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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7-33. Review/Other-Dx N/A Cancer statistics. Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality. 4
2. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA).  Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
3. Fujiki T, Nishimura R, Mase S, et al. Accurate detection of renal leukemic involvement in children using 3-D computed tomography modeling. Pediatr Int. 61(7):679-687, 2019 Jul. Observational-Dx 25 children To propose a new method for precise renal involvement detection using 3-D enhanced computed tomography (CT) reconstruction. According to the 3D-CT criteria, nine of 25 patients (36%) had renal involvement. All of them had bilateral mass lesions except for one who had diffuse nephromegaly alone. This method detected renal involvement more accurately than ultrasonography. When using conventional criteria based on the length of the renal axis, 19 of 25 (76%) had renal involvement, including many cases of false-positive nephromegaly. Patients with renal involvement had significantly more extramedullary involvement according to the 3D-CT-based criteria. 3
4. Brown P, Inaba H, Annesley C, et al. Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw.. 18(1):81-112, 2020 01. Observational-Dx 272 patients To test the hypothesis that Positron emission tomography-non-contrast computerized tomography (PET-CT) scans are sensitive tests for the evaluation of patients with CLL for second malignancies and serious infections. We show that PET-CT scans are sensitive but not specific for the diagnosis of these complications. Of the of 2,299 CLL patients seen in the Division of Hematology at Mayo Clinic Rochester between January 1, 2006 and December 31, 2011, 272 (11.8%) had 526 PET-CT scans and 472 (89.7%) of these were reported as abnormal. Among the 293 (55.7%) PET-CT scans used for routine evaluation of CLL, the PET component was of clinical value in only one instance. In contrast, in 83 (30.5%) patients, PET-CT scans used to evaluate new clinical complications localized high FDG avidity lesions for biopsies. This resulted in clinically relevant new diagnoses in 32 patients including more aggressive lymphoma (n=16), non-hematological malignancies (n=8), and opportunistic infections (n=3). Twenty-seven patients had high FDG avidity CLL, which was associated with prominent lymph node proliferation centers, an increased frequency of poor prognostic factors (17p13 deletion, unmutated IGHV, expression of ZAP-70 and CD38), and a shorter overall survival. 3
5. Krull K, Kunstreich M, Bronsema A, et al. Osteonecrosis in children with acute lymphoblastic leukemia at initial diagnosis and prior to any chemotherapy. Leuk Lymphoma. 60(1):78-84, 2019 01. Observational-Dx 7 children To report seven adolescents presenting with ON at diagnosis of ALL who were identified out of 76 prospectively screened patients. We analyzed 76 children enrolled in the ongoing OPAL trial, who had magnetic resonance imaging (MRI) studies at diagnosis. MRI screening revealed 14 osteonecrotic lesions (5 × hips, 9 × knees) of any grade (I–III) in 7 (9.2%) patients. Six months on, the number of ON per patient increased (1 patient), remained constant (2), and decreased (2). The severity increased from grade I to II in two patients, remained constant (1), completely resolved (2), and decreased from grade III to osteoedema (1). No differences between adolescents initially presenting with/without ON were observed concerning age, pubertal stage, body mass index, leukemia characteristics, and clinical presentation. In MRI screening, a remarkable number of adolescents with ALL present with ON at diagnosis. The course of these ON remains highly unpredictable. 2
