National Medical Policy

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "National Medical Policy"

Transcription

1 National Medical Policy Subject: Breast Tomosynthesis (Digital), 3-D Mammography Policy Number: NMP 526 Effective Date: December 2013 Update: April 2016 This National Medical Policy is subject to the terms in the IMPORTANT NOTICE at the end of this document *For Medicaid Plans: Please refer to the appropriate Medicaid Manuals for coverage guidelines prior to applying Health Net Medical Policies The Centers for Medicare & Medicaid Services (CMS) For Medicare Advantage members please refer to the following for coverage guidelines first: Use Source Reference/Website Link X National Coverage Determination (NCD) NCD Mammography AAA& National Coverage Manual Citation Local Coverage Determination (LCD)* Article (Local)* X Other Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/MM8874.pdf None Instructions Medicare NCDs and National Coverage Manuals apply to ALL Medicare members in ALL regions. Medicare LCDs and Articles apply to members in specific regions. To access your specific region, select the link provided under Reference/Website and follow the search instructions. Enter the topic and your specific state to find the coverage determinations for your region. *Note: Health Net must follow local coverage determinations (LCDs) of Medicare Administration Contractors (MACs) located outside their service area when those MACs have exclusive coverage of an item or service. (CMS Manual Chapter 4 Section 90.2) If more than one source is checked, you need to access all sources as, on occasion; an LCD or article contains additional coverage information than contained in the NCD or National Coverage Manual. If there is no NCD, National Coverage Manual or region specific LCD/Article, follow the Health Net Hierarchy of Medical Resources for guidance. Breast Tomosynthesis April

2 Current Policy Statement Note: Please refer to specific state regulation for coverage information as it may vary by state and product line. Digital breast tomosynthesis (DBT) is considered investigational for all indications as there currently is insufficient evidence in the medical literature to recommend this technology for routine screening or diagnosis at this time. Codes Related To This Policy ICD-10 C C Malignant neoplasm of nipple and areola, female (code range) C C Malignant neoplasm of central portion of breast, female (code range) C C Malignant neoplasm of upper-inner quadrant of breast, female (code range) C C Malignant neoplasm of lower-inner quadrant of breast, female (code range) C C Malignant neoplasm of upper-outer quadrant of breast, female (code range) C C Malignant neoplasm of lower-outer quadrant of breast, female (code range) C C Malignant neoplasm of axillary tail of breast, female (code range) C C Malignant neoplasm of overlapping sites of breast, female (code range) C C Malignant neoplasm of breast of unspecified site, female (code range) C79.81 Secondary malignant neoplasm of breast C79.89 Secondary malignant neoplasm of other specified sites C79.9 Secondary malignant neoplasm of unspecified site D05.00-D05.92 Lobular carcinoma in situ of breast (code range) D48.60-D48.62 Neoplasm of uncertain behavior of other and unspecified sites (code range) D49.3 Neoplasm of unspecified behavior of breast R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast Z12.31 Encounter for screening mammogram for malignant neoplasm of breast Z12.39 Encounter for other screening for malignant neoplasm of breast Z80.3 Family history of malignant neoplasm of breast Z85.3 Personal history of malignant neoplasm of breast CPT Codes Digital breast tomosynthesis; unilateral Digital breast tomosynthesis; bilateral Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) HCPCS Codes G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206) Background Digital breast tomosynthesis (DBT) also known as 3-dimensional (3-D) mammography is a modification of digital (2-D) mammography. The difference is that DBT uses a rotating X-ray tube to acquire multiple image slices at several angles. The patient s breast is placed on a digital flat-panel detector and lightly compressed while the X-ray tube rotates around the breast in an arc. It is rotated about +/-15 degrees, and 11 exposures are made every 3 degrees or so during a total scan. Data from the X-ray projections are then reconstructed by computer software to produce a 3D map of the breast, similar to the methods used in computed tomography. The DBT cross-sectional images are approximately 1 millimeter in thickness and can be viewed individually or in a dynamic movie mode. According to the FDA, traditional 2-D imaging has its limitations as about 10 percent of women receive further testing after the initial screening for abnormalities later determined to be noncancerous. DBT is proposed to resolve the issue of tissue overlap that can occur Breast Tomosynthesis April

3 in 2-D breast imaging that may hide cancerous lesions or cause benign masses to appear as suspicious, which are the major reasons for recalls and requests for additional imaging. Scientific Rationale - May 2016 HAYES (2015) identified 25 prospective or retrospective comparative cohort studies from January 2000 thru August 2015, evaluating digital breast tomosynthesis for screening, diagnosis, or characterization of breast lesions. Studies populations ranged from 100 to 100 to 454,850 patients and included adult women with no indications of breast cancer undergoing routine screening, or undergoing targeted or additional breast imaging to investigate known or suspected breast cancer. Studies compared digital breast tomosynthesis alone or in combination with digital mammography (DM) or ultrasonography (US). In women undergoing screening, outcomes included recall, biopsy, and cancer detection rates. Comparing the results of the best available studies led to the conclusion that for breast cancer detection, tomosynthesis is not consistently better than conventional DM unless it is combined with conventional DM. These imaging methods differ in that tomosynthesis combines multiple low-radiation dosage images while DM captures a single higher-dosage image. These differing image collection techniques may be complementary, allowing the combination of the 2 techniques to provide better breast imaging than either technique alone. However, additional studies are needed to confirm this conclusion and to determine whether the apparent benefits of combining tomosynthesis and conventional DM offset the increase in radiation dosage and additional time needed to collect and interpret the results of tomosynthesis and DM imaging. A particular concern is that most of the studies did not compare tomosynthesis with conventional DM that included spot compression and magnified and angled views. The two largest studies are noted here. Friedewald et al (2014) studied 454,850 women in 13 radiology practices to determine if mammography combined with tomosynthesis is associated with better performance of breast screening programs in the United States. The study took place in two time periods ad the mean age was 56.2 years.. Outcomes included recall rate for additional imaging, cancer detection rate and positive predictive values for recall and for biopsy. Period 1 included one full year of screening with digital mammography alone, ending on the date of 3D introduction at each institution. Period 2 included screening with digital mammography and tomosynthesis (2D) + 3D). Of the 454,850 examinations, 281,187 (period 1) received digital mammography; 173,663 (period 2) received digital mammography + tomosynthesis. With digital mammography, 29,726 patients were recalled and 5056 biopsies resulted in cancer diagnosis in 1207 patients (n=815 invasive; n=392 in situ). With digital mammography + tomosynthesis, 15,541 patients were recalled and 3285 biopsies resulted in cancer diagnosis in 950 patients (n=707 invasive; n=243 in situ). Results were reported as model-adjusted rates per 1000 screens. For recall rates: 107 (95%CI, ) with digital mammography vs 91 (95%CI, ) with digital mammography + tomosynthesis; difference, 16 (95%CI, 18 to 14; P <.001); For biopsies: 18.1 (95%CI, ) with digital mammography vs 19.3 (95%CI, ) with digital mammography + tomosynthesis; difference, 1.3 (95%CI, ; P =.004); For cancer detection: 4.2 (95%CI, ) with digital mammography vs 5.4 (95%CI, ) with digital mammography + tomosynthesis; difference, 1.2 (95%CI, ; P <.001); and For invasive cancer detection: 2.9 (95%CI, ) with digital mammography vs 4.1 (95%CI, ) with digital mammography + tomosynthesis; difference, 1.2 (95%CI, ; P <.001). Breast Tomosynthesis April

