CurrentUnitedHealthcarePolicy 2025T0375II

Breast Imaging for Screening and Diagnosing Cancer

Medical coverage policy for breast imaging modalities used to screen for and diagnose breast cancer, including criteria for MRI, ultrasound, mammography, and technologies considered unproven; applies to UnitedHealthcare members governed by this policy.

Policy Summary

PayerUnitedHealthcare

PolicyBreast Imaging for Screening and Diagnosing Cancer

Policy CodePolicy 2025T0375II

Change TypeNo material changes

Effective DateMay 1, 2025

Next Review DateN/A

Key ActionObtain and document clinical rationale, risk status (including lifetime risk ≥20% when applicable), breast density, and how the imaging result will influence management when ordering advanced or supplemental breast imaging.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Severalmodalities addressed

>=20%MRI high-risk threshold

Unproven listunproven modalities

19applicable codes

1165ABUS study size

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14-16/1000incremental MRI detection

Coverage Criteria and Policy Stance

Proven / Medically Necessary

The following are proven and medically necessary:

Proven/Medically Necessary Modalities

MRI high-risk criteria: Prior thoracic radiation therapy between ages 10 and 30 OR lifetime risk ≥ 20% by family-history dependent models (e.g., Gail, Claus, Tyrer-Cuzick, BRCAPRO) OR personal history of breast cancer (unless treated with bilateral mastectomy) OR personal history of high-risk genetic syndromes (Li-Fraumeni TP53; BRCA1/2; Peutz-Jeghers STK11/LKB1; PTEN) OR family history meeting specified criteria (e.g., first-degree relative with BRCA1/2 mutation; first-degree relative with TP53 or PTEN mutation; ≥ two first-degree relatives with breast or ovarian cancer; one first-degree relative with bilateral breast cancer or both breast and ovarian cancer; first- or second-degree male relative with breast cancer)>=20% lifetime risk
Supported by guideline sources cited in policy

Operational Note: See Medical Records Documentation Used for Reviews for required documentation when ordering these modalities

Unproven / Not Medically Necessary

The following are unproven and not medically necessary due to insufficient evidence of efficacy:

Unproven/Not Medically Necessary Modalities: Automated Breast Ultrasound (ABUS); Computer-aided detection (CAD) as a standalone modality; Computer-Aided Tactile Breast Imaging; Computed Tomography of the breast (including cone-beam breast CT); Electrical Impedance Scanning (EIS); Magnetic Resonance Elastography (MRE); MRI for individuals with dense breast tissue when density is the only risk factor; Molecular Breast Imaging (MBI/BSGI)/scintimammography/Positron Emission Mammography (PEM)

These modalities are considered unproven or investigational pending higher-quality evidence and demonstration of impact on clinical outcomes.

Modality-specific coverage summaries

Coverage/stance summarized by modality based on the evidence presented

Automated Breast Ultrasound (ABUS): ABUS as supplemental screening in women with dense breasts can increase cancer detection when added to mammography but is associated with higher recall rates; current studies are limited by single-center designs and small sample sizes, and further investigation is needed before broad clinical adoption.

See Gatta et al. and comparative studies for diagnostic yield and recall rate data.

Computer-Aided Detection (CAD) / S-Detect: CAD tools show promising diagnostic accuracy metrics (e.g., S-Detect pooled sensitivity ≈0.82 and specificity ≈0.83) but have not demonstrated improved patient outcomes or reduced mortality; clinical benefit remains unproven.

Evidence limited by small, retrospective studies.

Computer-Aided Tactile Breast Imaging: Evidence is very low quality and uncontrolled; diagnostic accuracy and impact on outcomes are uncertain, rendering these technologies investigational.

Further randomized, prospective studies needed.

