RCR updates guidance on breast imaging

AuntMinnieEurope.com staff writers

Oct 23, 2025

The U.K. Royal College of Radiologists (RCR) has released a document offering free guidance to radiologists on screening and symptomatic breast imaging.

“Clinical Radiology: Guidance on screening and symptomatic breast screening, fifth edition” replaces the fourth edition and provides relevant updates in light of new evidence and changing clinical trends. A new section on AI has been added, which is expected to expand considerably with future editions, the RCR said.

This guidance has been reviewed and endorsed by the Association of Breast Surgery and does not replace NHS Breast Screening Program guidance, which should be followed, the college noted.

A PDF copy of the 36-page publication can be found on the RCR’s website.

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A normal mammogram confirmed by three-year radiologic follow-up illustrates reader-marked regions of interest (ROIs) during (A) unaided (round 1) and (B) artificial intelligence (AI)–assisted (round 2) reading. Each colored dot represents an ROI for recall by a human reader. Readers could mark more than one ROI per case, represented by multiple dots of the same color. During AI-assisted reading, the AI system displayed three visible prompts: two with suspicion of malignancy scores of 35% (left mediolateral oblique [L MLO] and craniocaudal [L CC]) and one with a suspicion of malignancy score of 10% (right craniocaudal [R CC]), shown as polygonal overlays. Without AI, six of 10 readers (60%) marked a false-positive ROI. With AI assistance, this fell to two of 10 (20%). R MLO = right mediolateral oblique.

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MRI false positive for additional disease, (top to bottom): A. Index lesion—grade 2 invasive ductal carcinoma; B. MRI lesion two, upper inner quadrant: Stromal sclerosis and columnar cell change; C. MRI lesion three, upper outer quadrant: No ultrasound correlate, no malignancy on follow-up; D. CEM marked background parenchymal enhancement with a unifocal retroareolar lesion demonstrating wash-out on delayed MLO. Images are republished under a Creative Commons license (CC BY 4.0).

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A normal mammogram confirmed by three-year radiologic follow-up illustrates reader-marked regions of interest (ROIs) during (A) unaided (round 1) and (B) artificial intelligence (AI)–assisted (round 2) reading. Each colored dot represents an ROI for recall by a human reader. Readers could mark more than one ROI per case, represented by multiple dots of the same color. During AI-assisted reading, the AI system displayed three visible prompts: two with suspicion of malignancy scores of 35% (left mediolateral oblique [L MLO] and craniocaudal [L CC]) and one with a suspicion of malignancy score of 10% (right craniocaudal [R CC]), shown as polygonal overlays. Without AI, six of 10 readers (60%) marked a false-positive ROI. With AI assistance, this fell to two of 10 (20%). R MLO = right mediolateral oblique.

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MRI false positive for additional disease, (top to bottom): A. Index lesion—grade 2 invasive ductal carcinoma; B. MRI lesion two, upper inner quadrant: Stromal sclerosis and columnar cell change; C. MRI lesion three, upper outer quadrant: No ultrasound correlate, no malignancy on follow-up; D. CEM marked background parenchymal enhancement with a unifocal retroareolar lesion demonstrating wash-out on delayed MLO. Images are republished under a Creative Commons license (CC BY 4.0).

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Screening mammograms and AI score changes are depicted over time in two individuals with screen-detected cancer. Full-field digital mammograms show craniocaudal (top) and mediolateral (bottom) views of the left and right breast. The description below each mammogram indicates whether AI scores from three AI-based computer-aided detection systems (AI-1, AI-2, and AI-3) were above or below the 90th percentile. (A) Mammograms from three screening time points (in 2009, 2011, and 2014) in an individual who was diagnosed in February 2014 (at age 73 years) with a left-sided 25-mm grade 2 invasive breast carcinoma, no special type (arrow). Mammographic breast density was classified as BI-RADS B on all three mammograms. (B) Mammograms from four screening time points (in 2009, 2011, 2013, and 2015) in an individual who was diagnosed in October 2015 (at age 65 years) with a left-sided 45-mm grade 2 lobular carcinoma (arrow). Mammographic breast density was classified as BI-RADS C on all four mammograms. Screen-detected cancers were defined as those diagnosed within 90 days for individuals who were recalled at screening (*).

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