4 In situ cancer detection: 1.4 (95%CI, ) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3%to 6.4%(difference, 2.1%; 95%CI, 1.7%-2.5%; P <.001) and for biopsy from 24.2%to 29.2%(difference, 5.0%; 95%CI, 3.0%-7.0%; P <.001). The authors noted study limitations include the lack of prospective randomization and a lack of follow-up over several years but concluded that the addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes. Greenberg et al (2014) performed a retrospective comparative cohort study to evaluate breast DM plus tomosynthesis vs DM alone for detection of breast cancer in a community based radiology practice in 59, 617 women. Performance outcomes measures were assessed for 14 radiologists who interpreted more than 500 screening mammography 3D DBT studies after the initiation of tomosynthesis. Outcomes from screening mammography during the study period between August 9, 2011, and November 30, 2012, using 3D DBT (n = 23,149 patients) versus 2D DM (n = 54,684 patients) were compared. For patients screened with 3D DBT, the relative change in recall rate was 16.1% lower than for patients screened with 2D DM (p > ). The overall cancer detection rate (CDR), expressed as number of cancers per 1000 patients screened, was 28.6% greater (p = 0.035) for 3D DBT (6.3/1000) compared with 2D DM (4.9/1000). The CDR for invasive cancers with 3D DBT (4.6/1000) was 43.8% higher (p = ) than with 2D DM (3.2/1000). The positive predictive value for recalls from screening (PPV1) was 53.3% greater (p = ) for 3D DBT (4.6%) compared with 2D DM (3.0%). No significant difference in the positive predictive value for biopsy (PPV3) was found for 3D DBT versus 2D DM (22.8% and 23.8%, respectively) (p = 0.696). The authors concluded that in community-based radiology practice, mammography screening with 3D DBT yielded lower recall rates, an increased CDR for cancer overall, and an increased CDR for invasive cancer compared with 2D DM. The PPV1 was significantly greater in the group screened using 3D DBT. Society Positions/Recommendations United States Preventative Services Task Force (USPSTF). January 2016 The USPSTF concludes that the evidence on DBT as a primary screening method for breast cancer is insufficient, and the balance of benefits and harms cannot be determined: All women Women with dense breasts The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. These recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 Breast Tomosynthesis April

5 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age. National Comprehensive Cancer Network (NCCN) January 2015 According to the National Comprehensive Cancer Network, Early studies show promise for tomosynthesis mammography. Two large trials showing a combined use of digital mammography and tomosynthesis resulted in improved cancer detection and decreased call back rates; of note, this is double the dose of radiation and is a factor in recommending this modality. Definitive studies are still pending. American College of Obstetricians and Gynecologists (ACOG) 2013 Clinical data suggest that digital mammography with tomosynthesis produces a better image, improved accuracy, and lower recall rates compared with digital mammography alone. Further study will be necessary to confirm whether digital mammography with tomosynthesis is a cost-effective approach capable of replacing digital mammography alone as the first-line screening modality of choice for breast cancer screening. ACOG 2015: Current published evidence does not demonstrate meaningful outcome benefits (eg, reduction in breast cancer mortality) with supplemental tests (eg, ultrasonography and magnetic resonance imaging) to screening mammography or with alternative screening modalities (eg, breast tomosynthesis or thermography) in women with dense breasts who do not have additional risk factors. Evidence is lacking to advocate for additional testing until there are clinically validated data that indicate improved screening outcomes. American College of Radiology November 2014 A new digital technology, breast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing. This is extremely important. Lower recall rates result in fewer patients who may experience short-term anxiety awaiting test results. This is important evidence that tomosynthesis will have a positive impact on patient care. As this technology is used in clinical practice, we anticipate that further studies will clarify its impact on long-term clinical outcomes, including reduced mortality. It will also be important to further elucidate which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.). To facilitate such large scale outcome data collection, the technology must be widely available. Availability is greatly impacted by reimbursement for the service provided. The College applauds the decision by the Centers for Medicare and Medicaid Services (CMS) to facilitate access to these exams by covering beneficiaries for tomosynthesis and urges private payers to do the same. To be clear: tomosynthesis is no longer investigational. Tomosynthesis has been shown to improve key screening parameters compared to digital mammography. While the College encourages more studies to clarify the clinical role(s) of tomosynthesis and its long-term outcomes, it is clear that tomosynthesis represents an advance in breast imaging. The ACR will continue to update members and external stakeholders on this important matter. American Cancer Society October 2015 Although digital breast tomosynthesis units are steadily being introduced in mammography facilities, at the time the protocol for the evidence review was developed, there was too little data on digital breast tomosynthesis to include comparisons to 2D mammography. The issue will continue to be revisited and will be updated as evidence emerges. Breast Tomosynthesis April

6 American Society of Breast Disease (no date noted) DBT is an advanced imaging technology for breast cancer screening and diagnosis. The DBT technology produces cross-sectional images by using multiple, low-dose acquisitions with total radiation exposure and breast compression similar to that used for conventional 2D digital mammography. The addition of DBT to conventional DM improves the accuracy of diagnostic mammographic interpretation. This improvement in diagnostic accuracy can be achieved by enhanced detection of lesion, improvement in the analysis of the margins of a lesion and precise localization of a lesion. DBT with DM has a higher sensitivity than DM alone. Published studies showed an increase cancer detection rate of 27-30% at screening. Single center studies have shown that DBT and DM have increased specificity compared to DM alone. Multiple studies noted reduction in the recall rates of screening mammography with the addition of DBT. Recent studies suggest that young women with dense mammographic breast tissue may benefit the most from DBT and may have the greatest reduction in the recall rates. The three largest published DBT screening studies demonstrate a 40-50% increase in cancer detection rates. American Society of Breast Surgeons Consensus Statement: Oct 2015 Multiple large screening trials are currently underway comparing the utility of screening patients with 2D + 3D tomosynthesis to 2D conventional mammography alone. Recent data from the Screening with Tomosynthesis OR standard Mammography (STORM) study demonstrated a 17.1% reduction in false positive recalls and a 33.9% increase in the cancer detection rate by adding 3D tomosynthesis to screening. Another study reported similar results, with a 15% decrease in false positives and a 27% increase in the cancer detection rate. Of note, another study found that the increased sensitivity of tomosynthesis was largest for invasive cancers where 15-22% of cases were invasive versus 3% being in situ. Neither the USPSTF or ACS guidelines provide specific recommendations for type of mammogram but recognize that all prior randomized trials used film screen mammography. Breast tomography may be considered for screening a. Early data shows promise in higher sensitivity rates and specificity rates b. May increase detection rates and decrease false positive rates especially in women with dense breast tissue c. Data from large randomized clinical trials is pending Scientific Rationale December 2014 In the 2014 BCBS TECH assessment on the use of digital breast tomosynthesis (DBT) with mammography for breast cancer screening or diagnosis, six studies were identified. The strongest evidence for the use of both services for screening comes from a large trial in Norway involving 12,621 women where 121 screening-detected cancers were identified. The cancer detection rate was 6.1 per 1000 screening with mammography alone and 8.0 per 1000 women with both mammography and DBT. The authors noted that they did not ascertain any improvement in detecting Ductal Carcinoma In Situ (DCIS) by adding breast tomosynthesis. The false-positive rate was 61.1 per 1,000 screenings for mammography alone and 53.1 per 1,000 screenings for mammography plus breast tomosynthesis. Such a reduction in the false-positive rate would decrease the number of women recalled for additional imaging or biopsy. The authors noted that for this interim analysis, only limited data were available about interval cancers, so they could not estimate conventional absolute sensitivity and specificity. The second study (STORM) examined comparative cancer detection for traditional mammography with or without breast tomosynthesis in a general asymptomatic screening population of 7,292 Italian women. The reference standard was pathology for women Breast Tomosynthesis April