MRI Screening in High-Risk Individuals

Consider supplemental breast MRI screening when ALL of the following apply:

High-risk MRI screening criteria: Patient meets one or more high-risk indications: known pathogenic BRCA1/BRCA2 mutation or other high-penetrance germline mutation conferring high breast cancer risk; prior thoracic (chest) radiation between ages 10 and 30; calculated lifetime breast cancer risk ≥ 20% by validated family-history dependent models (e.g., Gail, Claus, Tyrer-Cuzick, BRCAPRO); personal history of breast cancer (unless treated with bilateral mastectomy); or personal diagnosis of specified high-risk syndromes (e.g., Li-Fraumeni TP53, PTEN, Peutz-Jeghers STK11/LKB1).>=20% lifetime risk

Endorsed by ACR, ASBrS, and NCCN guidelines; when MRI is contraindicated or unavailable consider alternative supplemental imaging per NCCN.

Supplemental Imaging for Dense Breasts

Guidance for supplemental imaging in women with dense breasts:

Supplemental imaging considerations for dense breasts: Supplemental imaging (MRI, ultrasound, or MBI/CEM) can increase cancer detection in certain subgroups of women with dense breasts but also increases recall and biopsy rates; evidence is insufficient to recommend routine MRI or ultrasound screening for women with dense breasts who have no additional risk factors.N/A

EUSOBI recommends offering screening MRI every 2–4 years for women aged 50–70 with extremely dense breasts; USPSTF finds evidence insufficient to support routine supplemental screening after a negative mammogram regardless of density.

Molecular Imaging (MBI/BSGI/Scintimammography)

Molecular breast imaging and scintimammography:

Role of MBI/BSGI/Scintimammography: MBI/BSGI/scintimammography demonstrate relatively high sensitivity and specificity in diagnostic settings and may be considered as adjuncts when MRI is unavailable or contraindicated, but current evidence does not support routine use for population screening; these modalities deliver higher radiation exposure than mammography.N/A

ACR recommends against BSGI for screening because of radiation dose; NCCN and ACS do not endorse routine screening use but acknowledge adjunctive roles in specific situations.

Magnetic Resonance Elastography (MRE)

MRE for breast tissue characterization:

MRE investigational use: MRE quantifies breast tissue mechanical properties (stiffness, elasticity, viscosity) and small studies show associations between stiffness metrics and elevated cancer risk as well as improved diagnostic accuracy when combined with contrast-enhanced MRI; however, clinical benefits, outcome impact, and optimal clinical indications are unproven and larger validation studies are needed.N/A

Considered investigational pending larger prospective studies.

MRI for breast density alone: Magnetic resonance imaging (MRI) of the breast for individuals whose only risk factor is breast density is considered unproven and not medically necessary. The evidence does not show that screening MRI in women with breast density as the sole risk factor improves patient management or health outcomes, and more robust data are needed to define a role for MRI in this population.

Breast CT / cone-beam breast CT (CBBCT): Use of breast computed tomography, including cone-beam breast CT, for routine screening is not supported by sufficient high-quality evidence. Current studies are small, heterogeneous, and at high risk of bias; systematic reviews conclude evidence is inconclusive and lacking clinical validity or utility to replace conventional screening modalities.

Computer-aided tactile breast imaging and electrical impedance scanning (EIS): These technologies are considered investigational. Available studies are low-quality, uncontrolled, and heterogeneous; they do not demonstrate that tactile imaging or EIS improves clinical outcomes or has validated diagnostic performance sufficient for routine clinical use. Further well-designed comparative trials are required.

BSGI / MBI (molecular breast imaging): Routine use of breast-specific gamma imaging (BSGI) or molecular breast imaging (MBI) for screening is not recommended. These modalities have relatively higher radiation exposure compared with mammography and, per the ACR, current evidence is insufficient to support their use for screening purposes.

Technologies designated as unproven or not medically necessary in this policy include: Automated Breast Ultrasound (ABUS), standalone Computer-Aided Detection (CAD), Computer-Aided Tactile Breast Imaging, Computed Tomography of the breast (including CBBCT), Electrical Impedance Scanning (EIS), Magnetic Resonance Elastography (MRE), and molecular modalities such as BSGI/MBI/PEM. These modalities lack sufficient high-quality evidence of clinical validity and outcome benefit to support routine screening use.

