title: ACR Appropriateness Criteria Staging of Testicular Malignancy.
abstract: 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.
authors.affiliation: Loyola University of Chicago, Chicago, Illinois. Electronic address: joeyacoub@gmail.com.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Yacoub
authors.affiliation: University of Chicago, Chicago, Illinois.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oto
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
authors.affiliation: Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: Barak
authors.initials: B
authors.lastname: Friedman
authors.affiliation: Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Hartman
authors.affiliation: Wake Forest University School of Medicine, Winston Salem, North Carolina.
authors.forename: Keyanoosh
authors.initials: K
authors.lastname: Hosseinzadeh
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington, American Urological Association, Linthicum, Maryland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Porter
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: V Anik
authors.initials: VA
authors.lastname: Sahni
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Sudakoff
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Sadhna
authors.initials: S
authors.lastname: Verma
authors.affiliation: University of Washington, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Wang
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: University of New Mexico, Albuquerque, New Mexico.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Eberhardt
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis; D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D010808:Physical Examination; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor
keywords: Appropriateness Criteria; cancer; imaging; staging; testis