ACR Appropriateness Criteria: Breast Imaging Should Not Be Deferred During Lactation

New ACR guideline: do not defer breast imaging because of lactation. Mammography with tomosynthesis, targeted ultrasound, and contrast MRI all have defined roles. Gadolinium and most nuclear medicine tracers result in negligible infant exposure — breastfeeding interruption not r…

• Evidence-based guideline (GRADE methodology, annual expert panel review) covering screening, diagnostic, and staging scenarios in lactating women across all age and risk groups.
• Image-guided core biopsy and aspiration deemed safe and effective during lactation; rare lactation-specific risks (e.g., milk fistula) should be disclosed during informed consent.
• Key limitation: in areas where peer-reviewed evidence is lacking or equivocal, expert opinion serves as the primary evidentiary source, which may limit the strength of some recommendations.

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