Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part-1

Abstract

Breast imaging is one of the prerequisites for providing high-quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease or the absence of it in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important therefore to provide uniform guidance to doctors in different health care setups of our country, urban and rural, government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists, to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The guidelines encompass all aspects of breast imaging including mammography, breast ultrasound, breast magnetic resonance imaging, as well as breast interventions. Algorithms for investigation of specific common breast symptoms and signs have been provided in this document. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Breast screening is an integral part of breast imaging and guidelines for the same have been incorporated in this document. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India.

Imaging Recommendations for Diagnosis, Staging, and Management of Breast Cancer

“…Mammography from the age of 40 years is recommended for women at average risk of developing BC. 11 12 The upper age limit for screening mammography should ideally be when a woman's life expectancy exceeds 5 to 7 years so that the benefits of screening could be fully realized 11 and an age limit of 70 years may be deemed appropriate. 12 13 Ultrasound can be used as an adjunct to screening mammography for women with dense breasts, but is not recommended as a standalone screening test.…”

“…11 12 The upper age limit for screening mammography should ideally be when a woman's life expectancy exceeds 5 to 7 years so that the benefits of screening could be fully realized 11 and an age limit of 70 years may be deemed appropriate. 12 13 Ultrasound can be used as an adjunct to screening mammography for women with dense breasts, but is not recommended as a standalone screening test. 14 For women with a lifetime risk of BC ≥20% according to risk assessment tools, with known BRCA1 and BRCA2 mutation or with a first degree relative to the mutation, with radiation therapy (RT) to the chest between ages of 10 and 30 years, screening can be started earlier.…”

“…However in the presence of strong clinical suspicion of BC, a combination of mammography and ultrasound can be performed at the outset in this group. 12 17 All women diagnosed with BC should have mammography irrespective of their age. 17 Digital breast tomosynthesis has shown improved cancer detection rate as compared with digital mammogram alone.…”

“…18 CEMRI (contrast-enhanced MRI) is indicated if there is a discrepancy in clinical and radiological findings, if breast conservation is considered with a diagnosed lobular cancer, for tumors occult on mammography, in cases of Paget's disease of the nipple if breast conservation is contemplated, if conventional imaging is suspicious for but does not confirm multifocal/multicentric disease, in cases of occult primary breast cancer such as proven metastatic axillary nodes without primary detected on mammogram and USG. 12 17 A recognized reporting system like the American College of Radiology (ACR) Breast Imaging – Reporting and Data System (BI-RADS) should be used to report the radiological investigations. Image-guided biopsy of lesions suspicious for malignancy (BI-RADS 4) or highly suggestive of malignancy (BI-RADS 5) is advised.…”

Annals of National Academy of Medical Sciences (2022) …An Appraisal

“…Among important review articles, second issue published “Best practice guidelines for breast imaging” part 1 and 2 authored by Chakrabarthi et al for Breast Imaging Society. 1 2 Another article is on Patient Safety, Clinical Microbiology, and Collaborative Healthcare by Chugh et al 3 We published two articles on mucormycosis and coronavirus disease 2019 (COVID-19) infection 4 5 and one each on COVID-19 vaccination and use of telemedicine in Covid-19 time. 6 7…”