Variant 1: 45-year-old man with stage IIA nodular sclerosis Hodgkin lymphoma (NSHL); supradiaphragmatic (involving bilateral neck and mediastinum), no bulky disease; ESR, 55.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 26-year-old man with stage IB NSHL; supradiaphragmatic, bulky disease 10 cm in the neck; fevers >38ºC and drenching night sweats; complete resolution of FDG uptake on PET scan after 2 cycles (Deauville score 2); partial response by CT (>50% reduction) after 6 cycles of ABVD. Deauville score 2 after repeat PET scan at chemotherapy completion.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 26-year-old man, CS IIA NSHL with bulky mediastinal mass (11 cm) and nonbulky bilateral neck disease; complete resolution of FDG uptake on PET scan after 2 cycles (Deauville score 2); partial response by CT (>50% reduction) after 4 cycles of ABVD.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 26-year-old woman, CS IIB NSHL with bulky mediastinal (13 cm) and left supraclavicular disease; >75% reduction of mass by CT (3 cm residual after chemotherapy) and negative PET after both 2 and 6 cycles of ABVD chemotherapy (both Deauville scores 2).
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 5: 26-year-old woman, CS IIB NSHL with bulky mediastinal (13 cm) and left supraclavicular disease treated with ABVD × 6; >75% reduction of mass by CT after 2 cycles (3 cm residual mass after chemotherapy) with good PET response (Deauville score 3); but after 6 cycles of ABVD chemotherapy residual mass is stable on CT but PET response looks worse (Deauville score 4). A needle biopsy of mediastinal mass shows CD30+ Reed-Sternberg cells.
| 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.