ACR Appropriateness Criteria® Imaging of Ductal Carcinoma in Situ (DCIS)

Abstract

Ductal carcinoma in situ (DCIS) accounts for approximately 20% of diagnosed breast cancer. It is important to understand which imaging studies are appropriate in patients with a new diagnosis or history of DCIS. Initial imaging for a new diagnosis of DCIS, consists of diagnostic mammography and/or tomosynthesis, whereas breast ultrasound and breast MRI may be appropriate as complementary examinations. Routine surveillance with annual mammography and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women who have completed breast conservation therapy for DCIS, and breast MRI may be appropriate. Advanced technologies such as contrast mammography or molecular breast imaging are usually not appropriate. In a patient with a history of mastectomy for DCIS, routine surveillance for ipsilateral recurrence with imaging is usually not appropriate. There is no role for imaging of the axilla in patients with known DCIS with or without microinvasion.

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.