7 undergoing biopsies; women with negative results on both mammography and breast tomosynthesis were not followed to detect interval cancers that might have been missed during screening, so neither the sensitivity nor specificity could be calculated. Mammography plus breast tomosynthesis detected 59 cancers; 20 of these cancers were missed by traditional mammography alone (p<0.0001). The incremental improvement in cancer detection using both modalities was 2.7 cancers per 1,000 screens (95% CI: 1.7 to 4.2). There were 395 false-positive results: 181 occurred using mammography and both imaging modalities together; an additional 141 occurred using mammography only; and 73 occurred using mammography and breast tomosynthesis combined (p<0.0001) (but not by mammography alone). In preplanned analyses, the researchers found that the combined results of mammography and digital breast tomosynthesis yielded more cancers in patients either younger or older than 60 years old and for both breast density categories (1 and 2 vs. 3 and 4, with 1 being least dense and 4 being most dense). The third study compared results before and after the introduction of breast tomosynthesis at their multisite center. In this apparently retrospective study, the subjects did not serve as their own controls. The addition of tomosynthesis reduced the recall rate from 8.7% to 5.5% (p<0.001). Breast cancer detection rates did not differ between the two periods (4.04 per 1,000 screenings to 5.37 per 1,000 with tomosynthesis; p=0.18). The positive predictive value for recalls increased from 4.7% with mammography alone to 10.1% with the addition of tomosynthesis (p<0.001). The improvement in recall rates was similar across breast density categories, ranging from 32.4% (densest) to 41.0% (least dense). The TEC Assessment concluded that the evidence suggests that use of mammography plus breast tomosynthesis may modestly increase the number of cancers detected, with a large decrease in the number of women who undergo unnecessary recalls or biopsies. However, the studies were nonrandomized and the lack of long-term follow-up prevents assessment of false negative results and full assessment of test performance. Further, overall impacts on health outcomes are unknown. Long-term effects of additional radiation exposure also are unknown and therefore digital breast tomosynthesis is considered investigational. A trial that randomizes women to digital mammography with or without tomosynthesis, or performs both screening methods in the same woman, is required to demonstrate that improvements in screening are due to tomosynthesis and not to confounding variables, eg, patient characteristics or radiologist experience in tomosynthesis interpretation. The utility of adding DBT to diagnostic mammography (such as spot views) to reduce the number of women who undergo unnecessary biopsies by screening out some fraction of women with false-positive results is also being evaluated. The TEC Assessment evaluated 3 studies as follows: In a study of 158 women consecutively recalled after screening mammography, breast tomosynthesis was evaluated as a possible triage tool to reduce the number of false-positive results. The results of the diagnostic assessment (including ultrasound and needle biopsy when performed) were used as the reference standard. Breast tomosynthesis eliminated 102 of the 158 recalls, all of which were unnecessary (i.e., false-positive results on mammography). No cancers were missed on breast tomosynthesis. The performance of breast tomosynthesis did not vary by breast density or age group, but the reduction in recalls was greater for asymmetric densities and distortions, and nodular opacities with regular margins. The authors noted that the decline in recall rates following the use of breast tomosynthesis was higher in this study than in blinded comparisons of digital mammography and breast tomosynthesis. Another study compared diagnostic mammography to breast tomosynthesis among women with abnormalities on screening mammography with no calcifications in a simulated clinical setting. The breast tomosynthesis rating was based on 2 readers ratings and their confidence that no additional studies were needed, as well as ultrasound results in some Breast Tomosynthesis April

8 cases. The reference standard was either the results of the entire clinical workup, including biopsy if performed, or follow- up for women not undergoing biopsy (86.1% of the entire sample). There was no statistically significant difference in sensitivity or specificity between diagnostic mammography and breast tomosynthesis. The third study evaluated 738 women with 759 lesions who were recalled after screening with film mammography. In this unblinded study, the incremental value of adding breast tomosynthesis to film and digital mammography was assessed. The reference standard consisted of pathology results or follow-up for 18 to 36 months. Adding breast tomosynthesis to film and digital mammography results increased the area under the curve (AUC) from ( ) to ( ) (p=0.001). The complete sensitivity (counting ratings of 3-5 as positive) increased from 39.7% for digital mammography to 58.3% when breast tomosynthesis was added; no confidence intervals or p values were reported. The specificity increased from 51% to 74.2% when breast tomosynthesis was added to digital mammography. The difference in AUC after the addition of breast tomosynthesis was statistically significant for soft-tissue lesions, but not for micro calcifications. The authors noted that ultrasound and MRI are used during the diagnostic work-up so studies comparing diagnostic mammography and DBT may not allow a good comparison and a different research design would be needed to accurately assess how DBT compares to these modalities. They conclude that the evidence currently available on the use of breast tomosynthesis plus diagnostic mammography versus diagnostic mammography alone for a diagnostic workup is insufficient to permit conclusions regarding the effect on health outcomes of adding breast tomosynthesis. In November 2014, the American College of Radiology issued a statement to regard DBT as an advancement over digital mammography because of higher cancer detection rates and fewer patient recalls for additional testing. The ACR also states that further studies are needed to clarify its impact on long-term clinical outcomes, including reduced mortality and to further elucidate which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.). Scientific Rationale - Initial Chen et al. (2007) carried out a small pilot study of 13 women recruited between April 2005 and November 2005 to assess the clinical feasibility of contrast enhanced (CE) DBT as an adjunct to digital mammography, and to correlate lesion enhancement characteristics and morphology obtained with CE-DBT to digital mammography, magnetic resonance (MR) and ultrasound (US). After undergoing breast imaging evaluation (including digital mammography, US, and MR) as part of the parent multimodality breast imaging study (NCIfunded grant [PO1-CA85484]) the participants were evaluated with CEDBT. Eleven of the 13 participants had pathology proven malignancies, (6 invasive ductal carcinoma, 4 ductal carcinoma in situ, 1 invasive lobular carcinoma). Suspicious lesions were demonstrated with CE-DBT in 10 of 11 cases of proven breast malignancy. The researchers concluded that when used in conjunction with diagnostic mammography, CE-DBT may be a potential alternative tool for breast lesion morphologic and vascular characterization. A 2007 study by Poplack et al. assessed the image quality of DBT with that of conventional mammography and to estimate the recall rate of screening when tomosynthesis is used in addition to mammography. A total of 98 consecutive women between 34 and 85 years of age with an abnormal digital screening mammogram were included in the study. During the initial evaluation each woman underwent a DBT examination using a research prototype tomosynthesis unit (Genesis, Hologic) and screening mammography using full-field digital technology. The image quality of DBT was subjectively rated as equivalent in 52% (51/99) or superior 37% (37/99) to diagnostic mammography in 89% (88/99) of cases. In the identification of masses, DBT image quality was rated as equivalent in 26% (5/19) or Breast Tomosynthesis April

9 superior to diagnostic mammography in 68% (13/19) of cases. Calcifications usually showed better image quality on diagnostic mammography than on DBT. The authors concluded that "tomosynthesis has comparable or superior image quality to that of film-screen mammography in the diagnostic setting, and it has the potential to decrease the recall rate when used adjunctively with digital screening mammography." However, limitations of the study included the small sample size and the fact that the study was unblinded, nonrandomized and uncontrolled. DBT may perform differently in a general screening population than in the study group of women who were recruited because of a breast screening abnormality. In this study group, only 5% (5/98) of women had fatty breast composition; the remainder, 95% (93/98), had higher density compositions. In a population with a greater proportion of fatty breast composition, DBT may prove to be less effective. A 2008 study by Goode et al. evaluated issues associated with digital tomosynthesis image interpretation. Nine board certified radiologists were asked to review the breast images from 30 women who underwent digital mammography and digital tomosynthesis to look for masses and micro calcification clusters from each film. Nine board certified radiologists independently reviewed the 30 cases 3 times: as displayed as digital mammography, as 11 low-dose projections prior to reconstruction of tomosynthesis images, and the reconstructed digital tomosynthesis examination. They were then asked to rate each image set for the presence or absence detect and rate masses and micro calcification clusters. When compared to digital mammography, the reconstructed DBT examination took much longer to review and interpret. Three of the 9 radiologists perceived the tomosynthesis frame mode to be better than digital mammography, and 6 of the 9 radiologists perceived the reconstructed tomosynthesis examination to be better than digital mammography. The detection rate of malignancies was slightly better for the reconstructed digital tomosynthesis examination than for digital mammography (93.9% versus 90%), and the recall rate for nonmalignancies was slightly lower (62.6% versus 64.3%). The researchers noted that better visualization and training tools will need to be developed before digital tomosynthesis can be used efficiently in a screening environment and additional studies are needed before this imaging approach finds its optimal role in the clinical environment. Andersson et al. (2008) conducted an unblinded study of 36 women to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or twoview digital mammography (DM). Forty breast cancers were found in 37 breasts. The authors found that cancer visibility on breast tomosynthesis was greater in 22 of 40 cancers found compared to single view digital mammography. Thirteen of the remaining 18 cancers were equally visible/clearly visible on single view digital mammography and breast tomosynthesis. While it appears that breast tomosynthesis identifies some cases of breast cancer, in over half of the patients accuracy of diagnosis was not increased and therefore it can not be concluded what type of patient should have breast tomosynthesis and at what stage in the screening process this should occur. The study is also limited by small sample size and non-blinded study design. Gur et al. (2009) conducted a retrospective observer study that compared digital tomosynthesis with digital mammography from 125 selected breast examinations from 8 experienced radiologists. In 35 examinations, cancer had been verified, and the other 90 showed no evidence of cancer. The combination of digital mammography with digital tomosynthesis was associated with a 30% reduction in recalls for the cancer-free examinations compared with the use of digital mammography alone. Digital tomosynthesis alone reduced recall rates by approximately 10%. Digital tomosynthesis did not substantially improve sensitivity. The authors acknowledged that while initial results are promising, further work is needed before DBT finds its optimal role in the clinical environment. Breast Tomosynthesis April