6. Cao W, Liang C, Gen Y, Wang C, Zhao C, Sun L. Role of diffusion-weighted imaging for detecting bone marrow infiltration in skull in children with acute lymphoblastic leukemia. Diagn Interv Radiol. 22(6):580-586, 2016 Nov-Dec. Observational-Dx 51 patients We aimed to determine whether diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement can detect skull bone marrow infiltration in newly diagnosed acute lymphoblastic leukemia (ALL) children before therapy and normalization in complete remission after treatment. Skull marrow infiltration, manifested with abnormal DWI signals, was present in 37 patients (72.5%) before treatment. Of these, 23 (62.2%) showed scattered signal abnormalities and 14 (37.8%) showed a uniform abnormal signal pattern. Compared with the control group, ADC was significantly decreased in patients with ALL. DWI signal intensity and ADC normalized in patients with complete remission. 2
7. Pryweller JR, Glass JO, Sabin ND, et al. Characterization of Leukoencephalopathy and Association With Later Neurocognitive Performance in Pediatric Acute Lymphoblastic Leukemia. Invest Radiol. 56(2):117-126, 2021 02 01. Observational-Dx 377 patients To objectively characterize the prevalence, extent, and intensity of leukoencephalopathy (LE), and their association with later neurocognitive performance. The prevalence of LE was greatest (22.8%, 74/324) after consolidation therapy. The prevalence of LE increased at MR2 relative to MR1 regardless of treatment risk arm (both P's < 0.001), age group (both P's < 0.001), or sex (male, P < 0.001; female, P = 0.013). The extent of white matter affected also increased at MR2 relative to MR1 regardless of treatment risk arm (standard/high risk, P < 0.001; low risk, P = 0.004), age group (both P's < 0.001), or sex (male, P < 0.001; female, P = 0.001). Quantitative relaxation rates were significantly longer in LE compared with that in normal-appearing white matter in the same examination (T1, P < 0.001; T2, P < 0.001). The LE prevalence early in therapy was associated with increased parent ratings of conduct problems (P = 0.039) and learning difficulties (P = 0.036) at 2-year follow-up compared with that at the end of therapy. A greater extent of LE early in therapy was associated with decreasing performance on a measure of processing speed (P = 0.003) from the end of therapy to 2-year follow-up. A larger extent of LE at the end of therapy was associated with decreased performance in reading (P = 0.004), spelling (P = 0.003), and mathematics (P = 0.019) at 2-year follow-up and increasing problems with attention (omissions, P = 0.045; ß, P = 0.015) and memory (list A total recall, P = 0.010) at 2-year follow-up compared with that at the end of therapy. 3
8. Lauer M, Kernen E, Schwabe D, Lehrnbecher T, Porto L. The role of magnetic resonance imaging in the diagnosis of central nervous system involvement in children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 67(10):e28294, 2020 10. Observational-Dx 215 patients with de novo ALL and 31 with relapsed ALL. To evaluate whether cranial magnetic resonance imaging (MRI) examinations findings correlate with cerebrospinal fluid (CSF) analysis on central nervous system (CNS) involvement and whether MRI examinations reveal incidental findings with a clinical consequence. Two hundred fifteen patients with de novo ALL and 31 with relapsed ALL were identified. In the de novo group, no patient was diagnosed CNS positive based on MRI results alone. In relapsed patients, only one patient had a positive MRI with negative CSF results and no neurological symptoms, thus was classified CNS positive solely on the basis of the MRI. In both groups, no patient showed an incidental finding that required therapy 3
9. Ranta S, Palomaki M, Levinsen M, et al. Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis. Pediatr Blood Cancer. 64(1):64-70, 2017 01. Observational-Dx The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. To evaluate the role of routine neuroimaging in children with CNS leukemia by investigating if the presence of leukemic involvement by imaging is associated with unfavorable prognosis. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53). 3
