American College of Radiology ACR Appropriateness Criteria

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Moses Wood
5 years ago
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1 American College of Radiology ACR Criteria Thyroid Carcinoma Variant 1: T1a N0 M0 papillary thyroid cancer: 40-year-old woman. 30 mci with thyrotropin 100 mci with thyrotropin 30 mci with thyroid hormone 100 mci with thyroid hormone Postoperative external beam radiotherapy Postoperative chemotherapy

2 Adjuvant concurrent Variant 2: T1b N0 M0 papillary thyroid carcinoma: 60-year-old man. 30 mci with thyrotropin 100 mci with thyrotropin 30 mci with thyroid hormone 100 mci with thyroid hormone Postoperative external beam radiotherapy Postoperative chemotherapy Adjuvant concurrent 4 n/a n/a Variant 3: T4a N1a M0 papillary thyroid carcinoma: 65-year-old man.

3 30 mci with thyrotropin 100 mci with thyrotropin 30 mci with thyroid hormone 100 mci with thyroid hormone 3D-CRT IMRT Treat thyroid bed first echelon LNs only Treat thyroid bed and entire elective neck Postoperative chemotherapy Adjuvant concurrent TBD TBD

4 Variant 4: T4a N0 M0 medullary thyroid carcinoma: 28-year-old woman. with neck dissection 30 mci (after total thyroidectomy) 100 mci (after subtotal thyroidectomy) 200 mci (after subtotal thyroidectomy) Postoperative adjuvant external beam radiotherapy 3D-CRT IMRT Postoperative chemotherapy Adjuvant concurrent Genetic testing for family members TBD TBD

5 Variant 5: T4a N0 M0 anaplastic thyroid carcinoma: 64-year-old man with excellent performance status. Lateral lymph node dissection Postoperative adjuvant radioactive iodine (RRA or RAI) Postoperative concurrent (if surgery indicated) Definitive (if no surgery performed) 3D-CRT IMRT Altered fractionation Treat thyroid/postoperative bed only Treat thyroid/postoperative bed and elective neck 6 n/a TBD TBD

6 Palliative chemotherapy alone Variant 6: T4b N1b M0 anaplastic thyroid carcinoma: 58-year-old woman with excellent performance status. Lymph node dissection Postoperative radioactive iodine (RRA or RAI) Definitive concurrent 3D-CRT IMRT Altered fractionation Treat thyroid/postoperative bed only Treat thyroid/postoperative bed and elective neck TBD TBD

7 Palliative chemotherapy alone Variant 7: T4a N1 M1 papillary thyroid carcinoma: 63-year-old man with excellent performance status and lung micronodules. Postoperative radioactive iodine Postoperative external beam radiotherapy 150 mci 200 mci Adjuvant concurrent chemoradiation Cytotoxic chemotherapy 6 n/a Variant 8: T3 N0 M1 papillary thyroid carcinoma: 40-year-old woman with excellent performance status and painful bony metastases; tumor is not iodine-avid. Palliative external beam radiotherapy

8 Tyrosine kinase inhibitors (TKI) therapy Cytotoxic chemotherapy Postoperative radioactive iodine

9 Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below. : A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, etc.) Disagree: The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation. References: Lists the references associated with the recommendation. SQ: Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed. RRL: Information on the Relative Radiation Level (RRL) designations can be found here.

Conservative Surgery and Radiation Stage I and II Breast Cancer

Conservative Surgery and Radiation Stage I and II Breast Cancer Variant 1: Premenopausal 41-year-old woman, 1.1-cm GII IDC, upper outer quadrant (UOQ), ER/PR ( ), HER2 ( ), primary excised with lumpectomy,