ACR Appropriateness Criteria ® Palpable Breast Masses

Abstract

Breast cancer is the most common female malignancy and the second leading cause of female cancer death in the United States. Although the majority of palpable breast lumps are benign, a new palpable breast mass is a common presenting sign of breast cancer. Any woman presenting with a palpable lesion should have a thorough clinical breast examination, but because many breast masses may not exhibit distinctive physical findings, imaging evaluation is necessary in almost all cases to characterize the palpable lesion. Recommended imaging options in the context of a palpable mass include diagnostic mammography and targeted-breast ultrasound and are dependent on patient age and degree of radiologic suspicion as detailed in the document Variants. There is little role for advanced technologies such as MRI, positron emission mammography, or molecular breast imaging in the evaluation of a palpable mass. When a suspicious finding is identified, biopsy is indicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Metastatic Breast Cancer Masked as Constipation

“…Despite the lack of unity on early screening practices in those aged 40 to 49, the clinical guidelines for the assessment of women with a palpable mass are less controversial. The American College of Radiology advocates for diagnostic mammograms in any woman aged 40 or older with a solid, palpable mass as these women are at two-fold increased risk of breast cancer [8,9]. Our patient was scheduled for a mammogram, but due to logistic issues resulting from the COVID-19 pandemic, her appointment was rescheduled.…”

Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size

“…Moreover, mammographic diagnosis of ILC is reported to be more difficult than IDC, and this relatively low sensitivity has generated interest in other imaging modalities, such as magnetic resonance imaging, high-frequency ultrasonography, shear-wave elastography, tomosynthesis, and, more recently, contrast-enhanced digital mammography, in order to try to improve early and more accurate detection [ 6 , 16 , 23 - 33 ]. However, MLO and CC mammographic views are still considered the first-line imaging modalities of choice in women aged 40 years or over, both in a screening context and in the diagnostic assessment of patients with breast symptoms [ 7 - 9 ].…”

“…Mammography is still considered the first-line imaging modality of choice in women aged 40 years or over, and it should be performed in patients under 40 years old with clinically suspicious findings and/or ultrasonically suspicious findings [ 7 - 9 ]. Even in women with clinically significant focal and noncyclical breast pain or with pathologic nipple discharge aged greater than or equal to 30 years, mammography is usually considered appropriate as an initial imaging modality [ 10 , 11 ].…”

Low-grade adenosquamous carcinoma of the breast: a review with focus on imaging and management

“…However, if a suspicious mass is identified, bilateral mammography is recommended. 23 …”