10. Smith WT, Shiao KT, Varotto E, et al. Evaluation of Chest Radiographs of Children with Newly Diagnosed Acute Lymphoblastic Leukemia. J Pediatr. 223:120-127.e3, 2020 08. Observational-Dx 187 patients To evaluate the diagnostic yield of baseline chest radiographs (CXRs) of children with acute lymphoblastic leukemia (ALL). Common findings were peribronchial/perihilar thickening (n = 187 [19.0%]), pulmonary opacity/infiltrate (n = 159 [16.1%]), pleural effusion/thickening (n = 109 [11.1%]), mediastinal mass (n = 107 [10.9%]), and cardiomegaly (n = 68 [6.9%]). Portable CXRs provided results comparable with those obtained with 2-view films. Forty of 107 patients with a mediastinal mass (37.4%) had tracheal deviation/compression. Mediastinal mass, pleural effusion/thickening, and tracheal deviation/compression were more often associated with T-cell ALL than with B-cell ALL (P < .001 for all). Pulmonary opacity/infiltrate was associated with younger age (P = .003) and was more common in T-cell ALL than in B-cell ALL (P = .001). Peribronchial/perihilar thickening was associated with younger age (P < .001) and with positive central nervous system disease (P = .012). Patients with cardiomegaly were younger (P = .031), more often black than white (P = .007), and more often categorized as low risk than standard/high risk (P = .017). Patients with a mediastinal mass, pleural effusion/thickening, tracheal deviation/compression, or pulmonary opacity/infiltrate were more likely to receive less invasive sedation and more intensive care unit admissions and respiratory support (P = .001 for all). Cardiomegaly was associated with intensive care unit admission (P = .008). No patients died of cardiorespiratory events during the initial 7 days of management. 3
11. Ceesay MM, Desai SR, Cleverley J, et al. Pre-symptomatic (Baseline) computed tomography predicts invasive pulmonary aspergillosis in high-risk adult haemato-oncology patients. Br J Haematol 2018;182:723-27. Observational-Dx 198 patients To investigate the prevalence, nature and utility of CT abnormalities among asymptomatic patients prior to initiation of chemotherapy, immunosuppressive therapy (IST) or HSCT, and is a secondary analysis of a previously reported study. On multivariate analysis, the final model showed that patients with an abnormal BCT had a significantly higher risk of IPA [adjusted hazard ratio (HR), 2.52; 95% confidence intervals (CI), 1.27–5.03; Fig. 1B]. The increased risk of IPA was primarily confined to those with EORTC/MSG-recognised signs (adjusted HR, 4.67; 95% CI, 2.04–10.75) and was less evident in patients with non-EORTC/MSG-recognised signs (adjusted HR, 1.30; 95% CI, 0.87–2.15) (Fig. 1C). 3
12. Brown PA, Shah B, Advani A, et al. Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw.. 19(9):1079-1109, 2021 09 20. Review/Other-Dx N/A To provide evidence-based guidelines that focus on the management of Philadelphia chromosome (Ph)-positive and Ph-negative Acute Lymphoblastic Leukemia (ALL) in adolescents and young adults, and management in relapsed settings. No abstract available. 4
13. Holland EM, Yates B, Ling A, et al. Characterization of extramedullary disease in B-ALL and response to CAR T-cell therapy. Blood Adv. 2022 Apr 12;6(7):2167-2182. Observational-Tx 180 patients To systematically evaluate the response of non-CNS extramedullary disease (EMD) to Chimeric antigen receptor (CAR) T cells in relation to bone marrow response. We conducted a retrospective review of B-ALL patients with non-CNS EMD who were screened for/enrolled on one of three CAR trials (CD19, CD22, and CD19/22) at our institution. Non-CNS EMD was identified according to histology or radiographic imaging at extramedullary sites excluding the cerebrospinal fluid and CNS parenchyma. Of ~180 patients with relapsed/refractory B-ALL screened across multiple early-phase trials over an 8-year period, 38 (21.1%) presented with isolated non-CNS EMD (n = 5) or combined medullary/non-CNS EMD (n = 33) on 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. A subset receiving CAR T cells (18 infusions) obtained FDG PET/CT scans preinfusion and postinfusion to monitor response. At best response, 72.2% (13 of 18) of patients showed a medullary minimal residual disease-negative complete remission and complete (n = 7) or partial (n = 6) non-CNS EMD response. Non-CNS EMD responses to CAR T cells were delayed (n = 3), and residual non-CNS EMD was substantial; rarely, discrepant outcomes (marrow response without EMD response) were observed (n = 2). Unique CAR-associated toxicities at non-CNS EMD sites were seen in select patients. CAR T cells are active in B-ALL non-CNS EMD. Still, non-CNS EMD response to CAR T cells may be delayed and suboptimal, particularly with multifocal disease. Serial FDG PET/CT scans are necessary for identifying and monitoring non-CNS EMD. 2
