What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel

Matthew Dixon, Roberta Cardoso, Jill Tinmouth, Lucy Helyer, Calvin Law, Carol Swallow, Lawrence Paszat, Robin McLeod, Rajini Seevaratnam, Alyson Mahar, Natalie G. Coburn, Tanios Bekaii-Saab, Ian Chau, Neal Church, Daniel Coit, Christopher H. Crane, Craig Earle, Paul Mansfield, Norman Marcon, Thomas Minder & 7 others Sung Hoon Noh, Geoff Porter, Mitchell C. Posner, Vivek Prachand, Takeshi Sano, Cornelis J.H. Van De Velde, Sandra Wong

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The approach for staging gastric adenocarcinoma (GC) has not been well defined, with heterogeneity in the application of staging modalities. Methods: Utilizing a RAND/UCLA appropriateness methodology (RAM), a multidisciplinary expert panel of 16 physicians scored 84 GC staging scenarios. Appropriateness was scored from 1 to 9. Median appropriateness scores from 1 to 3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 12 or more of 16 panelists scored the scenario similarly. Appropriate scenarios were subsequently scored for necessity. Results: Pretreatment TNM stage determination is necessary. Necessary staging maneuvers include esophagogastroduodenoscopy (EGD); biopsy of the tumor; documentation of tumor size, description, location, distance from gastroesophageal junction (GEJ), and any GEJ, esophageal, or duodenal involvement; if an EGD report is unclear, surgeons should repeat it to confirm tumor location. Pretreatment radiologic assessment should include computed tomography (CT)-abdomen and CT-pelvis, performed with multidetector CT scanners with 5-mm slices. Laparoscopy should be performed before resection of cT3-cT4 lesions or multivisceral resections. Laparoscopy should include inspection of the stomach, diaphragm, liver, and ovaries. Conclusions: Using a RAM, we describe appropriate and necessary staging tests for the pretreatment staging evaluation of GC, as well as how some of these staging maneuvers should be conducted.

Original languageEnglish (US)
Pages (from-to)377-382
Number of pages6
JournalGastric Cancer
Volume17
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Stomach
Adenocarcinoma
Digestive System Endoscopy
Esophagogastric Junction
Laparoscopy
Tomography
Neoplasms
Multidetector Computed Tomography
Diaphragm
Pelvis
Documentation
Abdomen
Ovary
Physicians
Biopsy
Liver

Keywords

  • Endoscopy
  • Gastric cancer
  • Laparoscopy
  • Radiology
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel. / Dixon, Matthew; Cardoso, Roberta; Tinmouth, Jill; Helyer, Lucy; Law, Calvin; Swallow, Carol; Paszat, Lawrence; McLeod, Robin; Seevaratnam, Rajini; Mahar, Alyson; Coburn, Natalie G.; Bekaii-Saab, Tanios; Chau, Ian; Church, Neal; Coit, Daniel; Crane, Christopher H.; Earle, Craig; Mansfield, Paul; Marcon, Norman; Minder, Thomas; Noh, Sung Hoon; Porter, Geoff; Posner, Mitchell C.; Prachand, Vivek; Sano, Takeshi; Van De Velde, Cornelis J.H.; Wong, Sandra.

In: Gastric Cancer, Vol. 17, No. 2, 01.01.2014, p. 377-382.

Research output: Contribution to journalArticle

Dixon, M, Cardoso, R, Tinmouth, J, Helyer, L, Law, C, Swallow, C, Paszat, L, McLeod, R, Seevaratnam, R, Mahar, A, Coburn, NG, Bekaii-Saab, T, Chau, I, Church, N, Coit, D, Crane, CH, Earle, C, Mansfield, P, Marcon, N, Minder, T, Noh, SH, Porter, G, Posner, MC, Prachand, V, Sano, T, Van De Velde, CJH & Wong, S 2014, 'What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel', Gastric Cancer, vol. 17, no. 2, pp. 377-382. https://doi.org/10.1007/s10120-013-0262-x
Dixon, Matthew ; Cardoso, Roberta ; Tinmouth, Jill ; Helyer, Lucy ; Law, Calvin ; Swallow, Carol ; Paszat, Lawrence ; McLeod, Robin ; Seevaratnam, Rajini ; Mahar, Alyson ; Coburn, Natalie G. ; Bekaii-Saab, Tanios ; Chau, Ian ; Church, Neal ; Coit, Daniel ; Crane, Christopher H. ; Earle, Craig ; Mansfield, Paul ; Marcon, Norman ; Minder, Thomas ; Noh, Sung Hoon ; Porter, Geoff ; Posner, Mitchell C. ; Prachand, Vivek ; Sano, Takeshi ; Van De Velde, Cornelis J.H. ; Wong, Sandra. / What studies are appropriate and necessary for staging gastric adenocarcinoma? Results of an international RAND/UCLA expert panel. In: Gastric Cancer. 2014 ; Vol. 17, No. 2. pp. 377-382.
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AU - Dixon, Matthew

