ACR Appropriateness Criteria® Breast Imaging During Lactation

This article provides evidence-based guidance for imaging lactating women across screening, diagnostic, and staging scenarios. Imaging should not be deferred because of lactation; mammography with digital breast tomosynthesis, targeted ultrasound, and contrast-enhanced MRI have defined roles based on age, presenting complaint, and cancer risk and may be used similarly to nonlactating patients. Physiologic changes during lactation can alter breast appearance and complicate clinical and imaging assessment. Gadolinium contrast and most nuclear medicine procedures result in negligible infant exposure and do not require interruption of breastfeeding. Image-guided core biopsy and aspiration are safe and effective, with rare lactation-specific risks, which should be discussed during consent. Recommendations aim to standardize care, minimize diagnostic delay, preserve breastfeeding when possible, and support multidisciplinary decision-making. These guidelines inform clinicians, radiologists, and multidisciplinary teams in routine practice. 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.