14. Bitterman R, Hardak E, Raines M, et al. Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study. Clin Infect Dis. 69(10):1805-1808, 2019 10 30. Observational-Dx 295 patients To report our experience with performing routine baseline chest computed tomography for early diagnosis of IPA. We found high rates of proven or probable IPA diagnosed on admission among patients with newly diagnosed acute myeloid leukemia. Overall, compared to patients diagnosed with IPA during the hospitalization, patients diagnosed by baseline chest CT were more likely to have a newly diagnosed hematologic malignancy (11/15, 73.3% vs 9/29, 31%, P = .008); to be admitted for chemotherapy compared to transplantation (12/15, 80% vs 13/29, 44.8%, P = .073); and to be older (64 ± 7 vs 51 ± 15, P = .004). 3
15. Vallipuram J, Dhalla S, Bell CM, et al. Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia. Leuk Lymphoma. 58(4):834-841, 2017 04. Review/Other-Dx 219 patients including 145 pts with baseline CT. To assess whether Chest computed tomography (CT) findings were present in asymptomatic individuals with acute myeloid leukemia (AML) at low risk of invasive fungal disease. Of 145 CT scans, the majority (88%) had pulmonary abnormalities. Many (70%) had one or both of unspecified opacities (52%) and nodules (49%). Ground glass opacities (18%) and consolidations (12%) occurred less frequently. Radiologists suggested pneumonia as a possible diagnosis in 32% (n¼47) of scans. 4
16. Stefanski M, Jamis-Dow C, Bayerl M, Desai RJ, Claxton DF, Van de Louw A. Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia: A retrospective cohort study of 73 patients. Medicine (Baltimore). 95(44):e5285, 2016 Nov. Observational-Dx 73 patients To analyze a large population of hyperleukocytic acute myeloid leukemia (AML) patients in order to describe the radiographic and computed tomography (CT) findings on admission and to assess the correlation between radiographic findings and clinical condition. Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ventilatory support requirements (P<0.01) and with day 28 mortality (45% vs 13%, P=0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n=13) or bilateral (n=3), while 16 patients had bilateral diffuse opacities, interstitial (n=12) or airspace and interstitial (n=4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75% of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P<0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n=12), airspace (n=11) and ground-glass (n=9) opacities, pleural effusions (n=12), and acute pulmonary embolism (n=2). 3
17. Heuser M, Ofran Y, Boissel N, et al. Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020;31:697-712. Review/Other-Tx N/A To provide key recommendations on the management of acute myeloid leukaemia (AML) including acute promyelocytic leukaemia (APL). No results stated in abstract. 4
18. Pollyea DA, Bixby D, Perl A, et al. NCCN Guidelines Insights: Acute Myeloid Leukemia, Version 2.2021. J. Natl. Compr. Cancer Netw.. 19(1):16-27, 2021 01 06. Review/Other-Tx N/A To provide recommendations for the diagnosis and treatment of adults with AML based on clinical trials that have led to significant improvements in treatment, or have yielded new information regarding factors with prognostic importance, and are intended to aid physicians with clinical decision-making. No results stated in abstract. 4
