502-S15. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for transgender breast cancer screening. No results stated in abstract. 4
14. Weinstein SP, Slanetz PJ, Lewin AA, et al. ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. J Am Coll Radiol 2021;18:S456-S73. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for supplemental breast cancer screening based on breast density No results stated in abstract. 4
15. Heller SL, Lourenco AP, Niell BL, et al. ACR Appropriateness Criteria® Imaging After Mastectomy and Breast Reconstruction. J Am Coll Radiol 2020;17:S403-S14. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging after mastectomy and breast reconstruction No results stated in abstract. 4
16. Mehta TS, Lourenco AP, Niell BL, et al. ACR Appropriateness Criteria® Imaging After Breast Surgery. J Am Coll Radiol 2022;19:S341-S56. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging after breast surgery. No results stated in abstract. 4
17. Rahman WT, Helvie MA. Breast cancer screening in average and high-risk women. [Review]. Best Practice & Research in Clinical Obstetrics & Gynaecology. 83:3-14, 2022 Sep. Review/Other-Dx N/A To review breast screening recommendations in women of average and high-risk. No results stated in abstract. 4
18. American College of Radiology. ACR Practice Parameter for the Performance of Molecular Breast Imaging (MBI) Using a Dedicated Gamma Camera.  Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=144+&releaseId=2 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
19. Hruska CB. Updates in Molecular Breast Imaging. Semin Roentgenol 2022;57:134-38. Review/Other-Dx N/A To discuss the latest updates in MBI technology, recent evidence supporting its clinical use, and work in progress that may aid in wider adoption of MBI. No results stated in abstract. 4
20. Brem RF, Tabar L, Duffy SW, et al. Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology. 274(3):663-73, 2015 Mar. Observational-Dx 112 women To determine improvement in breast cancer detection by using supplemental three-dimensional (3D) automated breast (AB) ultrasonography (US) with screening mammography versus screening mammography alone in asymptomatic women with dense breasts. Breast cancer was diagnosed at screening in 112 women: 82 with screening mammography and an additional 30 with AB US. Addition of AB US to screening mammography yielded an additional 1.9 detected cancers per 1000 women screened (95% confidence interval [CI]: 1.2, 2.7; P < .001). Of cancers detected with screening mammography, 62.2% (51 of 82) were invasive versus 93.3% (28 of 30) of additional cancers detected with AB US (P = .001). Of the 82 cancers detected with either screening mammography alone or the combined read, 17 were detected with screening mammography alone. Of these, 64.7% (11 of 17) were ductal carcinoma in situ versus 6.7% (two of 30) of cancers detected with AB US alone. Sensitivity for the combined read increased by 26.7% (95% CI: 18.3%, 35.1%); the increase in the recall rate per 1000 women screened was 284.9 (95% CI: 278.0, 292.2; P < .001). 3
21. Giuliano V, Giuliano C. Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts. Clin Imaging 2013;37:480-6. Observational-Dx 3418 women To demonstrate that ABUS increases the detection of non-palpable breast cancers in mammographically dense breasts when used as an adjunct diagnostic modality in asymptomatic women Automated breast ultrasound (ABUS)was performed in 3418 asymptomatic women with mammographically dense breasts. The addition of ABUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone. The mean tumor size was 14.3 mm and overall attributable risk of breast cancer was 19.92 (95% confidence level, 16.75 - 23.61) in our screened population. These preliminary results may justify the cost-benefit of implementing the judicious us of ABUS in conjunction with mammography in the dense breast screening population. 2
22. Klein KA, Kocher M, Lourenco AP, et al. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. J Am Coll Radiol 2023;20:S146-S63. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for palpable breast masses. No results stated in abstract. 4
