Before these appropriate use criteria (AUC) are consulted, it is assumed that:
- The clinician knows the modality-specific contraindications to various sarcoma surveillance imaging options.
- The patient has a confirmed sarcoma diagnosis. This AUC does not address tumors of unknown metastatic potential.
- The patient is surgically treated with an appropriate intervention for the local site of disease. Under normal clinical circumstances, gross positive margins should be avoided.
- The patient’s signs and symptoms are consistent with the history, physical exam, and imaging findings. The patient is subjected to routine history and physical examination.
- Imaging modalities are performed using consistent protocols across facilities and locations. Imaging modalities are regularly available.
- There will be patients not considered in this AUC (e.g. tumors of unknown metastatic potential), but the appropriateness of these guidelines for these patients was not considered in this document. Imaging modality is based on known metastatic proclivity.
- The treating physician ultimately determines whether the patient is higher or lower risk for local or distant metastatic disease for the purposes of surveillance. Traits of higher risk patients include large tumor size, high grade histology, unplanned positive margin, and radiation and/or chemotherapy resistance. Traits of lower risk patients include low grade histology, smaller size, and radiation and chemotherapy sensitivity.
- Patients with a history of pulmonary or extra pulmonary metastatic disease are assumed to be high-risk regardless of other clinical features.
Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment, or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.