19. Gurnari C, Breccia M, Di Giuliano F, et al. Early intracranial haemorrhages in acute promyelocytic leukaemia: analysis of neuroradiological and clinico-biological parameters. British Journal of Haematology. 193(1):129-132, 2021 04. Review/Other-Dx 13 patients with Acute promyelocytic leukaemia and 85 patients without this complication To examine clinical and/or biological parameters of severe bleeding in acute promyelocytic leukaemia. Compared to 85 patients without this complication, patients with ICH were older and more frequently had high-risk APL. Moreover, positivity for the ‘swirl’ sign at neuroradiological imaging and hydrocephalus were predictors of a fatal outcome, together with lower fibrinogen, prolonged international normalized ratio (INR) and higher lactate dehydrogenase levels. 4
20. Cribe AS, Steenhof M, Marcher CW, Petersen H, Frederiksen H, Friis LS. Extramedullary disease in patients with acute myeloid leukemia assessed by 18F-FDG PET. Eur J Haematol. 90(4):273-8, 2013 Apr. Observational-Dx 26 patients To compare the prevalence of EMD diagnosed by PET scans and by clinical examination. 18-F-FDG PET scans revealed more than twice as many patients with EMD than found by clinical examination (65% vs. 31%). PET demonstrated 55 EMD lesions compared with 15 diagnosed by clinical examination. 3
21. Stolzel F, Rollig C, Radke J, et al. 18F-FDG-PET/CT for detection of extramedullary acute myeloid leukemia. Haematologica. 96(10):1552-6, 2011 Oct. Observational-Dx 10 patients with de novo and relapsed acute myeloid leukemia and histologically proven extramedullary disease. To investigate the feasibility of using 18F-FDG-PET/CT scans to detect EM-AML in patients with newly diagnosed AML, as well as relapsed AML with histologically proven extramedullary disease. The scans were able to detect the known extramedullary lesions in 9 out of 10 patients (90%). Furthermore, additional extramedullary sites were detected in 6 patients (60%). 3
22. Gentile M, Cutrona G, Fabris S, et al. Total body computed tomography scan in the initial work-up of Binet stage A chronic lymphocytic leukemia patients: Results of the prospective, multicenter O-CLL1-GISL study. Am J Hematol. 88(7):539-44, 2013 Jul. Observational-Dx 240 patients To determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and ß2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. 3
23. Mauro FR, Chauvie S, Paoloni F, et al. Diagnostic and prognostic role of PET/CT in patients with chronic lymphocytic leukemia and progressive disease. Leukemia. 29(6):1360-5, 2015 Jun. Observational-Dx 90 patients To evaluate the predictive value of this imaging technique in discriminating the presence of a Richter’s syndrome (RS) or a second malignancy (SM), as well as the prognostic value of the FDG uptake in patients with a CLL/SLL. The median maximum Standardized Uptake Value (SUVmax) in the presence of a CLL/small lymphocytic lymphoma, a diffuse large B-cell lymphoma (DLBCL), a Hodgkin lymphoma (HL), a SM were 3.5, 14.6, 7.0 and 6.3, respectively (P?0.0001). A SUVmax cutoff value ?5 showed a sensitivity, specificity, positive and negative predictive values of 88.2, 71.2, 51.3 and 94%, respectively, for the presence of a more aggressive disease (DLBCL, HL and SM). A SUVmax ?5 identified also a subset of treatment naive patients with an inferior progression-free survival (P=0.011) and overall survival (P=0.067). 3
24. Strati P, Uhm JH, Kaufmann TJ, et al. Prevalence and characteristics of central nervous system involvement by chronic lymphocytic leukemia. Haematologica. 101(4):458-65, 2016 Apr. Review/Other-Dx 172 patients with CLL To report the first cohort study of patients with CLL undergoing evaluation of neurological symptoms, and describe the prevalence and characteristics of patients diagnosed with clinically significant CNS involvement by CLL or Richter syndrome (RS). After comprehensive evaluation, the etiology of neurological symptoms was: central nervous system chronic lymphocytic leukemia in 18 patients (10% evaluated by imaging and/or lumbar puncture, 0.4% overall cohort); central nervous system Richter Syndrome in 15 (9% evaluated, 0.3% overall); infection in 40 (23% evaluated, 1% overall); autoimmune/inflammatory conditions in 28 (16% evaluated, 0.7% overall); other cancer in 8 (5% evaluated, 0.2% overall); and another etiology in 63 (37% evaluated, 1.5% overall). Although the sensitivity of cerebrospinal fluid analysis to detect central nervous system disease was 89%, the specificity was only 42% due to the frequent presence of leukemic cells in the cerebrospinal fluid in other conditions. 4
