Tyagi N Kumar, Dhesy-Thind S
Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, ON.
Curr Oncol. 2018 Jun;25(Suppl 1):S151-S160. doi: 10.3747/co.25.3729. Epub 2018 Jun 13.
A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability.
Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor-positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario's Program in Evidence Based Care (cco's pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool.
The quality of the cpgs was greatest for the guidelines developed by asco and cco's pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory.
Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations-such as intrinsic guideline characteristics and the needs of end users-is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.
目前有许多关于乳腺癌筛查与管理的临床实践指南（CPG）。在此，我们从方法学质量、建议及可实施性方面，综述了各专业组织和共识小组制定的CPG的优缺点。
针对两种临床情况，对四个组织的指南进行了综述：早期雌激素受体阳性乳腺癌绝经前女性的辅助性卵巢功能抑制（OFS），以及局部晚期乳腺癌新辅助化疗（NAC）后前哨淋巴结活检（SLNB）的应用。由两位独立评估者对美国临床肿瘤学会（ASCO）、安大略癌症护理循证护理项目（CCO的PEBC）、美国国立综合癌症网络（NCCN）以及圣加仑国际乳腺癌共识会议制定的指南进行了综述。使用AGREE II工具对指南的方法学及适用性进行评估。
ASCO和CCO的PEBC制定的指南CPG质量最高。NCCN和圣加仑指南在方法学严谨性方面得分较低。所有指南在适用性方面得分均较低。三项指南中关于OFS的建议相似。各组织对于NAC后使用SLNB的建议相互矛盾。
我们的综述表明，CPG在方法学质量上可能存在异质性。低质量的CPG实施策略导致乳腺癌CPG的采用率和依从性较低。需要进一步研究探讨建议实施的障碍，如指南的内在特征和终端用户的需求。使用乳腺癌CPG可以缩小知识与实践之间的差距并改善患者预后。