10 Teertstra et al (2010) assessed mammography and DBT in 513 women with an abnormal screening mammogram or with clinical symptoms. The ACR BI-RADS criteria were used to classify the cases. In 112 newly detected cancers, DBT and mammography were each falsenegative in 8 cases (7%). In three cases, both mammography and DBT failed to detect the carcinoma. The sensitivity of both techniques for the detection of breast cancer was 92.9%, and the specificity of mammography was 86.1% and 84.4% for DBT. The authors concluded that DBT can be used as an additional technique to mammography in individuals referred with an abnormal screening mammogram or with clinical symptoms. They also acknowledged that the additional lesions detected by DBT are also likely to be detected by other techniques used in the clinical work-up of these individuals. A retrospective study by Spangler et al. (2011) compared the ability of digital breast tomosynthesis and full field digital mammography (FFDM) to detect and characterize calcifications in 100 paired examinations. There were 20 biopsy-proven cancers, 40 biopsy proven benign calcifications and 40 randomly selected negative screening studies reviewed. Overall calcification detection sensitivity was higher for digital mammography (84%) than for digital breast tomosynthesis (75%). Of the calcifications accurately detected using digital mammography, 14 cancers and 38 benign calcifications were not detected with digital breast tomosynthesis. Of the calcifications accurately detected using digital breast tomosynthesis, 4 cancers and 13 benign calcifications were not detected with FFDM. The authors concluded that digital mammography appears to be slightly more sensitive than digital breast tomosynthesis for the detection of calcification. This study is limited by retrospective design and a small study sample. Skaane et al. (2013) presented results of a clinical trial comparing digital mammography to digital mammography with plus DBT in a population-based screening program in Norway. The results of the 12,631 female participants, detection rates, including those for invasive and in situ cancers, were 6.1 per 1000 examinations for mammography alone and 8.0 per 1000 examinations for mammography plus tomosynthesis. False-positive rates before arbitration were 61.1 per 1000 examinations with mammography alone and 53.1 per 1000 examinations with mammography plus tomosynthesis (15% decrease, adjusted for reader; P <.001). After arbitration, positive predictive values for recalled patients with cancers verified later were comparable (29.1% and 28.5%, respectively, with mammography alone and mammography plus tomosynthesis; P =.72). Twenty-five additional invasive cancers were detected with mammography plus tomosynthesis (40% increase, adjusted for reader; P <.001). The mean interpretation time was 45 seconds for mammography alone and 91 seconds for mammography plus tomosynthesis (P <.001). The researchers found the use of mammography plus tomosynthesis in a screening environment resulted in a significantly higher cancer detection rate and enabled the detection of more invasive cancers. Rafferty et al (2013) conducted a study to compare radiologists' diagnostic accuracy and recall rates for breast tomosynthesis combined with digital mammography versus digital mammography alone. Mediolateral oblique and craniocaudal digital mammographic and tomosynthesis images of both breasts were obtained from 1192 subjects. Two studies were performed to compare digital mammography with tomosynthesis against digital mammography alone. Study 1 comprised 312 cases (48 cancer cases) with images read by 12 radiologists; study 2, 312 cases (51 cancer cases) with 15 radiologists. Study 1 readers recorded only that an abnormality requiring recall was present; study 2 readers had additional training and recorded both lesion type and location. Diagnostic accuracy was compared with receiver operating characteristic analysis. Recall rates of noncancer cases, sensitivity, specificity, and positive and negative predictive values determined by analyzing Breast Imaging Reporting and Data System scores were compared for the two methods. The authors report that diagnostic accuracy for combined tomosynthesis and digital mammography was superior to that of digital mammography alone. Average difference in Breast Tomosynthesis April

11 area under the curve in study 1 was 7.2% (95% confidence interval [CI]: 3.7%, 10.8%; P <.001) and in study 2 was 6.8% (95% CI: 4.1%, 9.5%; P <.001). All 27 radiologists increased diagnostic accuracy with addition of tomosynthesis. Recall rates for noncancer cases for all readers significantly decreased with addition of tomosynthesis (range, 6%- 67%; P <.001 for 25 readers, P <.03 for all readers). Increased sensitivity was largest for invasive cancers: 15% and 22% in studies 1 and 2 versus 3% for in situ cancers in both studies. Limitations of this study noted by the authors include that reader studies were enriched, almost all the patients with cancer where scheduled for biopsy as they had been detected on conventional mammogram. Therefore, it is likely that the study results underestimate the potential gains in sensitivity that might occur in clinical practice. Additional studies done in the clinical environment are needed to confirm the performance of tomosynthesis combined with digital mammography versus digital mammography alone Physician Organizations and Other Recommendations National Comprehensive Cancer Network According to the National Comprehensive Cancer Network Breast Cancer Screening and Diagnosis (V1.2015): Early studies show promise for tomosynthesis mammography. Two large trials showing a combined use of digital mammography and tomosynthesis resulted in improved cancer detection and decreased call back rates. Of note, this is double the dose of radiation and is a factor in recommending this modality. The radiation dose can be minimized by 2-D synthetic reconstruction. Definitive studies are still pending. The Society of Breast Imaging (SBI) and the American College of Radiology (ACR) statement on the on Skaane et al was published on their the ACR website in January 2013 Tomosynthesis Breast Cancer Screening Study states the following "While the study results are promising, they do not provide adequate information to define the role of tomosynthesis in clinical practice Although the cancer detection rate was higher when tomosynthesis was added to mammography alone, it is not known if an equal incremental benefit will be realized in a second screening round. This small study does not supply statistical information regarding subgroups of women that might benefit, or might not benefit from adding tomosynthesis. How the technology will affect screening accuracy among women of different ages, risk profiles and parenchymal density is uncertain. In addition, how this technology would affect reader performance among U.S. radiologists with varying practice patterns and expertise is also uncertain. Other questions include whether computer aided detection will provide any further benefit, and if reconstructed images can be used, in lieu of standard full field digital images, to reduce radiation dose" Guidelines on breast cancer screening from the American College of Obstetricians and Gynecologists (ACOG, 2011) considered, but did not recommend, breast tomosynthesis. The guidelines concluded that "[c]olor Doppler ultrasonography, computer-aided detection, positron emission tomography, scintimammography, and digital breast tomosynthesis have shown promise in selected clinical situations or as adjuncts to mammography for breast cancer diagnosis. However, these technologies are not considered alternatives to routine mammography." In November 2013, the California Technology Assessment Forum (CTAF) voted that the evidence supports supplemental screening of women at high risk for breast cancer, and that screening with MRI had the strongest evidence for use. In addition, the majority of CTAF members voted that MRI and ABUS (Automated Breast Ultrasound) represented high or Breast Tomosynthesis April

