Abstract：
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. 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.
摘要：
随着被诊断为浸润性乳腺癌的女性比例的增加，应根据循证指南确定影像学对分期和监测的作用.重要的是要了解疾病评估和分期程度的适应症，因为不必要的成像会延迟治疗,甚至导致不良结局.在接受治愈性治疗的无症状患者中，影像学检查对远端复发没有任何作用.建议每年进行2-D乳房X线照片和/或断层合成的常规监测，以检测有乳腺癌病史的女性的乳房内复发或新的原发性乳腺癌。磁共振成像越来越多地被用作这个人群的额外筛查工具，尤其是乳房致密的女性。美国放射学会适当性标准是针对特定临床状况的循证指南，每年由多学科专家小组审查。指南的制定和修订过程支持对同行评审期刊的医学文献进行系统分析。既定的方法论原则，如建议评估分级，发展,评估或等级适用于评估证据。RAND/UCLA适当性方法用户手册提供了确定特定临床场景的成像和治疗程序适当性的方法。在那些缺乏同行评审文献或模棱两可的情况下，专家可能是制定建议的主要证据来源。
