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J Am Coll Radiol. 2018 Nov;15(11S):S263-S275. doi: 10.1016/j.jacr.2018.09.013.

ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women.

Author information

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address:
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Panel Vice-Chair, NYU Clinical Cancer Center, New York, New York.
Roper St Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons.
Northwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians.
New York University School of Medicine, New York, New York.
Emory University Hospital, Atlanta, Georgia.
Alpert Medical School of Brown University, Providence, Rhode Island.
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists.
Mecklenburg Radiology Associates, Charlotte, North Carolina.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
Panel Chair, Emory University Hospital, Atlanta, Georgia.


Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC. 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.


AUC; Appropriate Use Criteria; Appropriateness Criteria; Breast cancer; Breast feeding; Lactation; Nipple discharge; Palpable mass; Pregnancy

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