ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Palpable breast masses are a common symptom of breast cancer in women.
• Current evidence for imaging recommendations for palpable masses across different age groups needs evaluation.

Approach:

• This document reviews and evaluates current evidence for imaging recommendations for palpable breast masses.
• It assesses scenarios and recommendations following initial imaging.
• The American College of Radiology Appropriateness Criteria methodology is utilized.

Key Points:

• For women under 30, ultrasound is the primary imaging modality; suspicious findings may warrant tomosynthesis or mammography with biopsy.
• For women aged 30-39, ultrasound, mammography, and tomosynthesis are all appropriate initial imaging choices.
• For women 40 and older, diagnostic mammography and tomosynthesis are recommended initial imaging, with ultrasound as an adjunct in specific cases.

Conclusions:

• Imaging recommendations for palpable breast masses vary by age and ultrasound/mammography findings.
• Biopsy decisions are guided by imaging results (BIRADS categories) and clinical context.
• Evidence-based guidelines, like the ACR Appropriateness Criteria, inform these recommendations.