23. Taylor-Cho MW, Peacock S, Wolf S, Thomas S, Grimm LJ, Johnson KS. Role of digital breast tomosynthesis in the evaluation of focal breast pain. Clinical Imaging. 82:73-76, 2022 Feb. Review/Other-Dx 91 cases of focal breast pain evaluated with DBT and ultrasound (US) To investigate the utility of digital breast tomosynthesis (DBT) in the evaluation of focal breast pain, considering breast density and breast cancer risk. Eighteen percent (16/91) of cases demonstrated findings, all benign. Of these, 6% (1/16) were detected by DBT only, 88% (14/16) by US only, and 6% (1/16) by DBT and US. US resulted in 3 benign biopsies. Ninety-nine percent (75/76) of cases with no findings at the site of pain on US also had no findings on DBT. Ninety-eight percent (89/91) of cases with no cancer detected at the site of pain on US also did not have cancer on DBT. DBT detected 2 incidental cancers not associated with pain. DBT and US agreed that there was no finding at the site of pain in 82% (75/91) of cases. A high degree of agreement between DBT and US was seen when stratified by breast density and TCS. 4
24. Robbins J, Jeffries D, Roubidoux M, Helvie M. Accuracy of diagnostic mammography and breast ultrasound during pregnancy and lactation.[Erratum appears in AJR Am J Roentgenol. 2011 May;196(5):1237]. AJR Am J Roentgenol. 196(3):716-22, 2011 Mar. Observational-Dx 155 pregnant, lactating, and postpartum women To determine the accuracy of mammography and sonography in evaluating pregnant, lactating, and postpartum women. Of 134 lesions, 87 (65%) were in patients who presented during lactation, 34 (25%) who presented during pregnancy, and 13 (10%) who presented postpartum. The presenting symptom for 86 lesions (64%) was a palpable mass. Biopsies were performed for 40 lesions. Of these lesions, four were malignant and 36 were benign. Mammograms were dense or heterogeneously dense in 88% of patients. All four malignancies were BI-RADS category 4 or 5 according to both mammography and ultrasound. For the 85 lesions evaluated with mammography, there was 100% sensitivity, 93% specificity, 40% positive predictive value, and 100% negative predictive value. For the 122 lesions evaluated with sonography, there was 100% sensitivity, 86% specificity, 19% positive predictive value, and 100% negative predictive value 3
25. Sanford MF, Slanetz PJ, Lewin AA, et al. ACR Appropriateness Criteria R Evaluation of Nipple Discharge: 2022 Update. Journal of the American College of Radiology. 19(11S):S304-S318, 2022 11. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for evaluation of nipple discharge. No results stated in abstract. 4
26. Chung HL, Le-Petross HT, Leung JWT. Imaging Updates to Breast Cancer Lymph Node Management. Radiographics 2021;41:1283-99. Review/Other-Dx N/A To discuss the imaging features of nodal metastases and the indications and techniques for the various image-guided procedures. No results stated in abstract. 4
27. Sun SX, Moseley TW, Kuerer HM, Yang WT. Imaging-Based Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Biopsy in Patients With Breast Cancer. [Review]. AJR. American Journal of Roentgenology. 214(2):249-258, 2020 02. Review/Other-Dx N/A To provide historical and current data to support the role of imaging-based axillary lymph node staging and sentinel lymph node biopsy as the standard of care for axillary management in women with a diagnosis of breast cancer, before and after neoadjuvant systemic therapy. No results stated in abstract. 4
28. Langer AK. Breast Imaging in Pregnancy and Lactation. [Review]. Advances in Experimental Medicine & Biology. 1252:17-25, 2020.Adv Exp Med Biol. 1252:17-25, 2020. Review/Other-Dx N/A To describe first line imaging techniques for breast disorders found during pregnancy and lactation. No results stated in abstract. 4
29. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=89+&releaseId=2. Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
30. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation.  Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=23+&releaseId=2. Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
31. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=28+&releaseId=2. Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
32. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety.  Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Radiology-Safety/Manual-on-MR-Safety.pdf. Review/Other-Dx N/A Guidance document to promote the use of magnetic resonance (MR) safe practices. No abstract available. 4
33. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
34. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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