Breast imaging surveillance after curative treatment for primary non-metastasised breast cancer in non-high-risk women: a systematic review

Insights into Imaging

Table 3 Recommendations on modalities for breast imaging surveillance

Guideline	Mammography		Ultrasound	(CE-)MRI	Other
	BCT	Mastectomy
ACR	BL^a	CL	Optional, especially for dense breasts	Recommended for - dense breast tissue - patients diagnosed < 50 years old	DBT^a
ACS-ASCO	BL	CL	NR	NR	NR
ASCO	BL	NS	NR	NR	NR
AHS	BL	CL	NR	NR	NR
BCMH-BCMA	BL	CL	NR	NR	NR
CAR	BL	NS	NS	NS	NS
CCMB	BL	CL	NR	NR	NR
DKG-DGGG	BL	CL	If quality-assured, should be added for breasts and axilla	May play an additional role in the differentiation of scar vs recurrence	NR
ESMO	BL	CL	BL/CL	May be indicated for young patients, especially in cases of dense breast tissue and genetic/familial predispositions	NR^b
GISMa-ICBR/SIRM	BL	NS	NS	NR	Brief mention of DBT as a supplemental investigation, without further elaboration or recommendation
HAS	BL	CL	May be associated	NR	NR^c
KCE	BL	NS	With or without	- Initial BC not seen on other imaging - Other imaging inconclusive	NR
NABON-KIMS	BL	CL	NS	May play an additional role in: - differentiation scar vs recurrence - BC not visible on mammography - autologous breast reconstructions	NR
NBOCC	BL	CL	If indicated on clinical or radiological grounds, including: - young women - dense breasts - initial breast cancer undetectable by mammography	Specific high-risk subgroups	NR
NCCN	BL	CL	NR	NR	NR^d
NICE	BL	CL	NR	NR	NR
NZGG	BL	NS	NS	NS	NR
RCR	BL	CL^e	NR	NR	NS

NS not specified, NR not recommended, RT radiation therapy, LRT locoregional therapy, BC breast cancer, BCT breast-conserving therapy, DBT digital breast tomosynthesis, IL ipsilateral, CL contralateral, BL bilateral, (CE-)MRI (contrast-enhanced) magnetic resonance imaging. For other abbreviations see Table 1
^aDiagnostic digital breast tomosynthesis (DBT) received identical appropriateness score (9/9) and relative radiation level rating (2/3) as diagnostic mammography. For intermediate-risk women, breast mammography or DBT (with accompanying planar or synthesised 2-D images) is recommended
^bFor patients who take tamoxifen, an annual gynaecological examination is recommended, possibly with a gynaecological ultrasound
For patients who take an aromatase inhibitor, regular bone density evaluation is recommended
^cDepending on the context, following examinations may be indicated: - for patients who take tamoxifen, an annual pelvic ultrasound for excluding endometrial malignancies; - for patients who take an aromatase inhibitor, bone density evaluation every 1–3 years
^dMonitoring of bone health with a bone mineral density determination at baseline and periodically thereafter is advised for women on aromatase inhibitors or women who experience ovarian failure secondary to treatment
^eAlso ipsilateral, if autologous reconstruction with high recurrence risk