ACR Appropriateness Criteria Palpable Breast Masses

ACR Appropriateness Criteria Palpable Breast Masses Jennifer A. Harvey, MDa, Mary C. Mahoney, MDb, Mary S. Newell, MDc, Lisa Bailey, MDd,e, Lora D. Barke, DOf, Carl D’Orsi, MDc, Mary K. Hayes, MDg, Peter M. Jokich, MDh, Su-Ju Lee, MDb, Constance D. Lehman, MD, PhDi, Martha B. Mainiero, MDj, David A. Mankoff, MD, PhDk,l, Samir B. Patel, MDm, Handel E. Reynolds, MDn, M. Linda Sutherland, MDo, Bruce G. Haffty, MDp

A palpable breast mass is one of the most common presenting features of breast carcinoma. However, the clinical features are frequently nonspecific. Imaging performed before biopsy is helpful in characterizing the nature of the mass. For women with clinically detected breast masses, the vast majority will require evaluation with ultrasound. Diagnostic mammography is the initial imaging modality of choice for women aged
40 years; ultrasound is typically necessary unless a definitively benign mass is identified as the etiology of the clinical finding. For evaluating women aged 97% [6-8]. Together, these imaging modalities can be reassuring when the physical examination is not highly suspicious and follow-up is planned. However, a highly suspicious physical examination should prompt biopsy regardless of the imaging findings. MRI

With respect to a palpable breast mass, other imaging techniques remain investigational. MRI has emerged as a useful modality for detecting occult breast cancer in highrisk women and for evaluating disease extent in women diagnosed with breast cancer. Although palpable masses can be imaged with MRI, it is generally more cost effective to use mammography and ultrasound as the initial imaging examinations. The use of MRI to evaluate women with a clinically suspicious clinical examination and negative imaging is not well documented. In one series [25], 112 women were referred for breast MRI with the indication of a clinical finding; MRI resulted in no additional true-positive findings and one false-negative finding. In patients with palpable biopsy-proven breast

Variant 6. Woman aged