25. Reinert CP, Federmann B, Hofmann J, et al. Computed tomography textural analysis for the differentiation of chronic lymphocytic leukemia and diffuse large B cell lymphoma of Richter syndrome. Eur Radiol. 29(12):6911-6921, 2019 Dec. Observational-Dx 52 patients To test the hypothesis that both indolent and aggressive chronic lymphocytic leukemia (CLL) can be differentiated from diffuse large B cell lymphoma (DLBCL) of Richter syndrome (RS) by CT texture analysis (CTTA) of involved lymph nodes. Compared with DLBCL of RS, CTTA of the entire CLL group showed significant differences of entropy heterogeneity (p < 0.001), mean intensity (p < 0.001), mean average (p = 0.02), and number non-uniformity gray-level dependence matrix (NGLDM) (p = 0.03). Indolent CLL significantly differed for entropy (p < 0.001), uniformity of heterogeneity (p = 0.02), mean intensity (p < 0.001), and mean average (p = 0.01). Aggressive CLL showed significant differences in mean intensity (p = 0.04). For differentiation between CLL and DLBCL of RS, cut-off values for mean intensity and entropy of heterogeneity were defined (e.g., 6.63 for entropy heterogeneity [aggressive CLL vs. DLBCL]; sensitivity 0.78; specificity 0.63). 3
26. Federmann B, Mueller MR, Steinhilber J, Horger MS, Fend F. Diagnosis of Richter transformation in chronic lymphocytic leukemia: histology tips the scales. Ann Hematol. 97(10):1859-1868, 2018 Oct. Observational-Dx 34 patients with clinically suspected Richter transformation. To report our single-center experience in patients with CLL with suspected RT, who underwent CT-based radiological analysis and histological examination. A histopathological diagnosis of RTwith concordant clinical and radiological findings was obtained in 13 patients. In 18 patients, CT did not show features of transformation, concordant with lack of RT in the biopsy. Of interest, a distinct lymphoma other than DLBCL was identified in two of these cases. A false-positive radiological diagnosis of RTwas rendered in two patients, including a case of Herpes simplex virus lymphadenitis. 3
27. Falchi L, Keating MJ, Marom EM, et al. Correlation between FDG/PET, histology, characteristics, and survival in 332 patients with chronic lymphoid leukemia. Blood. 123(18):2783-90, 2014 May 01. Observational-Dx 332 patients To evaluate how FDG/PET data correlate with disease histology and clinical outcomes in patients with CLL. A total of 332 patients with CLL were histologically classified as: 95 RS, 117 HAC, and 120 histologically indolent CLL (HIC). HAC and RS patients had higher maximum standardized uptake value (SUVmax), more frequent constitutional symptoms, poorer performance status (PS), lower hemoglobin and platelets, and higher lactate dehydrogenase and ß-2-microglobulin. An SUVmax =10 strongly correlated with mortality (overall survival [OS], 56.7 vs 6.9 months in patients with SUVmax <10 vs =10). Survival of patients with RS and HAC was similar among patients with SUVmax <10 or =10. SUVmax =10, PS =2, bulky disease, and age =65 were independently associated with shorter OS. In patients undergoing both fine-needle aspiration and biopsy, the former proved diagnostically inadequate in 23%, 29%, and 53% of HIC, HAC, and RS, respectively. 3
