9
ASCO Resource Levels
Strength of
Recommendation Basic Limited Enhanced Maximal
Tissue handling of pathologic specimen is critical to ensure
accurate diagnosis (see Patholog y Guidelines — J Clin Oncol
35:1453–1486, 2017)
Strong
Surgery and surgical specimen to patholog y Strong
Biopsy palpable mass (e.g., rectal mass, perianal mass) Moderate
N/A Flexible
sigmoidoscopy
Flexible sigmoidoscopy or
colonoscopy
Strong
Proceed to recommendations on diagnosis based on metastatic
disease (Recommendations 1.11 – 1.13)
N/A
Biopsy palpable mass (e.g., skin nodule, lymph node) Strong
N/A N/A Biopsy of metastatic sites under
US or fluoroscopy or CT
guidance
Strong
N/A N/A N/A Surgical specimen
from metastases
resection (e.g., liver,
lung )
Strong
N/A N/A N/A Molecular testing
for MSI/MMR,
KRAS, NRAS,
BRAF should be
done based on
existing guidelines
Strong
