University of Michigan, Ann Arbor, Michigan.
Research Author, Duke University Medical Center, Durham, North Carolina.
J Am Coll Radiol. 2023 May;20(5S):S146-S163. doi: 10.1016/j.jacr.2023.02.013.
Palpable masses in women are the most common symptom associated with breast cancer. This document reviews and evaluates the current evidence for imaging recommendations of palpable masses in women less than 30 to over 40 years of age. There is also a review of several different scenarios and recommendations after initial imaging. Ultrasound is usually the appropriate initial imaging for women under 30 years of age. If ultrasound findings are suspicious or highly suggestive of malignancy (BIRADS 4 or 5), it is usually appropriate to continue with diagnostic tomosynthesis or mammography with image-guided biopsy. No further imaging is recommended if the ultrasound is benign or negative. The patient under 30 years of age with a probably benign ultrasound may undergo further imaging; however, the clinical scenario plays a role in the decision to biopsy. For women between 30 to 39 years of age, ultrasound, diagnostic mammography, tomosynthesis, and ultrasound are usually appropriate. Diagnostic mammography and tomosynthesis are the appropriate initial imaging for women 40 years of age or older, as ultrasound may be appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy. If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy. 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.
在女性中，可触及的肿块是与乳腺癌最相关的常见症状。本文综述并评估了小于 30 岁至 40 岁以上女性可触及肿块的影像学推荐的现有证据。还回顾了几种不同的初始影像学检查后的情况和建议。对于 30 岁以下的女性，超声通常是合适的初始影像学检查。如果超声检查结果可疑或高度提示恶性肿瘤（BIRADS 4 或 5），通常应继续进行断层合成或乳腺 X 线摄影检查，并进行图像引导活检。如果超声检查为良性或阴性，则无需进一步影像学检查。对于 30 岁以下、超声表现可能为良性的患者，可能需要进一步影像学检查；但是，临床情况在活检决策中起作用。对于 30 至 39 岁的女性，超声、诊断性乳腺 X 线摄影、断层合成和超声通常是合适的。对于 40 岁或以上的女性，诊断性乳腺 X 线摄影和断层合成是合适的初始影像学检查，如果患者在就诊后 6 个月内或在乳腺 X 线摄影结果可疑或高度提示恶性肿瘤后立即进行了阴性乳腺 X 线摄影，则超声可能是合适的。如果诊断性乳腺 X 线摄影、断层合成和超声检查结果可能为良性，则无需进一步影像学检查，除非临床情况表明需要进行活检。美国放射学院（ACR）适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订过程支持对同行评议期刊上的医学文献进行系统分析。既定的方法学原则，如推荐评估、制定和评价（GRADE）分级，适用于评估证据。RAND/UCLA 适宜性方法用户手册提供了用于确定特定临床情况下影像学和治疗程序适宜性的方法。在缺乏或存在争议的同行评议文献的情况下，专家可能是制定建议的主要证据来源。
