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Kevin S. Scher, Juan-Sebastian Saldivar, Michael Fishbein, Alberto Marchevsky, and Karen L. Reckamp

fluorodeoxyglucose uptake in the right upper lobe mass and the right hilar and subcarinal regions. MRI of the brain in February 2010 was negative. She underwent an endobronchial ultrasound biopsy of a subcarinal node, which was positive for adenocarcinoma. Concurrent

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Jamie E. Flerlage, Susan M. Hiniker, Saro Armenian, Ellen C. Benya, Adam J. Bobbey, Vivian Chang, Stacy Cooper, Don W. Coulter, Branko Cuglievan, Bradford S. Hoppe, Leidy Isenalumhe, Kara Kelly, Leslie Kersun, Adam J. Lamble, Nicole A. Larrier, Jeffrey Magee, Kwadwo Oduro, Martha Pacheco, Anita P. Price, Kenneth B. Roberts, Christine M. Smith, Aliyah R. Sohani, Erin M. Trovillion, Emily Walling, Ana C. Xavier, Jennifer L. Burns, and Mallory Campbell

and 2 of 2, pages 745 and 746 in the algorithm). For staging and risk assessment, diagnostic imaging should be done before initiating chemotherapy or steroids whenever possible including: PET/CT or PET/MRI scans (whole-body); diagnostic contrast

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Lara Franziska Stolzenbach, Giuseppe Rosiello, Angela Pecoraro, Carlotta Palumbo, Stefano Luzzago, Marina Deuker, Zhe Tian, Anne-Sophie Knipper, Raisa Pompe, Kevin C. Zorn, Shahrokh F. Shariat, Felix K.H. Chun, Markus Graefen, Fred Saad, and Pierre I. Karakiewicz

profile. Fourth, we could not account for the use of additional staging tools, such as MRI. It is possible that the rates of prostate MRI have increased over time and approximate MRI use in prospective trials. However, it is unlikely that the follow-up of

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Matthew H. Kulke, Manisha H. Shah, Al B. Benson III, Emily Bergsland, Jordan D. Berlin, Lawrence S. Blaszkowsky, Lyska Emerson, Paul F. Engstrom, Paul Fanta, Thomas Giordano, Whitney S. Goldner, Thorvardur R. Halfdanarson, Martin J. Heslin, Fouad Kandeel, Pamela L. Kunz, Boris W. Kuvshinoff II, Christopher Lieu, Jeffrey F. Moley, Gitonga Munene, Venu G. Pillarisetty, Leonard Saltz, Julie Ann Sosa, Jonathan R. Strosberg, Jean-Nicolas Vauthey, Christopher Wolfgang, James C. Yao, Jennifer Burns, and Deborah Freedman-Cass

used techniques include CT and MRI. NETs of the gastrointestinal tract and lungs are highly vascular and can appear isodense with liver on conventional CT scan, depending on contrast phase. Multiphase CT or MRI scans should therefore be used for

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Ling-Long Tang, Yu-Pei Chen, Yan-Ping Mao, Zi-Xian Wang, Rui Guo, Lei Chen, Li Tian, Ai-Hua Lin, Li Li, Ying Sun, and Jun Ma

imaging modalities, such as MRI and PET scanning, have made it possible to measure tumor volume and extension more precisely in NPC. Additionally, developments in radiation technology, such as intensity-modulated radiotherapy (IMRT), have improved tumor

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Zhi Ven Fong and Cristina R. Ferrone

underwent an R0 surgical resection. To improve the ability of imaging to determine response, FDG PET/CT, FDG PET/MRI, and radiomics are being explored by multiple groups. A recent study from the Medical College of Wisconsin indicated that patients with

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NCCN Guidelines Insights: Rectal Cancer, Version 6.2020

Featured Updates to the NCCN Guidelines

Al B. Benson III, Alan P. Venook, Mahmoud M. Al-Hawary, Mustafa A. Arain, Yi-Jen Chen, Kristen K. Ciombor, Stacey Cohen, Harry S. Cooper, Dustin Deming, Ignacio Garrido-Laguna, Jean L. Grem, Andrew Gunn, Sarah Hoffe, Joleen Hubbard, Steven Hunt, Natalie Kirilcuk, Smitha Krishnamurthi, Wells A. Messersmith, Jeffrey Meyerhardt, Eric D. Miller, Mary F. Mulcahy, Steven Nurkin, Michael J. Overman, Aparna Parikh, Hitendra Patel, Katrina Pedersen, Leonard Saltz, Charles Schneider, David Shibata, John M. Skibber, Constantinos T. Sofocleous, Elena M. Stoffel, Eden Stotsky-Himelfarb, Christopher G. Willett, Alyse Johnson-Chilla, and Lisa A. Gurski

body habitus (ie, a measured distance of 12 cm from the anal verge would yield very different anatomic features in a patient who is 4 feet tall compared with one who is 7 feet tall). Furthermore, the panel considers MRI to be a superior tool compared

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Thomas A. D’Amico, Lindsey A.M. Bandini, Alan Balch, Al B. Benson III, Stephen B. Edge, C. Lyn Fitzgerald, Robert J. Green, Wui-Jin Koh, Michael Kolodziej, Shaji Kumar, Neal J. Meropol, James L. Mohler, David Pfister, Ronald S. Walters, and Robert W. Carlson

intravenous and oral contrast to maximize detection of potential metastatic disease. An alternative, if an abdominal or pelvic CT is inadequate or if CT with intravenous contrast is contraindicated, is abdominal/pelvic MRI with contrast plus a noncontrast

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Peter E. Clark, Philippe E. Spiess, Neeraj Agarwal, Matthew C. Biagioli, Mario A. Eisenberger, Richard E. Greenberg, Harry W. Herr, Brant A. Inman, Deborah A. Kuban, Timothy M. Kuzel, Subodh M. Lele, Jeff Michalski, Lance Pagliaro, Sumanta K. Pal, Anthony Patterson, Elizabeth R. Plimack, Kamal S. Pohar, Michael P. Porter, Jerome P. Richie, Wade J. Sexton, William U. Shipley, Eric J. Small, Donald L. Trump, Geoffrey Wile, Timothy G. Wilson, Mary Dwyer, and Maria Ho

patient for regional lymph node involvement. 27 MRI or ultrasound can be used to evaluate the depth of tumor invasion. 28 For the evaluation of lymph nodes, see “Management of Regional Lymph Nodes,” this page. NCCN Recommendations Tis or Ta: For

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Al B. Benson, Michael I. D’Angelica, Daniel E. Abbott, Daniel A. Anaya, Robert Anders, Chandrakanth Are, Melinda Bachini, Mitesh Borad, Daniel Brown, Adam Burgoyne, Prabhleen Chahal, Daniel T. Chang, Jordan Cloyd, Anne M. Covey, Evan S. Glazer, Lipika Goyal, William G. Hawkins, Renuka Iyer, Rojymon Jacob, R. Kate Kelley, Robin Kim, Matthew Levine, Manisha Palta, James O. Park, Steven Raman, Sanjay Reddy, Vaibhav Sahai, Tracey Schefter, Gagandeep Singh, Stacey Stein, Jean-Nicolas Vauthey, Alan P. Venook, Adam Yopp, Nicole R. McMillian, Cindy Hochstetler, and Susan D. Darlow

imaging (abdominal multiphasic CT or MRI) is recommended in the setting of a rising serum AFP or following identification of a liver mass nodule ≥10 mm on US, based on AASLD and Liver Imaging Reporting and Data System (LI-RADS) guidelines. 3 , 30 It is