28. Mato AR, Wierda WG, Davids MS, et al. Utility of positron emission tomography-computed tomography in patients with chronic lymphocytic leukemia following B-cell receptor pathway inhibitor therapy. Haematologica. 104(11):2258-2264, 2019 11. Observational-Dx 127 patients To describe a post hoc analysis to determine if PET-CT and/or patient characteristics were able to differentiate RT versus CLL progression for patients who discontinued BCRi. A PET-CT maximum standardized uptake value (SUVmax) =10 had 71% sensitivity and 50% specificity for detecting Richter's transformation [Odds Ratio (OR): 2.5, 95%CI: 0.4-15; P=0.318]. Response rate to venetoclax was similar for screening SUVmax <10 versus =10 (65% vs. 62%) (n=127 enrolled), though median progression-free survival was longer at <10 months (24.7 vs. 15.4 months; P=0.0335). Six patients developed Richter's transformation on venetoclax, of whom two had screening biopsy demonstrating CLL (others did not have a biopsy) and five had screening SUVmax <10. 3
29. Papajik T, Myslivecek M, Urbanova R, et al. 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography examination in patients with chronic lymphocytic leukemia may reveal Richter transformation. Leuk Lymphoma. 55(2):314-9, 2014 Feb. Observational-Dx 23 patients To assess the benefit of PET/CT in patients with newly diagnosed or relapsed CLL and Richter transformation (RT). The median SUV(max) was 3.4 (range: 1.5-6.3) and 3.1 (range: 1.2-5.9) in newly diagnosed and relapsed patients, respectively. The median SUV(max) of patients with suspected or confirmed RT reached 16.5 (range: 7.2-25.3), a value different from that of the previous groups (p < 0.001). 2-[18F]fluoro- 2-deoxy-D-glucose ((18)F-FDG) PET/CT revealed inflammatory lesions in seven patients (16%) and synchronous tumors in two newly diagnosed patients. 3
30. Conte MJ, Bowen DA, Wiseman GA, et al. Use of positron emission tomography-computed tomography in the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma. Leuk Lymphoma. 55(9):2079-84, 2014 Sep. Observational-Dx 272 patients To test the hypothesis that PET-CT scans are sensitive tests for the evaluation of patients with CLL for second malignancies and serious infections. 272 patients (11.8%) had 526 PET-CT scans and 472 (89.7%) of these were reported as abnormal. Among the 293 (55.7%) PET-CT scans used for routine evaluation of CLL, the PET component was of clinical value in only one instance. In contrast, in 83 (30.5%) patients, PET-CT scans used to evaluate new clinical complications localized high FDG-avidity lesions for biopsies. This resulted in clinically relevant new diagnoses in 32 patients, including those with more aggressive lymphoma (n = 16), non-hematological malignancies (n = 8) and opportunistic infections (n = 3). Twenty-seven patients had high FDG-avidity CLL, which was associated with prominent lymph node proliferation centers, an increased frequency of poor prognostic factors (17p13 deletion, unmutated immunoglobulin heavy chain variable gene [IGHV], expression of ZAP-70 and CD38) and a shorter overall survival. We conclude that FDG PET scans should not be used for routine surveillance of patients with CLL. 3
31. Jones G, Parry-Jones N, Wilkins B, Else M, Catovsky D, British Committee for Standards in Haematology. Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant*. Br J Haematol. 156(2):186-95, 2012 Jan. Review/Other-Tx N/A To provide healthcare professionals with clear guidance on the management of patients with hairy cell leukaemia (HCL). No results stated in abstract. 4
32. Robak P, Jesionek-Kupnicka D, Kupnicki P, Polliack A, Robak T. Multifocal osteolytic lesions in hairy cell leukemia-the importance of PET/CT in diagnosis and assessment. Ann Hematol 2021;100:1641-45. Review/Other-Dx 1 To report a case of multiple bone involvement by hairy cell leukemia. No results stated in abstract. 4
33. Gibson G, Lai J, Thomas P. Unusual soft tissue infiltrates with 18F-FDG uptake in a patient with hairy cell leukemia. Clin Nucl Med 2015;40:e282-4. Review/Other-Dx 1 patient To present a case of a 53-year-old man with HCL who was found to have soft tissue masses within the mediastinum and neck during pretreatment workup. These extensive infiltrates were FDG avid, and core biopsy of the mediastinal tissue was undertaken. Results were consistent with HCL. 4
34. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
35. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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