Specifically, breast CT (including cone-beam breast CT) is considered not medically necessary for routine screening given the current evidence base: studies are limited in size and design, results are heterogeneous, and assessments by independent reviewers conclude insufficient clinical validity or utility to justify routine screening use.

Routine annual MRI screening is not supported for individuals at average risk. In particular, MRI screening is not indicated for women with a lifetime risk below 15% or when breast density is the only risk factor; MRI screening is reserved for those meeting high‑risk criteria (e.g., lifetime risk ≥ 20% or other listed high‑risk conditions).

Summary — Not covered / Unproven technologies: The policy lists multiple modalities considered unproven or not medically necessary for routine screening, including ABUS, standalone CAD, computer‑aided tactile imaging, CT of the breast (CBBCT), electrical impedance scanning (EIS), MRE, MRI for density alone, and molecular imaging techniques such as BSGI/MBI/PEM. Coverage is not supported without higher‑quality evidence demonstrating clinical validity and patient benefit.

NOT COVERED — The policy states that the routine use of breast CT / cone‑beam breast CT for screening is not covered due to lack of evidence demonstrating clinical validity or utility; prior authorization is likely required if these modalities are requested given current evidence limitations.

NOT COVERED — As reiterated in multiple sections, breast CT / CBBCT for routine screening lacks sufficient supporting evidence and is therefore considered not medically necessary for screening in place of conventional modalities.

NOT COVERED — The policy repeatedly documents that routine screening with breast CT / CBBCT is not supported by available evidence and should not replace established screening approaches; claims may be at risk if used routinely.

Specific Covered Indications

Breast MRI for high-risk individuals

Breast MRI for high-risk individuals: Covered when the individual meets high-risk criteria as defined by this policy (see Proven/Medically Necessary Modalities and MRI high-risk criteria).>=20% lifetime risk where applicable

Documentation of risk assessment and indication should be available in the medical record.

Supplemental screening for women with dense breasts

Supplemental screening for women with dense breasts: Supplemental imaging may be indicated for women with dense breasts when additional risk factors or shared decision-making support its use; routine supplemental screening based solely on breast density without other risk factors is not supported by current evidence.N/A

When considering supplemental modalities, weigh incremental cancer detection against increased recalls and biopsies; EUSOBI suggests MRI every 2–4 years for select women aged 50–70 with extremely dense breasts.

Applicable Procedure and Billing Codes

Applicable procedure codes (CPT/HCPCS/T codes)mixed

0422T	Tactile breast imaging by computer-aided tactile sensors, unilateral or bilateral.
0633T	Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material.
0634T	Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s).
0635T	Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s).
0636T	Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s).
0637T	Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s).
0638T	Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s).
76376	3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation.
76377	3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation.
76391	Magnetic resonance (e.g., vibration) elastography.

1–10 of 19

1/2

Covered CPT Codes (not listed here)mixed

Not specified in this section

Document does not list explicit CPT/HCPCS/ICD-10 codes in these chunks

High-risk lifetime risk threshold

High-risk lifetime risk threshold>= 20% lifetime risk (per family-history–based models such as Gail, Claus, Tyrer-Cuzick, BRCAPRO)

Other high-risk indications for MRIPrior thoracic radiation between ages 10 and 30

Genetic/syndromic high-risk conditionsConfirmed BRCA1/BRCA2, TP53 (Li‑Fraumeni), PTEN, STK11/LKB1 (Peutz‑Jeghers)

Personal history criterionPersonal history of breast cancer (unless treated with bilateral mastectomy)

Family-history criteriaFirst‑degree relative with BRCA1/2 mutation or multiple first‑degree relatives with breast/ovarian cancer

Lifetime risk threshold for MRI screening

Actions, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization May Be Required

Prior authorization may be required when ordering breast computed tomography (including cone-beam breast CT/CBBCT) or other novel CT-based breast imaging techniques for screening or diagnostic use. Providers should verify plan-specific prior authorization requirements before scheduling these services.