AU - Cardoso, Roberta

AU - Tinmouth, Jill

AU - Helyer, Lucy

AU - Law, Calvin

AU - Swallow, Carol

AU - Paszat, Lawrence

AU - McLeod, Robin

AU - Seevaratnam, Rajini

AU - Mahar, Alyson

AU - Coburn, Natalie G.

AU - Bekaii-Saab, Tanios

AU - Chau, Ian

AU - Church, Neal

AU - Coit, Daniel

AU - Crane, Christopher H.

AU - Earle, Craig

AU - Mansfield, Paul

AU - Marcon, Norman

AU - Minder, Thomas

AU - Noh, Sung Hoon

AU - Porter, Geoff

AU - Posner, Mitchell C.

AU - Prachand, Vivek

AU - Sano, Takeshi

AU - Van De Velde, Cornelis J.H.

AU - Wong, Sandra

PY - 2014/1/1

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N2 - Background: The approach for staging gastric adenocarcinoma (GC) has not been well defined, with heterogeneity in the application of staging modalities. Methods: Utilizing a RAND/UCLA appropriateness methodology (RAM), a multidisciplinary expert panel of 16 physicians scored 84 GC staging scenarios. Appropriateness was scored from 1 to 9. Median appropriateness scores from 1 to 3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 12 or more of 16 panelists scored the scenario similarly. Appropriate scenarios were subsequently scored for necessity. Results: Pretreatment TNM stage determination is necessary. Necessary staging maneuvers include esophagogastroduodenoscopy (EGD); biopsy of the tumor; documentation of tumor size, description, location, distance from gastroesophageal junction (GEJ), and any GEJ, esophageal, or duodenal involvement; if an EGD report is unclear, surgeons should repeat it to confirm tumor location. Pretreatment radiologic assessment should include computed tomography (CT)-abdomen and CT-pelvis, performed with multidetector CT scanners with 5-mm slices. Laparoscopy should be performed before resection of cT3-cT4 lesions or multivisceral resections. Laparoscopy should include inspection of the stomach, diaphragm, liver, and ovaries. Conclusions: Using a RAM, we describe appropriate and necessary staging tests for the pretreatment staging evaluation of GC, as well as how some of these staging maneuvers should be conducted.

AB - Background: The approach for staging gastric adenocarcinoma (GC) has not been well defined, with heterogeneity in the application of staging modalities. Methods: Utilizing a RAND/UCLA appropriateness methodology (RAM), a multidisciplinary expert panel of 16 physicians scored 84 GC staging scenarios. Appropriateness was scored from 1 to 9. Median appropriateness scores from 1 to 3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 12 or more of 16 panelists scored the scenario similarly. Appropriate scenarios were subsequently scored for necessity. Results: Pretreatment TNM stage determination is necessary. Necessary staging maneuvers include esophagogastroduodenoscopy (EGD); biopsy of the tumor; documentation of tumor size, description, location, distance from gastroesophageal junction (GEJ), and any GEJ, esophageal, or duodenal involvement; if an EGD report is unclear, surgeons should repeat it to confirm tumor location. Pretreatment radiologic assessment should include computed tomography (CT)-abdomen and CT-pelvis, performed with multidetector CT scanners with 5-mm slices. Laparoscopy should be performed before resection of cT3-cT4 lesions or multivisceral resections. Laparoscopy should include inspection of the stomach, diaphragm, liver, and ovaries. Conclusions: Using a RAM, we describe appropriate and necessary staging tests for the pretreatment staging evaluation of GC, as well as how some of these staging maneuvers should be conducted.

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KW - Gastric cancer

KW - Laparoscopy

KW - Radiology

KW - Staging

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