CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2022; 58(02): 069-077
DOI: 10.1055/s-0042-1744392
Review Article

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—2

Suma Chakrabarthi
1   Department of Radiology and Imaging, Peerless Hospitex Hospital and Research Center Limited, Kolkata, West Bengal, India
Shikha Panwar
2   Department of Radiology, Mahajan Imaging, Delhi, India
Tulika Singh
3   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Shilpa Lad
4   Department of Radiology, NM Medical, Mumbai, Maharashtra, India
Jwala Srikala
5   Department of Radiology and Imaging, Krishna Institute of Medical Sciences, Secunderabad, India
Niranjan Khandelwal
6   Former Head, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Sanjeev Misra
7   Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
Sanjay Thulkar
8   Department of Radiology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations


Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.


The Best Practice Guidelines of Breast Imaging Society, India (BISI) are the broad guidelines for investigation, intervention, and management of clients opting for breast screening and patients with breast symptoms in India and intended for the use of qualified medical caregivers only. These are based on various national and international guidelines and personal experiences and opinions of BISI members, as there are no large credible Indian data to formulate these guidelines. These guidelines are purely recommendatory in nature. Actual decisions for the management of patients should be individualized according to own judgment of the caregiver and tailored on case-to-case basis. As scientific knowledge is continuously improving, a regular update of the same by the caregiver is essential. Failure to do so may result in untoward patient management or outcome and BISI members or BISI as the organization cannot be held responsible for that in any manner.

Author Contributions

S.C. contributed to mammography and all other sections, S.P. contributed to breast MRI, T.S. contributed to breast ultrasound, S.L. contributed to breast interventions, J.S. contributed to breast MRI, N.K. contributed to mammography, S.M. contributed to common breast symptoms: algorithm for imaging evaluation and all other sections, and S.T. contributed to common breast symptoms: algorithm for imaging evaluation and all other sections.

Publication History

Article published online:
07 June 2022

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