Indications per 2014 ACR Practice Parameter +  2016 ACR Appropriateness Criteria (Adapted)

1.     Screening

– Annual: High risk women (with BRCA gene mutation and their untested 1st-degree relatives, with other genetic syndromes that increase the risk of breast cancer [eg, Li Fraumeni syndrome], with h/o chest irradiation between ages 10-30)

– Annual: Consider for intermediate risk women (with personal h/o breast cancer, LN, or ADH)

– Annual: Women with > 20% (consider for > 15%) lifetime risk of breast cancer

– To assess integrity of breast implants in whom mammography is difficult

– Newly diagnosed breast cancer (one-time MRI of contralateral breast)

2.     Extent of disease

– Invasive carcinoma or DCIS (one-time bilateral MRI)

– Pre-operative planning (tumor relationship to deep fascia/muscle before breast conserving surgery or mastectomy)

– Positive/close margins after breast conserving surgery (to evaluate for residual disease)

– Before/during/after neoadjuvant chemotherapy (to assess treatment response and/or to assess the extent of residual disease before surgery)

3.     Additional evaluation of imaging/clinical findings

– Suspicion for recurrent breast cancer when mammogram and US inconclusive

– Suspicion for recurrent breast cancer after tissue flap reconstruction

– Metastatic cancer when primary is unknown and suspected to be breast (eg, axillary adenopathy) with no clinical or mammographic evidence of primary breast carcinoma

– (Rare) Lesion characterization when imaging/physical exam inconclusive and biopsy cannot be performed (eg, possible distortion seen on only 1 view with no US correlate)

– MRI-guided biopsy (vaccuum-assisted biopsy or pre-op wire loc) for lesions that are mammographically and sonographically occult and visible only on MRI