This is the current release of the guideline.

Definitions for the strength of evidence and recommendation grades (1A-2C) follow the recommendations.

1. The guideline developers recommend that the use of the term bronchioloalveolar carcinoma (BAC) be reserved for lung cancers that meet the criteria established in the revised World Health Organization (WHO) classification system for lung tumors. Grade of recommendation, 1B
2. For patients with suspected BAC, the guideline developers recommend that a surgical biopsy be used to establish a histopathologic diagnosis. Grade of recommendation, 1C
3. For patients who are unable to undergo surgical biopsy, the diagnosis of BAC should be made only with compatible histopathologic pattern on transbronchial or core needle biopsy and a computed tomography (CT) demonstrating a pure ground-glass or pneumonic appearance. Grade of recommendation, 1C
4. For patients whose CT scans show ground-glass attenuation or pneumonic consolidation (suggesting BAC), positron emission tomography (PET) scans often have false-negative results, and therefore the guideline developers recommend that a PET scan with negative results be followed by additional diagnostic testing to exclude the presence of cancer. Grade of recommendation, 1C
5. In patients who have suspected BAC and are good surgical candidates, a sublobar resection may be appropriate, provided that the CT scan shows a pure ground-glass appearance, intraoperative pathologic consultation confirms pure BAC without evidence of invasion, and surgical margins are free of disease. Grade of recommendation, 1B
6. For patients with good performance status (PS) and unresectable BAC, the guideline developers recommend the use of standard chemotherapy. The use of first-line epidermal growth factor receptor (EGFR)-targeted agents should be reserved for patients with poor PS or those who are enrolled in clinical trials. Grade of recommendation, 2C

Definitions:

Quality of Evidence Scale

High - Randomized controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies*

Moderate - RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies*

Low or very low - Observational studies or case series

*Although the determination of magnitude of the effect based on observational studies is often a matter of judgment, the guideline developers offer the following suggested rule to assist this decision: a large effect would be a relative risk > 2 (risk ratio < 0.5) [which would justify moving from weak to moderate], and a very large effect is a relative risk > 5 (risk ratio < 0.2) [which would justify moving from weak to strong]. There is some theoretical justification in the statistical literature for these thresholds (the magnitude of effect that is unlikely or very unlikely to be due to residual confounding after adjusted analysis). However, once the decision is made, authors should be explicit in justifying their decisions.

Grade of Recommendations Scale

Relationship of Strength of the Supporting Evidence to the Balance of Benefits to Risks and Burdens

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2007 Sep

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on Lung Cancer Guidelines

Primary Author: Douglas Arenberg, MD, FCCP

American Association for Bronchology - Disease Specific Society
American Association for Thoracic Surgery - Medical Specialty Society
American College of Surgeons - Medical Specialty Society
American Society for Therapeutic Radiology and Oncology
Asian Pacific Society of Respirology - Disease Specific Society
Oncology Nursing Society - Professional Association
Society of Thoracic Surgeons - Medical Specialty Society
World Association of Bronchology - Disease Specific Society

This is the current release of the guideline.

This NGC summary was completed by ECRI Institute on November 30, 2007. The information was verified by the guideline developer on December 21, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.