 The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Imaging of Invasive Breast Cancer and later-stage breast cancer prior to treatment. Additionally, we investigate the use of surveillance imaging after completion of treatment, both in the asymptomatic and symptomatic settings. In the post-treatment setting, we differentiate recommended imaging algorithms by symptomatology, because routine screening of asymptomatic patients after treatment for metastatic disease does not provide survival benefit, but early detection of nonmetastatic recurrence does improve overall outcomes [10]. Special Imaging Considerations Although still investigational, whole body diffusion weighted imaging and whole body fluorine-18-2-fluoro-2- deoxy-D-glucose (FDG) PET/MRI may show improved staging compared with whole body FDG-PET/CT in patients with later-stage disease [11-15]. Further studies are warranted to support their use in routine practice. Discussion of Procedures by Variant Variant 1: Newly diagnosed. Clinical stage I-IIA (early stage) breast cancer at presentation. Evaluation for locoregional disease (includes invasive ductal carcinoma [IDC], or invasive lobular carcinoma [ILC], or not otherwise specified [NOS]). Bone Scan Whole Body There is no evidence to support the use of Tc-99m bone scan whole body to evaluate for locoregional disease. CT Chest, Abdomen, and Pelvis With IV Contrast Few studies have evaluated the use of CT chest, abdomen, and pelvis with intravenous (IV) contrast to determine locoregional disease.
Imaging of Invasive Breast Cancer.  The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Imaging of Invasive Breast Cancer and later-stage breast cancer prior to treatment. Additionally, we investigate the use of surveillance imaging after completion of treatment, both in the asymptomatic and symptomatic settings. In the post-treatment setting, we differentiate recommended imaging algorithms by symptomatology, because routine screening of asymptomatic patients after treatment for metastatic disease does not provide survival benefit, but early detection of nonmetastatic recurrence does improve overall outcomes [10]. Special Imaging Considerations Although still investigational, whole body diffusion weighted imaging and whole body fluorine-18-2-fluoro-2- deoxy-D-glucose (FDG) PET/MRI may show improved staging compared with whole body FDG-PET/CT in patients with later-stage disease [11-15]. Further studies are warranted to support their use in routine practice. Discussion of Procedures by Variant Variant 1: Newly diagnosed. Clinical stage I-IIA (early stage) breast cancer at presentation. Evaluation for locoregional disease (includes invasive ductal carcinoma [IDC], or invasive lobular carcinoma [ILC], or not otherwise specified [NOS]). Bone Scan Whole Body There is no evidence to support the use of Tc-99m bone scan whole body to evaluate for locoregional disease. CT Chest, Abdomen, and Pelvis With IV Contrast Few studies have evaluated the use of CT chest, abdomen, and pelvis with intravenous (IV) contrast to determine locoregional disease.