Affected modalities: CBBCT and other novel breast CT techniques
Reason: evidence is limited and inconsistent; claims may be at risk without PA

Billing Rule

Coding Inclusion Is Not a Guarantee of Payment

Inclusion of a procedure or diagnosis code in this policy or the applicable code list is for reference only and does not guarantee coverage or payment. Benefit determination is made by member-specific plan documents, and applicable laws may require coverage for certain services. Providers should not assume reimbursement solely on the basis of a code appearing in this policy.

Prior Authorization and Pre-service Requirements

Billing Rule

MRI codes 77048/77049 include CAD; no separate CAD reimbursement

Coding clarification: MRI breast codes 77048 and 77049 describe MRI without and with contrast material(s) and explicitly include computer-aided detection when performed; no separate CAD reimbursement is available with these codes.

Prior Authorization

Prior authorization recommended for CBBCT / breast CT used for screening

Prior authorization is recommended when CBBCT or other breast CT techniques are used for screening or as a replacement for conventional imaging because the evidence is limited and clinical usefulness is unproven.

Prior Authorization

PA may be required for MRI, MBI/BSGI, or CEM based on risk and plan rules

Prior authorization may be required for screening breast MRI or advanced adjunct imaging (MRI, MBI/BSGI, CEM) depending on the patient’s risk status and local plan rules; verify requirements prior to scheduling.

Contrast Use and Related Coding Guidance

Billing Rule

MRI breast codes describe without/with contrast; CAD inclusion noted

MRI breast CPT codes 77046–77049 distinguish procedures with and without contrast; 77048 and 77049 specifically describe MRI without and with contrast material(s) and include CAD when performed.

Note

CE-CBBCT showed higher sensitivity/specificity than non-contrast CBBCT in limited studies

Contrast-enhanced CBBCT (CE-CBBCT) demonstrated higher pooled sensitivity and specificity versus non-contrast CBBCT in limited studies; protocols for IV contrast administration varied across reports.

Billing Rule

Contrast-enhanced imaging may increase detection but also false positives

Use of contrast-enhanced modalities (e.g., MRI, CEM) can increase cancer detection but also increases false positives and potential contrast-related risks; document indication and weigh benefits versus harms when ordering.

Definitions and Technology Descriptions

Automated Breast Ultrasound (ABUS)

DefinitionAutomated Breast Ultrasound (ABUS) are ultrasound platforms that automate acquisition of volume data using high‑frequency broadband transducers to produce 2D and 3D B‑mode images as an adjunct to mammography.

Technology descriptionAutomated 3D acquisition (prone or supine systems) provides volumetric datasets for double reading and can improve cancer detection when added to mammography in women with dense breasts.

Clinical contextStudies show ABUS plus mammography can increase cancer detection (example: Gatta et al. prospective cohort) but also increase recall rates; generalizability remains limited.

Breast Specific Gamma Imaging (BSGI) / Molecular Breast Imaging (MBI)

DefinitionBreast‑Specific Gamma Imaging (BSGI) / Molecular Breast Imaging (MBI) are nuclear medicine functional imaging tests using intravenous radioactive tracers and gamma cameras to detect breast tissue with increased tracer uptake.

Frequency and Interval Guidance

MRI frequency guidance

Recommended intervalEvery 2–4 years

Population referencedEUSOBI recommendation for women aged 50–70 with extremely dense breasts

RationaleEUSOBI cites potential mortality reduction and cost‑effectiveness of periodic MRI screening in this subgroup, balanced against availability and QA considerations.

Not Covered / Exclusions

NOT COVERED — The following are summarized as not covered or unproven: Automated Breast Ultrasound (ABUS), standalone Computer‑Aided Detection (CAD), computer‑aided tactile imaging, computed tomography of the breast (CBBCT), electrical impedance scanning (EIS), magnetic resonance elastography (MRE), MRI for density alone, and molecular breast imaging (BSGI/MBI/PEM). These technologies require higher‑quality evidence before being considered medically necessary for routine screening.

NOT COVERED — The policy indicates that the routine use of breast CT / cone‑beam breast CT for screening is not covered due to insufficient clinical validity and utility, and that further well‑designed prospective studies are needed to validate clinical usefulness.

