title: ACR Appropriateness Criteria® management of locoregionally advanced squamous cell carcinoma of the vulva.
abstract: OBJECTIVE
  Locoregionally advanced vulvar cancer (LRAVC) is a rare disease that presents many challenging medical decisions. An expert panel was convened to reach consensus on the most appropriate pretreatment assessment and therapeutic interventions in LRAVC patients.
  
  
  METHODS
  The American College of Radiology Appropriateness Criteria are evidenced-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journal and the application of a well-established consensus methodology (modified Delphi) to rate appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to formulate recommendations.
  
  
  RESULTS
  Three clinical variants were developed to address common scenarios in the management of LRAVC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches, with numerical ratings and descriptive commentary.
  
  
  CONCLUSIONS
  In combining available medical literature and expert opinion, this manuscript may serve as an aid for other practitioners in the appropriate management of patients with LRAVC.
authors.affiliation: Stanford Cancer Center, Stanford, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kidd
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.forename: Mahesh A
authors.initials: MA
authors.lastname: Varia
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.forename: Nina A
authors.initials: NA
authors.lastname: Mayr
authors.forename: Ajmel A
authors.initials: AA
authors.lastname: Puthawala
authors.forename: Gautam G
authors.initials: GG
authors.lastname: Rao
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Wahl
authors.forename: Aaron H
authors.initials: AH
authors.lastname: Wolfson
authors.forename: Catheryn M
authors.initials: CM
authors.lastname: Yashar
authors.forename: William
authors.initials: W
authors.lastname: Yuh
authors.forename: Higinia Rosa
authors.initials: HR
authors.lastname: Cardenes
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012955:Societies, Medical; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*