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Systematic review of clinical practice guidelines on the diagnosis and management of thyroid nodule and cancer

Date and Location




Monday 23 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Ka-Wai Tam

Contact person

Mei-Yi Wu
Abstract text
Background: Usually, physicians base their practice on clinical practice guidelines (CGPs), but recommendations on the same topic may vary across guidelines. Given the uncertainties regarding thyroid nodule assessment and management, physicians should be able to identify systematically and transparently developed recommendations. Objectives: The aim of this systematic review was to assess the quality and consistency of recommendations of international CGPs on the diagnosis and management of thyroid nodule and cancer, and to assist physicians in their choice of recommendations. Methods: CGPs on the management of thyroid nodule and cancer published before March 1, 2013 were retrieved using MEDLINE, EMBASE, CINAHL, the National Guideline Clearinghouse, and the G-I-N International Guideline Library. All guidelines in English were included. Four reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines Research and Evaluation-II (AGREE-II) instrument, and their reported evidence base was evaluated. Results: Ten guidelines were deemed eligible: nine had been developed by professional organizations, and the other one had regional independent body endorsements. Three guidelines performed satisfactorily, achieving a score of greater than 50% in all six AGREE-II domains. The overall quality ranged from 2.5 to 6.25 out of 7 on the AGREE-II tool. The highest scores were for “scope and purpose” (>61.1% for 8 CGPs) and the lowest were for “applicability” (<38.5% for 5 CGPs). Most of the CPGs’ recommendations on the management of thyroid cancer were quite consistent. Guidelines varied in the indication of fine needle aspiration for thyroid nodule, and the suggestion of radioiodine ablation postoperatively. Cervical lymph node dissection was unnoticed by 3/10 CPGs. Conclusions: Our analysis shows that the current CPGs varied in methodological quality, more efforts are need to improve the quality of recommendations on the diagnosis and management of thyroid nodule and cancer.