12 reasonable value and DBT represented low value compared to HHUS (Hand Held Ultrasound). Review History December 2013 December 2014 May 2016 Medical Advisory Council initial review Updated Scientific Rationale and added new CPT codes Republished policy Evidence Based Sources 1. American College of Obstetricians-Gynecologists. Practice bulletin no. 122: Breast cancer screening. Obstet Gynecol. 2011; 118(2 Pt 1): Available at: Accessed on November 20, American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion No. 625: Management of women with dense breasts diagnosed by mammography. Obstet Gynecol. 2015;125(3): American College of Radiology. Press Releases.ACR, SBI Statement on Skaane et al Tomosynthesis Breast Cancer Screening Study (2013). Available at: Releases/ ACR-SBI-Statement-on-Skaane-et-al. Accessed on November 20, National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology Breast Cancer Screening and Diagnosis (V ). NCCN website: References - May Greenberg JS, Javitt MC, Katzen J, Michael S, Holland AE. Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. AJR Am J Roentgenol. 2014;203(3): Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 014;311(24): United States Preventive Services Task Force Breast Cancer: Screening Jan /breast-cancer-screening1 4. Winifred Hayes Digital Breast Tomosynthesis for Breast Cancer Diagnosis or Screening Hayes Medical Technology Directory Published September 24, American College of Breast Surgeons Consenus Statement on Screening Mammography phy.pdf 6. American Society of Breast Disease. Statement of Digital Breast Tomosynthesis thesis pdf References December BCBS Technology Assessment (January 2014) Use of Breast Digital Tomosynthesis with Mammography for Breast Cancer Screening and Diagnosis. Volume 28 No. 6. Accessed on December 3, 2014 at 2. American College of Radiology (November 24, 2014) Position Statement on Breast Tomosynthesis. Accessed December 2014 at Center/Position-Statements/Position-Statements-Folder/ ACR-Statementon-Breast-Tomosynthesis Breast Tomosynthesis April

13 References Initial 1. Andersson I, Ikeda DM, Zackrisson S, et al. Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol. 2008; 18(12): Chen S, Carton AK, Albert M, et al. Initial Clinical Experience with Contrast-Enhanced Digital Breast Tomosynthesis. Acad Radiol. 2007; 14(2): Good, WF, Abrams GS, Catullo VJ, et al. Digital breast tomosynthesis: a pilot observer study. AJR Am J Roentgenol. 2008; 190(4): Gur D, Abrams GS, Chough DM, Ganott MA. Digital breast tomosynthesis: observer performance study. AJR Am J Roentgenol. 2009; 193(2): Michell MJ, Iqbal A, Wasan RK, et al. A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis. Clin Radiol. 2012; 67(10): Poplack SP, Tosteson TD, Kogel CA, Nagy HM. Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol. 2007; 189(3): Rafferty EA, Park JM, Philpotts LE, et al. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology. 2013; 266(1): Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013; 267(1): Spangler ML, Suley ML, Sumkin JH, et al. Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. Am J Roentgenol. 2011; 196(2): Teertstra HJ, Loo CE., van den Bosch MA, et al. Breast tomosynthesis in clinical practice: initial results. Eur Radiol. 2010; 20(1): California Technology Assessment Forum. September 25, Supplemental Cancer Screening for Women with Dense Breasts. Accessed at: Important Notice General Purpose. Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peerreviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether under the facts and circumstances of a particular case, the proposed procedure, drug, service or supply is medically necessary. The conclusion that a procedure, drug, service or supply is medically necessary does not constitute coverage. The member's contract defines which procedure, drug, service or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net s National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment, and services. In order to be eligible, all services must be medically necessary and otherwise defined in the member's benefits contract as described this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the member s benefits, nor is it intended to dictate to providers how to practice medicine. Policy Effective Date and Defined Terms. Breast Tomosynthesis April

14 The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. * In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative. Policy Amendment without Notice. Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective. No Medical Advice. The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to members. Members should consult with their treating physician in connection with diagnosis and treatment decisions. No Authorization or Guarantee of Coverage. The Policies do not constitute authorization or guarantee of coverage of particular procedure, drug, service or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations, and dollar caps apply to a particular procedure, drug, service or supply. Policy Limitation: Member s Contract Controls Coverage Determinations. Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the member s contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member s contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member s contract shall govern. The Policies do not replace or amend the Member s contract. Policy Limitation: Legal and Regulatory Mandates and Requirements The determinations of coverage for a particular procedure, drug, service or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. Reconstructive Surgery CA Health and Safety Code requires health care service plans to cover reconstructive surgery. Reconstructive surgery means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) To improve function or (2) To create a normal appearance, to the extent possible. Reconstructive surgery does not mean cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance. Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery. Reconstructive Surgery after Mastectomy California Health and Safety Code requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the co-payment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon. Policy Limitations: Medicare and Medicaid Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service or supply for Medicare or Medicaid members shall not be construed to apply to any other Health Net plans and members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid members by law and regulation. Breast Tomosynthesis April

15 Breast Tomosynthesis April

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: digital_breast_tomosynthesis 3/2011 6/2015 6/2016 12/2015 Description of Procedure or Service Conventional

More information

Personalized Breast Screening Service

Personalized Breast Screening Service Frequently Asked Questions WHAT IS BREAST DENSITY? Breasts are made up of a mixture of fibrous, glandular and fatty tissue. Your breasts are considered if you have predominantly fibrous or glandular tissue

More information

BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER

BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER MEDICAL POLICY BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER Policy Number: 2015T0375N Effective Date June 1, 2015 Table of Contents BENEFIT CONSIDERATIONS COVERAGE RATIONALE APPLICABLE CODES.. DESCRIPTION

More information

Hologic Selenia Dimensions C-View Software Module. October 24, 2012

Hologic Selenia Dimensions C-View Software Module. October 24, 2012 Hologic Selenia Dimensions C-View Software Module October 24, 2012 Introduction and Agenda Peter Soltani, Ph.D. Senior VP & GM, Breast Health Hologic, Inc. Agenda Technology Overview Clinical Overview

More information

Mammography. What is Mammography?

Mammography. What is Mammography? Scan for mobile link. Mammography Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer early before women experience symptoms when it is most treatable. Tell your

More information

P080003/S001 Hologic Selenia Dimensions C-View Software Module. Glossary of Terms

P080003/S001 Hologic Selenia Dimensions C-View Software Module. Glossary of Terms Glossary of Terms 2D plus 3D images a set of images that allow radiology is compare the results of a standard 2D mammogram image and the corresponding 3D tomosynthesis image, while viewing them independently

More information

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests Mammograms - Updated Billing Guide for Screening and Diagnostic Tests This article from Medicare B News Issue 223 dated October 21, 2005 is being updated and reprinted to ensure that the Noridian Administrative

More information

BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER

BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER Oxford BREAST IMAGING FOR SCREENING AND DIAGNOSING CANCER UnitedHealthcare Oxford Clinical Policy Policy Number: DIAGNOSTIC 105.8 T2 Effective Date: August 1, 2016 Table of Contents Page INSTRUCTIONS FOR

More information

Q: What differentiates a diagnostic from a screening mammography procedure?