NOT COVERED — Duplicate entry reiterating that routine breast CT / CBBCT screening is not supported by current evidence and is considered not medically necessary pending further validation.

NOT COVERED — Repeated notice that breast CT / CBBCT for routine screening is not covered because available studies are insufficient to demonstrate clinical benefit or replace conventional screening modalities.

Background and Policy Scope

Background: Breast imaging encompasses multiple modalities — mammography, ultrasound (including ABUS), MRI, molecular imaging (MBI/BSGI), CT‑based techniques, and adjunct methods such as MRE and EIS. MRI screening is indicated for individuals who meet defined high‑risk criteria (for example, known BRCA mutation, prior chest irradiation between ages 10–30, or a calculated lifetime risk ≥ 20%), while many newer or adjunct modalities remain investigational or not medically necessary for routine screening.

Policy Summary

PayerUnitedHealthcare

PolicyBreast Imaging for Screening and Diagnosing Cancer

Policy CodePolicy 2025T0375II

Change TypeNo material changes

Effective DateMay 1, 2025

Next Review DateN/A

SourceLink

On This Page

Computed Tomography of the Breast (CBBCT): Cone-beam and other breast CT techniques have shown variable diagnostic performance versus mammography in small studies and meta-analyses; overall evidence quality is low and insufficient to support routine screening use.

Additional large-scale prospective validation required.

Electrical Impedance Scanning (EIS)/EIT: Heterogeneous evidence with pooled analyses suggesting moderate diagnostic accuracy, but prospective data are inconsistent and clinical utility is unproven; use should be limited to research or with strong justification.

Magnetic Resonance Elastography (MRE): MRE can quantify breast tissue stiffness and small studies show associations with cancer risk and potential to improve diagnostic accuracy when combined with contrast MRI, but clinical benefit and outcome impact are unproven.

Investigational; larger studies required.

Molecular Breast Imaging (MBI/BSGI)/Scintimammography: These modalities demonstrate relatively high sensitivity and specificity in diagnostic contexts and may be considered adjuncts when MRI is contraindicated or unavailable, but they are not supported for routine population screening due to limited outcome data and higher radiation exposure.

ACR recommends against BSGI for screening because of radiation dose; NCCN does not support routine use for average-risk screening.

Adjunctive lesion characterization with ultrasound

Adjunctive lesion characterization with ultrasound: Ultrasound (including handheld ultrasound) is appropriate as an adjunct for lesion workup and characterization; adjunctive CAD tools (e.g., S-Detect) may assist interpretation but have not been shown to improve patient outcomes and should be used with documentation of results.

CAD metrics demonstrate promising sensitivity/specificity but are limited by small retrospective studies.

Supplemental breast imaging indications

Supplemental imaging for screening high-risk individuals: Supplemental breast imaging (e.g., MRI) is indicated for screening in individuals who meet high-risk criteria per this policy; when MRI is contraindicated or unavailable, consider alternatives such as contrast-enhanced mammography (CEM), molecular imaging (MBI), or whole-breast ultrasound as adjuncts per guideline recommendations.>=20% lifetime risk for standard MRI screening indications

NCCN endorses CEM or MBI when MRI cannot be performed; document rationale and how results will influence management.

Other supplemental imaging indications (diagnostic/adjunct): Adjunctive imaging modalities (e.g., MBI/BSGI, scintimammography, CBBCT) may be considered for diagnostic problem-solving or when standard modalities are inconclusive, but routine population screening with these techniques is not supported by evidence.N/A

Use of these adjuncts should be justified in the record and follow stepwise imaging principles.

Primary MRI screening threshold>= 20% lifetime risk (per validated family-history dependent risk models)

Society guidance rangeSome societies cite 20–25% lifetime risk as the MRI screening threshold

Supporting guideline sourcesACR and NCCN consider MRI appropriate at >=20% lifetime risk

Coding inclusion is not a guarantee of payment
Verify member benefits and medical necessity documentation prior to performing services

Denial Risk

Insufficient Evidence to Support Routine Use of Breast CT for Screening

Current evidence is insufficient to support the routine use of breast CT (including CBBCT) or many other emerging CT techniques for breast cancer screening. Studies are small, retrospective, uncontrolled, or heterogeneous, and lack high-quality prospective data demonstrating improved health outcomes compared with established modalities.

