Variant 1: 65-year-old man with a good performance status presents with cT2N1M0 non–small-cell lung cancer of the left lower lobe. Preoperative mediastinoscopy demonstrates absence of nodal disease in stations 7, 4L, and 4R. Following lobectomy and mediastinal nodal sampling, pathology shows a 3.5 cm-adenocarcinoma in left lower lobe and a positive left hilar and a subcarinal node (pT2N2, IIIA). Other sampled hilar and mediastinal nodes are negative. Surgical margins are negative.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 65-year-old man with a good performance status presents with low-volume cT2pN2M0 non–small-cell lung cancer of the left lower lobe. After 4 cycles of platinum-based induction chemotherapy he has a left lower lobectomy. Pathology shows a 2.5-cm adenocarcinoma in left lower lobe with treatment effect and 2 positive left hilar nodes (pT1N1). Other sampled hilar and mediastinal nodes are negative. Surgical margins are negative.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 62-year-old man with a good performance status with cT2pN2M0 non–small-cell left lung cancer. Candidate for lobectomy.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 62-year-old man with a good performance status with cT2pN2M0 non–small-cell right lung cancer. Right pneumonectomy planned.
| 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.