ACR Appropriateness Criteria® Breast Imaging During Pregnancy

There are physiologic and structural changes of the breast that occur during pregnancy that can make the clinical examination and imaging more challenging. Pregnancy-associated breast cancer (PABC) is uncommon but increasing as more women postpone childbearing. PABC can present clinically as a palpable lump, focal pain, nipple discharge, or diffuse breast enlargement. Mammography is safe to perform during pregnancy. Both high- and normal-risk women should continue their routine screening mammography examinations during pregnancy. Diagnostic mammography and/or ultrasound is tailored to evaluate the clinical symptoms and for locoregional staging of newly diagnosed PABC. Breast MRI is not advocated for screening or diagnostic evaluation of the breast during pregnancy due to unknown safety of gadolinium exposure to the fetus. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.