ACR Appropriateness Flashcards
Breast Cancer Screening:
Variant 1: High risk women
Who does this include?
BRCA
(+ untested 1st degree relatives),
History of chest radiation,
Risk model shows 20% or greater lifetime risk
Breast Cancer Screening:
Variant 1: High risk women
What imaging appropriate? (And #)
Mammo (9)
Tomo (9)
MRI (9)
Breast Cancer Screening:
Variant 1: High risk women
When start screening exams?
- Beginning at age 25-30, OR
- 10 years before age of first degree relative with breast cancer
- 8 years after radiation therapy (but not before age 25)
Breast Cancer Screening:
Variant 1: High risk women
Should you do mammography AND MRI?
Yes. They are complementary exams and both should be performed.
Breast Cancer Screening:
Variant 2: Medium risk women
Who fits this category?
- personal history of breast CA
- lobular hyperplasia,
- atypical ductal hyperplasia, or
- risk model shows 15-20% lifetime risk
Breast Cancer Screening:
Variant 2: Medium risk women
What imaging (and appropriateness score)?
Mammo (9)
Tomo (9)
MRI (7)*****
Mammography + MRI? They are complementary exams, MRI should NOT replace mammography.
Breast Cancer Screening:
Variant 3: Average risk women
Who?
<15% lifetime risk
Breast Cancer Screening:
Variant 3: Average risk women
Imaging (and appropriateness score)?
Mammo (9)
Tomo (9)
MRI is a 3–NOT appropriate
Breast Pain
Variant 1: Cyclical, Unilateral or Bilateral, Age < 40
Imaging (and scores)?
No imaging is appropriate!!
Ultrasound is least inappropriate, and it’s a 2..
Breast Pain:
Variant 2: Cyclical, Unilateral or Bilateral, Age > 40
Imaging (and score)?
No imaging is appropriate!!!
Ultrasound, mammo, and tomo are the least inappropriate and are all 2s…
Breast Pain:
Variant 3: NON-Cyclical, Unilateral or Bilateral, Age < 40
Imaging (and score)?
Ultrasound (5)
Might be appropriate
Stage 1 Breast CA: Initial workup and surveillance (NO symptoms)
Newly diagnosed: rule out mets to bone, chest, liver, and/or brain
Imaging ?
NO imaging is appropriate
CT, MRI, PET, etc…not indicated with initial stage 1
Stage 1 Breast CA: Initial workup and surveillance (NO symptoms)
Surveillance—rule out local recurrence
Imaging (and scores)?
Diagnostic Mammo or Tomo (9)
Ultrasound (5)—maybe
MRI (5)—maybe
Symptomatic Male Breast:
Variant 1: Any age, physical exam + history consistent with gynecomastia or pseudogynecomastia
Imaging?
NO imaging is appropriate
Symptomatic Male Breast:
Variant 2: Age <25, with indeterminate palpable
Imaging?
Ultrasound (8)
Mammo (5)—maybe
only if Ultrasound doesn’t answer your question
Symptomatic Male Breast:
Variant 3: Age>25, with indeterminate palpable
Imaging?
Mammo (8)
Ultrasound (5)—maybe
(Note: opposite of same issue in age<25)
Symptomatic Male Breast:
Variant 4: Age >25, with indeterminate palpable. Mammogram indeterminate or suspicious.
Imaging?
Ultrasound (9)
Symptomatic Male Breast:
Variant 5: Physical Exam highly concerning for cancer. (Dude has ulcerative mass, axillary nodes, nipple retraction, etc…)
Imaging?
Mammo (9)
Ultrasound (8)—to stage breast and axilla just like female breast CA workup.
Woman >40 with palpable
Imaging?
Mammo (9)
Woman >40, mammo suspicious for CA
Imaging?
Ultrasound (9)
Woman >40, mammo findings of lipoma at site of palpable
Imaging?
NO imaging appropriate
Woman >40 with palpable, mammo negative
Imaging?
Ultrasound (9)
Woman <30, initial evaluation
Imaging?
Ultrasound (9)
Woman 30-39, initial evaluation
Imaging?
Ultrasound (8)
Mammo (8)
Woman <30, Ultrasound suspicious for CA
Imaging?
Core Biopsy (9) Mammo (8)
Woman <30, Ultrasound negative
Imaging?
NO imaging is appropriate
Woman <30, Ultrasound has a B9 finding (like a cyst)
Imaging?
NO imaging is appropriate
Woman <30, Ultrasoundis BR3 able—example fibroadenoma
Imaging?
Short interval follow-up—usually q6 months x 2 years