Q: What differentiates a diagnostic from a screening mammography procedure? The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure

More information

A Guide to Breast Imaging: The Latest Technology for Screening and Detecting Breast Cancer

A Guide to Breast Imaging: The Latest Technology for Screening and Detecting Breast Cancer A Guide to Breast Imaging: The Latest Technology for Screening and Detecting Breast Cancer Sally Herschorn, MD Associate Professor of Radiology University of Vermont College of Medicine Medical Director

More information

Appropriate Imaging for Breast Cancer Screening in Special Populations

Appropriate Imaging for Breast Cancer Screening in Special Populations Health Technology Assessment Appropriate Imaging for Breast Cancer Screening in Special Populations Draft Evidence Report: & December 10, 2014 Health Technology Assessment Program (HTA) Washington State

More information

American Medical Women s Association. Position Paper on Principals of Breast Cancer Screening

American Medical Women s Association. Position Paper on Principals of Breast Cancer Screening American Medical Women s Association Position Paper on Principals of Breast Cancer Screening Breast cancer affects one woman in eight in the United States and is the most common cancer diagnosed in women

More information

FDA Review. Hologic Selenia Dimensions 3D System with C-View Software Module

FDA Review. Hologic Selenia Dimensions 3D System with C-View Software Module Radiology Advisory Panel Meeting Hologic Selenia Dimensions 3D System with C-View Software Module FDA Review Robert Ochs, PhD Branch Chief Mammography, Ultrasound, and Imaging Software Branch Division

More information

Breast Cancer Screening Guideline July 1, 2010

Breast Cancer Screening Guideline July 1, 2010 Breast Cancer Screening Guideline July 1, 2010 Introduction These guidelines are informational only and are not intended or designed to substitute the reasonable exercise of independent clinical judgment

More information

Consensus Statement on Screening Mammography

Consensus Statement on Screening Mammography Consensus Statement on Screening Mammography Purpose: To outline mammogram screening guidelines for asymptomatic women Associated ASBrS Guidelines or Quality Measures : 1. None ( prior statement from 2011)

More information

CURRENT STATE of BREAST CANCER SCREENING. James A. Nudelman, MD

CURRENT STATE of BREAST CANCER SCREENING. James A. Nudelman, MD CURRENT STATE of BREAST CANCER SCREENING James A. Nudelman, MD A great deal of confusion has arisen since the United States Preventative Services Task Force (USPSTF) recently published new recommendations

More information

Learning Objectives. Breast Density, Risk Assessment and Supplemental Screening Options. Breast Density. What is Breast Density??

Learning Objectives. Breast Density, Risk Assessment and Supplemental Screening Options. Breast Density. What is Breast Density?? , Risk Assessment and Supplemental Screening Options ASCLS ND Convention May 2016 Christina Tello Skjerseth, MD Sanford Health Bismarck Radiology Learning Objectives Understand what breast density is and

More information

The Triad Breast Cancer Screening. Mary Helen Hackney, MD FACP VCU Massey Cancer Center March 2016

The Triad Breast Cancer Screening. Mary Helen Hackney, MD FACP VCU Massey Cancer Center March 2016 The Triad Breast Cancer Screening Mary Helen Hackney, MD FACP VCU Massey Cancer Center March 2016 I have no financial disclosures I am a medical oncologist with a practice focused on breast cancer The

More information

The Oslo Tomosynthesis Screening Trial

The Oslo Tomosynthesis Screening Trial British Society of Breast Radiology BSBR Liverpool November 11, 2013 The Oslo Tomosynthesis Screening Trial Professor dr. med. Per Skaane Oslo University Hospital Ullevaal Breast Imaging Center Oslo /

More information

Breast Implants and Reconstruction

Breast Implants and Reconstruction Last Review Date: October 9, 2015 Number: MG.MM.SU.fv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE:

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE: MEDICAL POLICY SUBJECT: MANAGEMENT OF BREAST PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328)

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID L29328

More information

Evaluation and Management of the Breast Mass. Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003

Evaluation and Management of the Breast Mass. Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003 Evaluation and Management of the Breast Mass Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003 Common Presentations of Breast Disease Breast Mass Abnormal

More information

Provincial Quality Management Programs for Mammography, Colonoscopy and Pathology in Ontario

Provincial Quality Management Programs for Mammography, Colonoscopy and Pathology in Ontario Provincial Quality Management Programs for Mammography, Colonoscopy and Pathology in Ontario Quality Management Partnership Consultation Materials: Mammograp hy October 20, 2014 Table of Contents 1.0 Background

More information

Breast Density Legislation: Implications for primary care providers

Breast Density Legislation: Implications for primary care providers Breast Density Legislation: Implications for primary care providers Deborah J. Rhodes MD Associate Professor of Medicine 2012 MFMER slide-1 Disclosure Relevant financial relationship(s) None Off-label

More information

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA Breast Imaging Made Brief and Simple Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA What women are referred for breast imaging? Two groups of women are referred for

More information

Office of Population Health Genomics

Office of Population Health Genomics Office of Population Health Genomics Policy: Protocol for the management of female BRCA mutation carriers in Western Australia Purpose: Best Practice guidelines for the management of female BRCA mutation

More information

VI. FREQUENTLY ASKED QUESTIONS CONCERNING BREAST IMAGING AUDITS

VI. FREQUENTLY ASKED QUESTIONS CONCERNING BREAST IMAGING AUDITS ACR BI-RADS ATLAS VI. FREQUENTLY ASKED QUESTIONS CONCERNING BREAST IMAGING AUDITS American College of Radiology 55 ACR BI-RADS ATLAS A. All Breast Imaging Modalities 1. According to the BI-RADS Atlas,

More information

Sustaining a High-Quality Breast MRI Practice

Sustaining a High-Quality Breast MRI Practice Sustaining a High-Quality Breast MRI Practice Christoph Lee, MD, MSHS Associate Professor of Radiology Adjunct Associate Professor, Health Services University of Washington September 11, 2015 Overview

More information

Medical Policy Original Effective Date: Revised Date: Page 1 of 8

Medical Policy Original Effective Date: Revised Date: Page 1 of 8 Page 1 of 8 Breast Implant Removal and/or Replacement and Capsulectomy Disclaimer Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on

More information

2011 Radiology Diagnosis Coding Update Questions and Answers

2011 Radiology Diagnosis Coding Update Questions and Answers 2011 Radiology Diagnosis Coding Update Questions and Answers How can we subscribe to the Coding Clinic for ICD-9 guidelines and updates? The American Hospital Association publishes this quarterly newsletter.

More information

Infrared Thermography Not a Useful Breast Cancer Screening Tool

Infrared Thermography Not a Useful Breast Cancer Screening Tool Contact: Jeanne-Marie Phillips Sharon Grutman HealthFlash Marketing The American Society of Breast Surgeons 203-977-3333 877-992-5470 Infrared Thermography Not a Useful Breast Cancer Screening Tool Mammography

More information

Illinois Insurance Facts Illinois Department of Insurance Coverage for the Diagnosis and Treatment of Breast Conditions

Illinois Insurance Facts Illinois Department of Insurance Coverage for the Diagnosis and Treatment of Breast Conditions Illinois Insurance Facts Illinois Department of Insurance Coverage for the Diagnosis and Treatment of Breast Conditions Revised May 2015 Note: This information was developed to provide consumers with general

More information

An Action Guide for Supplemental Cancer Screening for Women with Dense Breasts: Next Steps for Patients, Clinicians, and Insurers

An Action Guide for Supplemental Cancer Screening for Women with Dense Breasts: Next Steps for Patients, Clinicians, and Insurers Supplemental Screening Tests Following Negative Mammography in Women with Dense Breast Tissue The New England Comparative Effectiveness Public Advisory Council An Action Guide for Supplemental Cancer Screening

More information

CMS Limitations Guide Mammograms and Bone Density Radiology Services

CMS Limitations Guide Mammograms and Bone Density Radiology Services CMS Limitations Guide Mammograms and Bone Density Radiology Services Starting July 1, 2008, CMS has placed numerous medical necessity limits on tests and procedures. This reference guide provides you with

More information

BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D.

BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D. - 71-5. BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D. The general approach to breast mass work-ups was obtained from opinions of the Committee of Gynecologic Practice of the American College

More information

Lung Cancer Screening

Lung Cancer Screening Scan for mobile link. Lung Cancer Screening What is lung cancer screening? Screening examinations are tests performed to find disease before symptoms begin. The goal of screening is to detect disease at

More information

Low-dose CT Imaging. Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital

Low-dose CT Imaging. Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital Lung Cancer Screening with Low-dose CT Imaging Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital Despite recent declines in the incidence of lung cancer related to the

More information

Clinical Trials and Screening: What You Need to Know

Clinical Trials and Screening: What You Need to Know Scan for mobile link. Clinical Trials and Screening: What You Need to Know What is a Clinical Trial? At A Glance A clinical trial is a research study that tests how well new medical techniques work in

More information

Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics

Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics Wisconsin Cancer Data Bulletin Wisconsin Department of Health Services Division of Public Health Office of Health Informatics In Situ Breast Cancer in Wisconsin INTRODUCTION This bulletin provides information

More information

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection

More information

ICD-10 Diagnostic Coding for. Breast Reconstruction

ICD-10 Diagnostic Coding for. Breast Reconstruction ICD-10 Diagnostic Coding for Webinar Hosted by: Breast Reconstruction December 5, 2013 Presented by: Kim Pollock, RN, MBA, CPC Meet Kim Pollock RN, MBA, CPC Kim Pollock, RN, MBA, CPCspecializes in streamlining

More information

Breast Cancer. Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine

Breast Cancer. Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine Breast Cancer Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine DISCLOSURE Neither I nor my spouse has any relevant financial

More information

2015 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations

2015 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations 2015 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations The decision to start screening mammography in women before age 50 years should be an individual one. Women who place a

More information

Screening Mammography Program of BC

Screening Mammography Program of BC Screening Mammography Program of BC Dr. Christine M. Wilson MD FRCPC Medical Director, Screening Mammography Program BC Cancer Agency March 19, 2015 Disclosure The presenter, Dr. Christine M. Wilson, has

More information

White Paper Spring Breast Tomosynthesis The Use of Breast Tomosynthesis in a Clinical Setting

White Paper Spring Breast Tomosynthesis The Use of Breast Tomosynthesis in a Clinical Setting White Paper Spring 2015 Breast Tomosynthesis The Use of Breast Tomosynthesis in a Clinical Setting Table of Contents Introduction...1 Superiority of Hologic Mammography to...1 Improved Sensitivity and

More information

Fundamentals of Breast Tomosynthesis

Fundamentals of Breast Tomosynthesis 78967-12_WP-00007_FundmntlsTomo 10/3/12 3:47 PM Page 1 Fundamentals of Breast Tomosynthesis Improving the Performance of Mammography Andrew Smith, Ph.D. This white paper is one in a series of research

More information

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8 Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan

More information

Ellis Fischel Cancer Center Registry Data Public Reporting of Outcomes: Breast Cancer

Ellis Fischel Cancer Center Registry Data Public Reporting of Outcomes: Breast Cancer Ellis Fischel Cancer Center Registry Data 13 Public Reporting of Outcomes: Breast Cancer To satisfy Standard 1.12 of the American College of Surgeons Commission on Cancer, a review of outcomes related

More information

D. FREQUENTLY ASKED QUESTIONS

D. FREQUENTLY ASKED QUESTIONS ACR BI-RADS ATLAS D. FREQUENTLY ASKED QUESTIONS 1. Under MQSA, is it necessary to include a numeric assessment code (i.e., 0, 1, 2, 3, 4, 5, or 6) in addition to the assessment category in all mammography

More information

Benign Breast Diseases

Benign Breast Diseases Benign Breast Diseases Most women have changes in their breasts during their lifetime. Many of these changes are caused by hormones. For example, your breasts may feel more lumpy or tender at different

More information

Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives

Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives Rotation 1 (Radiology year 1/2) Knowledge Based Objectives: At the end of the rotation, the resident

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: Revised: This policy applies

More information

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D.

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D. Breast Cancer: from bedside and grossing room to diagnoses and beyond Adriana Corben, M.D. About breast anatomy Breasts are special organs that develop in women during puberty when female hormones are

More information

Recommendations for cross-sectional imaging in cancer management, Second edition

Recommendations for cross-sectional imaging in cancer management, Second edition www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Breast cancer Faculty of Clinical Radiology www.rcr.ac.uk Contents Breast cancer 2 Clinical background 2 Who

More information

ASPIRATION OF PALPABLE CYST

ASPIRATION OF PALPABLE CYST CYSTS ASPIRATION OF PALPABLE CYST GALACTOCELE New lump in nursing mother-soft to firm non-tender Treatment Aspiration FAT NECROSIS Usually there is a history of trauma - MVA, surgery. The fat dies and

More information

1. BREAST CANCER SCREENING. Deidre Gifford, MD, MPH

1. BREAST CANCER SCREENING. Deidre Gifford, MD, MPH 1. BREAST CANCER SCREENING Deidre Gifford, MD, MPH The literature for this chapter was identified by a MEDLINE search for English language review articles on breast cancer screening from 1992 to the present,

More information

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 12/17/2011 Radiology Quiz of the Week # 51 Page 1 CLINICAL PRESENTATION AND RADIOLOGY

More information

BREAST CANCER SCREENING GUIDELINES

BREAST CANCER SCREENING GUIDELINES Chris I Flowers MBBS Associate Professor Department of Radiology and Biomedical imaging University of California, San Francisco chris.flowers@radiology.ucsf.edu BREAST CANCER SCREENING GUIDELINES Introduction

More information

Breast Imaging Protocol Eastern Radiologists, Inc. Breast Imaging Network

Breast Imaging Protocol Eastern Radiologists, Inc. Breast Imaging Network Breast Imaging Protocol Eastern Radiologists, Inc. Breast Imaging Network Screening Mammography Images: Routine CC and MLO views, XCCL if needed. Implant Patients: CC and MLO in both routine and implant

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click

More information

General Information on Mammography and Breast Cancer Screening

General Information on Mammography and Breast Cancer Screening General Information on Mammography and Breast Cancer Screening General Information on Mammography and Breast Cancer Screening You have made an appointment with your doctor for a mammogram. If this is your

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Proteomics-based Testing Related to Ovarian Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: proteomics_based_testing_related_to_ovarian_cancer 7/2010

More information

Digital Breast Tomosynthesis

Digital Breast Tomosynthesis Digital Breast Tomosynthesis White Paper A clinical assessment based on literature by Dr. Finn Lindhardt, senior consultant, Breast Center Regionshospitalet Viborg June 2010 This article summarizes the

More information

Variability and Accuracy in Mammographic Interpretation Using the American College of Radiology Breast Imaging Reporting and Data System

Variability and Accuracy in Mammographic Interpretation Using the American College of Radiology Breast Imaging Reporting and Data System Variability and Accuracy in Mammographic Interpretation Using the American College of Radiology Breast Imaging Reporting and Data System Karla Kerlikowske, Deborah Grady, John Barclay, Steven D. Frankel,

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: February 24, 2012 Revised:

More information

I have no disclosures

I have no disclosures Breast Imaging: Ultrasound Evaluation of Breast Masses Jennifer Kohr, MD Radiologist Virginia Mason Medical Center I have no disclosures 1 Case 1: Additional views of baseline screening mammogram finding

More information

CONSOLIDATED GUIDANCE ON STANDARDS FOR THE NHS BREAST SCREENING PROGRAMME

CONSOLIDATED GUIDANCE ON STANDARDS FOR THE NHS BREAST SCREENING PROGRAMME CONSOLIDATED GUIDANCE ON STANDARDS FOR THE NHS BREAST SCREENING PROGRAMME NHSBSP Publication No 60 (Version 2) April 2005 Published by: NHS Cancer Screening Programmes The Manor House 260 Ecclesall Road

More information

Breast cancer screening and prevention: Update from the USPSTF

Breast cancer screening and prevention: Update from the USPSTF Breast cancer screening and prevention: Update from the USPSTF Mark H. Ebell MD, MS Member, USPSTF College of Public Health The University of Georgia What we re going to do today Overview of the USPSTF

More information

GUIDELINES FOR ORDERING

GUIDELINES FOR ORDERING GUIDELINES FOR ORDERING BREAST IMAGING EXAMINATIONS 1 One of the challenges of medical practice in the twenty-first century is ordering imaging studies in a manner that provides your patients and you with

More information

National Medical Policy

National Medical Policy National Medical Policy Subject: Policy Number: Vertebral Axial Decompression (VAX-D) NMP42 Effective Date*: October 2003 Updated: November 2015 This National Medical Policy is subject to the terms in

More information

ACR BI-RADS ATLAS MAMMOGRAPHY MAMMOGRAPHY II. REPORTING SYSTEM. American College of Radiology 121

