For the full tables of evidence click on the guideline number
Mammography
GUIDELINES
Ultrasound
and MRI GUIDELINES
Explanation of terms -
1) recommendations - a 5 point scale is used
1 |
Indicated |
2 |
Not indicated initially |
3 |
Not indicated routinely |
4 |
Not indicated |
5 |
Specialised examination |
2) Grade of recommendation
A |
Required- at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing specific recommendation. |
B |
Required - availability of well conducted clinical studies but no randomised clinical trials on the topic of recommendation. |
C |
Required - evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates absence of directly applicable clinical studies of good quality. |
| Table No: | Description | Recommendation | Grade |
Comments |
| Screening women under 40 years | Not Indicated | B |
Not indictaed unless at high risk | |
| Screening women age 40-49 years | Not indicated routinely | A |
Women need to be aware of the risks and benefits of screening in this age group | |
| Screening women age 50-64 years | Indicated | A |
NHS BSP available every 3 years in UK. Evidence on recommended frequency between screens awaited. | |
| Screening women age > 64 years | Indicated | A |
Until expansion of NHS BSP, women are encouraged to self refer | |
| Family history of breast cancer | Not Indicated initially | B |
Benefits outweigh risks in younger women | |
| Women <50 years having or being considered for HRT | Not indicated routinely | C |
HRT increases density of breast tissue causing decreased sensitivity and specificity wih an increased recall rate | |
| Breast screening in women age 50 and over who have had augmentation mammoplasty | Indicated | C |
Lowered sensitivity for cancer detection. Partly dependant on size of prosthesis | |
| Clinical Suspicion of cancer | Indicated | B |
Mammography and US should be used in the context of the triple test | |
| Generalised lumpiness, pain or tenderness, longstanding nipple retraction | Not indicated routinely | C |
May be worthwhile in women over 40 years with persisting non-suspicious breast symptoms | |
| Cyclical Mastalgia | Not indicated | B |
In absence of clinical signs, mammography should not be performed | |
| Augmentation mammoplasty | Not indicated for implant integrity. Indicated if symptoms of malignancy | B |
Dependant on the proportional volume of the prosthesis compared with the remaining breast tissue | |
| Suspected Pagets Disease of Nipple | Indicated | C |
Abnormality found in about 50% to enable image guided biopsy | |
| Breast Inflammation | Specialised investigation | C |
Ultrasound is the examination of first choice. It can differentiate between an abscess requiring drainage, and inflammation. Mammography may show malignancy |
Breast Ultrasound and MRI scanning
| Table No | Title | Recommendation | Grade |
Comments |
| Breast Screening | Not recommended routinely | B |
Useful adjunct to mammography, especially for dense breasts and women with implants | |
| Clinical Suspicion of Cancer | Indicated | B |
Ultrasound recommended as an adjunct to mammography | |
| Generalised pain, generalised tenderness and long term nipple inversion | Not routinely indicated. Specialised investigation | C |
In the absence of other signs suggestive of malignancy, breast ultrasound is unlikely to influence management | |
| Cyclical Mastalgia | Not recommended | C |
No evidence base | |
| Assessment of integrity of implants | Specialised investigation | B |
The assessment of integrity of breast implants or coincident masses requires specialist skills and facilities.Ultrasound is highly predictive of an intact implant. Positive US has a 94% chance of rupture. MRI more sensitive for comprehensive examination | |
| Breast Inflammation | Indicated | C |
Ultrasound is the examination of first choice. It can differentiate between an abscess requiring drainage, and inflammation. |
