TY - JOUR
T1 - ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)
T2 - 2022 Update
AU - Expert Panel on Vascular Imaging
AU - Singh, Nimarta
AU - Aghayev, Ayaz
AU - Ahmad, Sarah
AU - Azene, Ezana M.
AU - Ferencik, Maros
AU - Hedgire, Sandeep S.
AU - Kirsch, David S.
AU - Lee, Yoo Jin
AU - Nagpal, Prashant
AU - Pass, Helen A.
AU - Pillai, Anil K.
AU - Ripley, Beth
AU - Tannenbaum, Andrew
AU - Thomas, Richard
AU - Steigner, Michael L.
N1 - Publisher Copyright:
© 2022 American College of Radiology
PY - 2022/11
Y1 - 2022/11
N2 - Breast cancer is the most common malignancy in women in the United States, with surgical options including lumpectomy and mastectomy followed by breast reconstruction. Deep inferior epigastric perforator (DIEP) flap is a muscle-sparing perforator free flap breast reconstruction technique, which uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle. Multiple perforators are identified by preoperative imaging, which are typically ranked based on size, location, and intramuscular course. The goal of preoperative imaging is to aid the surgical team in preoperative planning given the variability of the DIEA perforator branches anatomy between patients. The objective of this document is to review the imaging modalities that can be used preoperatively to identify the optimal perforator and thereby reduce intraoperative complications, reduce postoperative complications, and improve clinical outcomes. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
AB - Breast cancer is the most common malignancy in women in the United States, with surgical options including lumpectomy and mastectomy followed by breast reconstruction. Deep inferior epigastric perforator (DIEP) flap is a muscle-sparing perforator free flap breast reconstruction technique, which uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle. Multiple perforators are identified by preoperative imaging, which are typically ranked based on size, location, and intramuscular course. The goal of preoperative imaging is to aid the surgical team in preoperative planning given the variability of the DIEA perforator branches anatomy between patients. The objective of this document is to review the imaging modalities that can be used preoperatively to identify the optimal perforator and thereby reduce intraoperative complications, reduce postoperative complications, and improve clinical outcomes. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
KW - AUC
KW - Appropriate Use Criteria
KW - Appropriateness Criteria
KW - Breast cancer
KW - Breast reconstruction
KW - CT
KW - CT angiography
KW - Deep inferior epigastric artery
KW - Deep inferior epigastric perforator (DIEP) flap
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U2 - 10.1016/j.jacr.2022.09.004
DO - 10.1016/j.jacr.2022.09.004
M3 - Article
C2 - 36436962
AN - SCOPUS:85142501853
SN - 1546-1440
VL - 19
SP - S357-S363
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 11
ER -