ACR Appropriateness Criteria® Staging and Follow-up of Gastric Cancer

Gastric cancer requires optimal imaging for staging and surveillance. This document provides evidence-based recommendations for four scenarios: suspected gastric adenocarcinoma, staging of confirmed disease, posttreatment evaluation, and surveillance. For suspected gastric cancer, CT abdomen/pelvis with contrast and FDG-PET/CT are usually appropriate for initial staging. For confirmed disease staging, these modalities are usually appropriate for evaluating locoregional and distant metastases. For posttreatment evaluation, CT abdomen/pelvis with contrast is usually appropriate for treatment response assessment and recurrence detection, particularly in high-risk patients. FDG-PET/CT is usually appropriate for treatment response evaluation and distant recurrence detection. MRI with diffusion-weighted imaging may be appropriate when radiation exposure is a concern. For surveillance following curative surgical resection of gastric adenocarcinoma, CT abdomen and pelvis with contrast is usually appropriate as the primary imaging modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.