Variant 1: 56-year-old woman undergoes a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and para-aortic/pelvic lymph node dissection for a grade 2 endometrial adenocarcinoma, endometrioid type, invading 12 mm of a 22-mm myometrial wall. No LVSI present. Tumor size was 4.0 cm. Para-aortic and pelvic lymph nodes were negative.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 70-year-old woman undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy without a pelvic lymph node dissection for a grade 2 endometrial adenocarcinoma, endometrioid type, invading 8 mm of a 15-mm myometrial wall. LVSI was present. Patient is healthy otherwise.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 66-year-old woman undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with a para-aortic and pelvic lymph node dissection for a grade 3 endometrial adenocarcinoma, endometrioid type, with deep myometrial invasion (19/21 mm). No LVSI was present. Deeply invasive cervical stromal invasion was present. Margins were negative. Five left pelvic, 6 right pelvic, and 4 para-aortic lymph nodes were negative.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.
Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.
SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.
- References: The citation number and PMID for the reference(s) associated with the recommendation.
- Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.
RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.
Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.
Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.
Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).
Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.