CBBCT evidence: limited, small studies with high heterogeneity
No conclusive data showing outcome benefit over mammography or MRI

Denial Risk

MRI Screening Not Supported When Density Is the Sole Risk Factor

Evidence does not demonstrate that performing MRI for screening in individuals whose only risk factor is breast density leads to improved outcomes. MRI screening is supported for certain high-risk populations (e.g., BRCA mutation carriers, prior chest irradiation, ≥20% lifetime risk) but is not routinely recommended solely for dense breasts without additional risk factors.

MRI screening supported for high-risk groups per ACR and guideline recommendations
Not supported for density alone—verify risk status before ordering MRI

Documentation Required

Documentation Required for Reviews and Prior Authorization

Document clinical rationale and maintain medical records to support imaging decisions and authorization requests. Records should include patient risk status, breast density, symptoms/findings, prior imaging results, and how the advanced or supplemental imaging result is expected to affect management.

Document: risk status (e.g., genetic, prior chest radiation, lifetime risk estimate)
Document: breast density and prior imaging
Document: clinical indication and expected impact on management
Retain copies of prior authorization approvals and supporting records for review

Note

Study-Level Evidence Considered in Policy Rationale

Policy decisions consider study-level evidence, with emphasis on prospective studies and randomized controlled trials where available. Retrospective, single-center, and small-sample studies are given less weight; additional well-designed prospective research is needed to establish clinical utility for many supplemental and novel imaging technologies.

Prospective and randomized data prioritized when available
Retrospective and uncontrolled studies raise risk of bias and limit conclusions
Providers should reference higher-quality evidence when justifying novel imaging

Note

Alternatives When MRI Is Contraindicated or Unavailable

When MRI is contraindicated or unavailable, consider alternative supplemental imaging modalities such as contrast-enhanced mammography (CEM), molecular breast imaging (MBI)/breast-specific gamma imaging (BSGI), or whole-breast ultrasound depending on patient risk, availability, and local practice guidelines. Be aware that some modalities (e.g., MBI/BSGI) involve higher radiation exposure and may have guideline limitations.

Alternatives: CEM, MBI/BSGI, whole-breast ultrasound
Consider risks: iodinated contrast for CEM; radiation dose for MBI/BSGI
Follow guideline recommendations for high-risk patients who cannot undergo MRI

Step Therapy

Consideration of Stepwise Imaging (Conventional Mammography ± Supplemental Imaging)

Consider a stepwise imaging approach for screening: conventional mammography (with or without digital breast tomosynthesis/DBT) as first-line, with supplemental handheld ultrasound or other modalities added based on breast density and individual risk. Use evidence-based justification for adding supplemental imaging and document how it will change management.

Stepwise approach: mammography ± DBT first
Add supplemental ultrasound or other modalities for dense breasts or elevated risk
Document rationale and expected management impact

Procedure notesPerformed after IV tracer administration with a dedicated gamma camera; proposed primarily as an adjunct to mammography for lesion characterization or biopsy selection.

Radiation considerationMBI/BSGI have a higher radiation burden than mammography; evidence supports relatively high sensitivity and specificity but not routine screening use.

Computer-Aided Tactile Breast Imaging

DefinitionComputer‑Aided Tactile Breast Imaging uses a tactile array sensor moved across the breast to capture pressure/conductance data that are processed into multi‑dimensional color images representing size, shape, hardness, and location of suspicious masses.

TechnologyHand‑held tactile sensor data are immediately processed and displayed on a computer to assist detection and localization of palpable or nonpalpable lesions.

Evidence/stanceCurrent evidence is very low‑quality and investigational; clinical impact on outcomes is unproven.

Electrical Impedance Scanning (EIS)

DefinitionElectrical Impedance Scanning (EIS) detects abnormal breast tissue by applying small electrical currents and creating conductivity maps to identify areas of higher conductivity associated with malignancy.

