ACR appropriateness criteria® pretreatment staging of colorectal cancer

Catherine Dewhurst, Max P. Rosen*, Michael A. Blake, Mark E. Baker, Brooks D. Cash, Jeff L. Fidler, Frederick L. Greene, Nicole M. Hindman, Bronwyn Jones, Douglas S. Katz, Tasneem Lalani, Frank H Miller, William C. Small, Gary S. Sudakoff, Mark Tulchinsky, Vahid Yaghmai, Judy Yee

*Corresponding author for this work

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Because virtually all patients with colonic cancer will undergo some form of surgical therapy, the role of preoperative imaging is directed at determining the presence or absence of synchronous carcinomas or adenomas and local or distant metastases. In contrast, preoperative staging for rectal carcinoma has significant therapeutic implications and will direct the use of radiation therapy, surgical excision, or chemotherapy. CT of the chest, abdomen, and pelvis is recommended for the initial evaluation for the preoperative assessment of patients with colorectal carcinoma. Although the overall accuracy of CT varies directly with the stage of colorectal carcinoma, CT can accurately assess the presence of metastatic disease. MRI using endorectal coils can accurately assess the depth of bowel wall penetration of rectal carcinomas. Phased-array coils provide additional information about lymph node involvement. Adding diffusion-weighted imaging to conventional MRI yields better diagnostic accuracy than conventional MRI alone. Transrectal ultrasound can distinguish layers within the rectal wall and provides accurate assessment of the depth of tumor penetration and perirectal spread, and PET and PET/CT have been shown to alter therapy in almost one-third of patients with advanced primary rectal cancer. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)775-781
Number of pages7
JournalJACR Journal of the American College of Radiology
Volume9
Issue number11
DOIs
StatePublished - Jan 1 2012

Keywords

  • Appropriateness criteria
  • colorectal neoplasms
  • computed tomography
  • magnetic resonance imaging
  • tumor staging
  • ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Dewhurst, C., Rosen, M. P., Blake, M. A., Baker, M. E., Cash, B. D., Fidler, J. L., Greene, F. L., Hindman, N. M., Jones, B., Katz, D. S., Lalani, T., Miller, F. H., Small, W. C., Sudakoff, G. S., Tulchinsky, M., Yaghmai, V., & Yee, J. (2012). ACR appropriateness criteria® pretreatment staging of colorectal cancer. JACR Journal of the American College of Radiology, 9(11), 775-781. https://doi.org/10.1016/j.jacr.2012.07.025