ACR BI-RADS ATLAS MAMMOGRAPHY MAMMOGRAPHY II. REPORTING SYSTEM. American College of Radiology 121 ACR BI-RADS ATLAS II. REPORTING SYSTEM American College of Radiology 121 2013 122 American College of Radiology ACR BI-RADS ATLAS A. REPORT ORGANIZATION (Guidance chapter, see page 147) The reporting system

More information

Health Quality Ontario The provincial advisor on the quality of health care in Ontario

Health Quality Ontario The provincial advisor on the quality of health care in Ontario Health Quality Ontario The provincial advisor on the quality of health care in Ontario Ontario Health Technology Assessment Series Ultrasound as an Adjunct to Mammography for Breast Cancer Screening: A

More information

Lung Cancer Screening Insights from the NLST Benefits, Harms and Unresolved Issues

Lung Cancer Screening Insights from the NLST Benefits, Harms and Unresolved Issues Lung Cancer Screening Insights from the NLST Benefits, Harms and Unresolved Issues Christine D. Berg, MD Co-Principal Investigator NLST Adjunct Professor Department of Radiation Oncology and Molecular

More information

Sam & Jennie Bennett Breast Care Center

Sam & Jennie Bennett Breast Care Center Sam & Jennie Bennett Breast Care Center Sam & Jennie Bennett Breast Care Center d Central Maine Medical Center s Sam & Jennie Bennett Breast Care Center is a private place where a woman can find comprehensive

More information

Ultrasound - Breast. What is Ultrasound Imaging of the Breast?

Ultrasound - Breast. What is Ultrasound Imaging of the Breast? Scan for mobile link. Ultrasound - Breast Ultrasound imaging of the breast uses sound waves to produce pictures of the internal structures of the breast. It s primarily used to help diagnose breast lumps

More information

Coverage Analysis: The Cornerstone of Clinical Research Billing Presented by: Mary L. Veazie, CPA, MBA, CHC, CHRC Executive Director, Clinical

Coverage Analysis: The Cornerstone of Clinical Research Billing Presented by: Mary L. Veazie, CPA, MBA, CHC, CHRC Executive Director, Clinical Coverage Analysis: The Cornerstone of Clinical Research Billing Presented by: Mary L. Veazie, CPA, MBA, CHC, CHRC Executive Director, Clinical Research Finance The University of Texas MD Anderson Cancer

More information

Male Breast Cancer Published on Diagnostic Imaging (http://www.diagnosticimaging.com)

Male Breast Cancer Published on Diagnostic Imaging (http://www.diagnosticimaging.com) Case Studies [1] July 22, 2014 By Danielle DeMulder, MD [2] and Erini Makariou, MD [3] Case History: 54-year-old male presents with palpable right retroareolar abnormality. Case History: 54-year-old male

More information

Test Sensitivity in the Computer-Aided Detection of Breast Cancer from Clinical Mammographic Screening: a Meta-analysis

Test Sensitivity in the Computer-Aided Detection of Breast Cancer from Clinical Mammographic Screening: a Meta-analysis Test Sensitivity in the Computer-Aided Detection of Breast Cancer from Clinical Mammographic Screening: a Meta-analysis Corresponding Author: Jacob Levman 1,2, PhD 1. Institute of Biomedical Engineering

More information

12 OF 172 / Set 1 Copyright (c) 2004 Los Angeles Times 000037057

12 OF 172 / Set 1 Copyright (c) 2004 Los Angeles Times 000037057 12 OF 172 / Set 1 Copyright (c) 2004 Los Angeles Times 000037057 Ultrasound as a breast cancer test is becoming more accepted * Though not routine, the procedure proves helpful in spotting disease among

More information

Breast Cancer Screening

Breast Cancer Screening Breast Cancer Screening Summary of the Clinical Practice Guideline September 2013 These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate

More information

Additional Double Reading of Screening Mammograms by Radiologic Technologists: Impact on Screening Performance Parameters

Additional Double Reading of Screening Mammograms by Radiologic Technologists: Impact on Screening Performance Parameters ARTICLE Additional Double Reading of Screening Mammograms by Radiologic Technologists: Impact on Screening Performance Parameters Lucien E. M. Duijm, Johanna H. Groenewoud, Jacques Fracheboud, Harry J.

More information

MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS

MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS Daniel R. Levinson Inspector General April 2011 OEI-07-09-00450

More information

Senate-Passed Bill (Patient Protection and Affordable Care Act H.R. 3590)**

Senate-Passed Bill (Patient Protection and Affordable Care Act H.R. 3590)** Prevention and Screening Services Cost-sharing Eliminates cost sharing requirements for requirements for all preventive services (including prevention and colorectal cancer screening) that have a screening

More information

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11

More information

Learning objectives. Performance of ultrasound. Many advantages of ultrasound. Elastography for evaluation of breast masses

Learning objectives. Performance of ultrasound. Many advantages of ultrasound. Elastography for evaluation of breast masses Elastography for evaluation of breast masses Learning objectives List physical principles of elastography imaging of the breast List different types of elastography imaging of the breast State results

More information

patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015

patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015 patient education Fact Sheet PFS007: BRCA1 and BRCA2 Mutations MARCH 2015 BRCA1 and BRCA2 Mutations Cancer is a complex disease thought to be caused by several different factors. A few types of cancer

More information

Breast Ultrasound: Benign vs. Malignant Lesions

Breast Ultrasound: Benign vs. Malignant Lesions October 25-November 19, 2004 Breast Ultrasound: Benign vs. Malignant Lesions Jill Steinkeler,, Tufts University School of Medicine IV Breast Anatomy Case Presentation-Patient 1 62 year old woman with a

More information

Is it time for a new drug development paradigm?

Is it time for a new drug development paradigm? Is it time for a new drug development paradigm? Robert McDonough, M.D. Senior Director, Clinical Policy Research and Development 1 The Aetna Way Our Cause To make quality health care more affordable and

More information

BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute

BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute Rotation Director: Margaret Szabunio, M.D. General Goals: On this rotation, the resident will learn to interpret screening mammograms

More information

Prototype Internet consultation system for radiologists

Prototype Internet consultation system for radiologists Prototype Internet consultation system for radiologists Boris Kovalerchuk, Department of Computer Science, Central Washington University, Ellensburg, WA 98926-7520, USA borisk@tahoma.cwu.edu James F. Ruiz

More information

HAVE YOU BEEN NEWLY DIAGNOSED with DCIS?

HAVE YOU BEEN NEWLY DIAGNOSED with DCIS? HAVE YOU BEEN NEWLY DIAGNOSED with DCIS? Jen D. Mother and volunteer. Diagnosed with DCIS breast cancer in 2012. An educational guide prepared by Genomic Health This guide is designed to educate women

More information

Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy

Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy File name: Cancer Antigen 125 (CA-125A) Testing File Code: UM.DIAG.05 Origination: 02/2011 Last Review: 02/2014 (ICD-10 remediation only) Next

More information

Breast Cancer. What is breast cancer?

Breast Cancer. What is breast cancer? Scan for mobile link. Breast Cancer Breast cancer is a malignant tumor in or around breast tissue. It usually begins as a lump or calcium deposit that develops from abnormal cell growth. Most breast lumps

More information

Formulary Management

Formulary Management Formulary Management Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective

More information

Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care

Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION:

More information

Ductal Carcinoma in Situ: A Case Report

Ductal Carcinoma in Situ: A Case Report Ductal Carcinoma in Situ: A Case Report Abstract Breast ductal carcinoma in situ (DCIS) is a preinvasive form of breast cancer and is the most common type of in situ breast cancer found in women. There

More information

Disclaimer CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS

Disclaimer CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS AND STAFF Chicago Dermatological Society January 26, 2013 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park Plaza Court Indianapolis,

More information

Breast Imaging East Duarte Road Duarte, CA HOPE MED M

Breast Imaging East Duarte Road Duarte, CA HOPE  MED M Breast Imaging 1500 East Duarte Road Duarte, CA 91010-3000 800.826.HOPE www.cityofhope.org MED 8116 0607 25M Breast Imaging Benefits of Early Detection One out of eight women in the U.S. will develop breast

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information