Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Panel Chair, Boston University School of Medicine, Boston, Massachusetts; and President, Massachusetts Radiological Society.
J Am Coll Radiol. 2021 Nov;18(11S):S456-S473. doi: 10.1016/j.jacr.2021.09.002.
Mammography remains the only validated screening tool for breast cancer, however, there are limitations to mammography. One of the limitations of mammography is the variable sensitivity based on breast density. Supplemental screening may be considered based on the patient's risk level and breast density. For average-risk women with nondense breasts, the sensitivity of digital breast tomosynthesis (DBT) screening is high; additional supplemental screening is not warranted in this population. For average-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhanced mammography, screening ultrasound (US), breast MRI, or abbreviated breast MRI. In intermediate-risk women, there is emerging evidence suggesting that women in this population may benefit from breast MRI or abbreviated breast MRI. In intermediate-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhancedmammography or screening US. There is strong evidence supporting screening high-risk women with breast MRI regardless of breast density. Contrast-enhanced mammography, whole breast screening US, or abbreviated breast MRI may be also considered. 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.
乳腺 X 线摄影仍然是乳腺癌唯一经过验证的筛查工具，但是，它也存在一定的局限性。乳腺 X 线摄影的局限性之一是基于乳房密度的可变敏感性。根据患者的风险水平和乳房密度，可以考虑进行补充性筛查。对于乳房非致密且风险较低的女性，数字乳腺断层合成（DBT）筛查的敏感性较高；在该人群中，不需要进行额外的补充性筛查。对于乳房致密且风险较低的女性，鉴于乳腺 X 线摄影/DBT 的敏感性降低，该人群可能受益于对比增强乳腺 X 线摄影、筛查超声（US）、乳腺 MRI 或简化乳腺 MRI 等额外的补充性筛查。对于中等风险的女性，有新的证据表明该人群中的女性可能受益于乳腺 MRI 或简化乳腺 MRI。对于乳房致密且风险中等的女性，鉴于乳腺 X 线摄影/DBT 的敏感性降低，该人群可能受益于对比增强乳腺 X 线摄影或筛查 US 等额外的补充性筛查。有强有力的证据支持对高危女性进行乳腺 MRI 筛查，无论其乳房密度如何。还可以考虑使用对比增强乳腺 X 线摄影、全乳筛查超声或简化乳腺 MRI。美国放射学院适宜性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订包括对同行评议期刊的现有医学文献进行广泛分析，并应用成熟的方法学（RAND/UCLA 适宜性方法和推荐评估、制定和评估分级或 GRADE）来评估特定临床情况下影像学和治疗程序的适宜性。在缺乏证据或证据存在争议的情况下，专家意见可以补充现有证据，推荐进行影像学检查或治疗。
