What are the American College of Radiology (ACR) appropriateness criteria for staging non-small cell lung cancer (NSCLC)?

Updated: Aug 27, 2019
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

The American College of Radiology (ACR) appropriateness criteria finds that chest CT with IV contrast or without IV contrast is usually appropriate for the noninvasive initial clinical staging of NSCLC, as follows [7]

  • FDG-PET/CT is usually appropriate to evaluate for extrathoracic metastases. 
  • FDG-PET/CT is not required for patients with stage 0 adenocarcinoma in situ with an otherwise normal chest CT examination. 
  • Head MRI without and with IV contrast is usually appropriate in any patient with clinical stage II, III, or IV NSCLC, even in the absence of neurologic symptoms. 
  • Head MRI without and with IV contrast is optional in patients with clinical stage IB NSCLC without neurologic symptoms. 
  • Head MRI without and with IV contrast is recommended in all NSCLC patients exhibiting neurologic symptoms, regardless of stage.

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