TechniqueCurrent is transmitted via an arm patch or handheld device and measured by surface probes to generate maps of suspicious sites.

Evidence/stanceEvidence is heterogeneous; EIS is considered investigational with insufficient data demonstrating improved clinical outcomes.

Magnetic Resonance Elastography (MRE)

DefinitionMagnetic Resonance Elastography (MRE) is an MRI technique that measures mechanical properties of tissue (elastic modulus, stiffness) by applying a known stressor and imaging resulting tissue deformation.

Technique detailsPhase‑contrast–based acquisition uses an electromechanical driver and integrated RF coil to quantify tissue stiffness; malignant tissue typically demonstrates higher elastic modulus than surrounding tissue.

Clinical statusFeasibility studies show MRE can depict tissue stiffness and may aid lesion characterization, but clinical benefits and outcome impact remain investigational.

Positron Emission Mammography (PEM)

DefinitionPositron Emission Mammography (PEM) is a high‑resolution metabolic breast imaging modality using FDG tracer with detectors integrated into a mammography system to acquire emission images immediately after mammography.

Clinical rolePEM provides metabolic imaging for patients who cannot have MRI and offers higher spatial resolution than PET‑CT for breast lesions.

Procedure noteUses FDG tracer and is considered a functional imaging adjunct rather than first‑line screening in average‑risk populations.

Automated Breast Ultrasound System (ABUS)

DefinitionAutomated Breast Ultrasound System (ABUS) is an automated 3‑D ultrasound acquisition technology generating volumetric datasets for whole‑breast evaluation as a supplemental screening tool in women with dense breasts.

Screening contextWhen added to mammography in women with dense breasts, ABUS has been reported to increase cancer detection but may increase recall rates; study generalizability is limited and further validation is needed.

ExamplesProspective studies (e.g., Gatta et al.) reported doubled detection in one cohort with an incremental diagnostic yield of 3.4 per 1000 screened when ABUS was added to mammography.

S-Detect (CAD for ultrasound)

DefinitionS‑Detect is a software‑based computer‑aided detection (CAD) tool for ultrasound that performs morphological image analysis to help distinguish benign from malignant breast masses.

PerformanceMeta‑analysis reports pooled sensitivity ~0.82 and specificity ~0.83 for S‑Detect in differentiating breast nodules, but studies are limited in size and quality.

Clinical roleMay be used adjunctively with conventional ultrasound interpretation; impact on patient outcomes remains unproven.

Cone-Beam Breast Computed Tomography (CBBCT)

DefinitionCone‑Beam Breast Computed Tomography (CBBCT) is a breast‑dedicated CT technique available in non‑contrast and contrast‑enhanced forms to provide three‑dimensional breast imaging.

Diagnostic contextLimited systematic reviews show CE‑CBBCT may have higher pooled sensitivity and specificity than non‑contrast CBBCT and diagnostic accuracy numerically comparable to breast MRI in some analyses, but evidence is heterogeneous and limited.

Clinical stanceInsufficient high‑quality evidence exists to support routine screening use; further large prospective studies are needed.

Magnetic Resonance Elastography (MRE) — MRI‑based technique

Short labelMRE (Magnetic Resonance Elastography)

Technique summaryMRI‑based technique quantifying tissue mechanical properties (stiffness, elasticity, viscosity) that may be associated with malignancy.

Clinical statusInvestigational; may aid characterization but requires further validation in larger studies.

MRE — short label

LabelMRE

MeaningMagnetic Resonance Elastography

ContextPhase‑contrast MRI method to quantify tissue stiffness for potential lesion characterization; investigational status noted.

MBI / BSGI — abbreviations

AbbreviationMBI = Molecular Breast Imaging; BSGI = Breast‑Specific Gamma Imaging

UsageThese abbreviations denote nuclear medicine functional imaging modalities that detect tracer uptake in breast tissue and are used as adjuncts to mammography.

Radiation noteAssociated with higher radiation dose than mammography; not recommended for routine population screening by some societies.