ACR Appropriateness Criteria Breast Cancer Screening.
ACR Appropriateness Criteria Breast Cancer Screening.
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DOI：
10.1016/j.jacr.2016.09.021
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发表时间：
2016-11-01
期刊：
影响因子：
--
通讯作者：
Haffty, Bruce G
中科院分区：
文献类型：
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作者：
Mainiero, Martha B;Lourenco, Ana;Haffty, Bruce G
乳房X光检查是一般人群中女性乳腺癌筛查的推荐方法。然而，对于高危女性，单独进行乳房X光检查的效果不如乳房X光检查加上补充筛查。因此，建议对选定的高危人群进行 MRI 或超声补充筛查。根据家族史或遗传倾向，建议对乳腺癌高危女性进行乳房 MRI 筛查。对于那些无法接受 MRI 的高危女性来说，超声检查是一种选择。最近的文献也支持在一些中等风险的女性中使用乳腺 MRI，超声检查可能是乳房致密的中等风险女性的一种选择。没有足够的证据支持使用其他成像方式（例如热成像、乳房特异性伽马成像、正电子发射乳房X线照相术和光学成像）进行乳腺癌筛查。 ACR 适当性标准是针对特定临床状况的循证指南，由多学科专家小组每两年审查一次。指南的制定和审查包括对来自同行评审期刊的当前医学文献的广泛分析，以及应用完善的共识方法（修改后的德尔菲法）来评估专家组成像和治疗程序的适当性。在缺乏证据或证据不明确的情况下，可以使用专家意见来推荐影像学或治疗。
Mammography is the recommended method for breast cancer screening of women in the general population. However, mammography alone does not perform as well as mammography plus supplemental screening in high-risk women. Therefore, supplemental screening with MRI or ultrasound is recommended in selected high-risk populations. Screening breast MRI is recommended in women at high risk for breast cancer on the basis of family history or genetic predisposition. Ultrasound is an option for those high-risk women who cannot undergo MRI. Recent literature also supports the use of breast MRI in some women of intermediate risk, and ultrasound may be an option for intermediate-risk women with dense breasts. There is insufficient evidence to support the use of other imaging modalities, such as thermography, breast-specific gamma imaging, positron emission mammography, and optical imaging, for breast cancer screening. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.