Palpable breast masses are the most common presenting feature of breast carcinoma, which is the second leading cause of female cancer deaths in the United States. Imaging evaluation of breast masses is necessary in almost every case, as their clinical features are commonly nonspecific. The ACR Appropriateness Criteria for palpable breast masses, which provides thorough recommendations for particular imaging methods and patient situations, was published in the October issue of the Journal of the American College of Radiology.

The guidelines emphasize the necessity of completing a thorough imaging workup of a palpable mass before biopsy because of frequent inconsistencies in clinical examination. Diagnostic mammography should be the initial imaging modality for evaluating a clinically detected palpable breast mass in women 40 years of age or older. Women who are 30 to 39 years old, however, should have an ultrasound or mammography used for initial evaluation.

Any highly suspicious breast mass detected by imaging should be biopsied, regardless of palpable findings, as well as any mass found by palpation. 

Importantly, the correlation between imaging and palpable area of concern is essential, according to the latest ACR criteria.  

And, as always, radiation exposure should be taken into account in the decision-making process.

“Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level indication has been included for each imaging examination,” wrote Jennifer A. Harvey, MD, of the American College of Radiology, and colleagues.