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Open Access Research article

Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer

Tsai-Wei Huang1, Jun-Hung Lai12, Mei-Yi Wu34, Shiah-Lian Chen1, Chih-Hsiung Wu56 and Ka-Wai Tam456789*

Author Affiliations

1 Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan

2 Department of Internal Medicine, Erlin Branch of Changhua Christian Hospital, Taichung, Taiwan

3 Division of Nephrology, Department of Internal Medicine, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan

4 Center for Evidence-based Health Care, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan

5 Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

6 Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan

7 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

8 Center for Evidence-based Medicine, Taipei Medical University, Taipei, Taiwan

9 Evidence-based Medicine Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 11031, Taiwan

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BMC Medicine 2013, 11:191  doi:10.1186/1741-7015-11-191

Published: 29 August 2013

Abstract

Background

Given the uncertainties regarding thyroid nodule assessment and management, physicians require systematically and transparently developed recommendations. This systematic review assesses the quality and consistency of the recommendations of international clinical practice guidelines (CPGs) for the diagnosis and management of thyroid nodules and cancer to assist physicians in making appropriate recommendations.

Methods

The CPGs on the management of thyroid nodules and cancer published before June 2013 were retrieved. All the reviewed guidelines were in English. Four reviewers independently assessed the rigor of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated.

Results

Ten eligible guidelines were included: nine had been developed by professional organizations, and the remaining guideline was endorsed by an independent regional body. Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Guidelines scored highest on the measurement of ‘scope and purpose’ (≥61.1% for eight CPGs) and lowest on the measurement of ‘applicability’ (≤38.5% for five CPGs). The overall quality ranged from 3.0 to 6.25 on a seven-point scale on the AGREE-II tool. Most CPG recommendations on the management of thyroid cancer were relatively consistent. Guidelines varied regarding the indication of fine-needle aspiration for thyroid nodules, as well as in their suggestions for postoperative radioiodine ablation.

Conclusions

Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of thyroid nodules and cancer.

Keywords:
Clinical practice guidelines; Thyroid cancer; Thyroid nodule; Systematic review