ACR Appropriateness Criteria Staging of Testicular Malignancy.

Testicular cancer represents only 1% of all malignancies occurring in men. However, it is the most frequent malignancy in men between the ages of 20 and 34 years, accounting for 10% to 14% of cancer incidence in that age group. In most instances, the diagnosis of testicular tumors is established with a carefully performed physical examination and scrotal ultrasonography. Tumor markers are useful for determining the presence of residual disease. Cross-sectional imaging studies (CT, MRI) are useful in determining the location of metastases. Chest radiography and CT are used to assess pulmonary disease. Fluorine-18-2-fluoro-2-deoxy-d-glucose (FDG) PET scans have slightly higher sensitivity than CT, but their role in staging testicular cancer has not been determined in a large study. FDG PET may play a role in the follow-up of higher stage seminoma after chemotherapy. Bone scans are useful in the absence of FDG PET scans and should be used when bone metastases are suspected. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Journal of the American College of Radiology : JACR. 2016 Aug 12 [Epub ahead of print]

Joseph H Yacoub, Aytekin Oto, Brian C Allen, Fergus V Coakley, Barak Friedman, Matthew S Hartman, Keyanoosh Hosseinzadeh, Christopher Porter, V Anik Sahni, Gary S Sudakoff, Sadhna Verma, Carolyn L Wang, Erick M Remer, Steven C Eberhardt

Loyola University of Chicago, Chicago, Illinois. Electronic address: ., University of Chicago, Chicago, Illinois., Duke University Medical Center, Durham, North Carolina., Oregon Health and Science University, Portland, Oregon., Long Island Jewish Medical Center, New Hyde Park, New York., Allegheny General Hospital, Pittsburgh, Pennsylvania., Wake Forest University School of Medicine, Winston Salem, North Carolina., Virginia Mason Medical Center, Seattle, Washington, American Urological Association, Linthicum, Maryland., Brigham & Women's Hospital, Boston, Massachusetts., Medical College of Wisconsin, Milwaukee, Wisconsin., University of Cincinnati Medical Center, Cincinnati, Ohio., University of Washington, Seattle Cancer Care Alliance, Seattle, Washington., Cleveland Clinic, Cleveland, Ohio., University of New Mexico, Albuquerque, New Mexico.