Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2024 Jan;170(1):20-33. doi: 10.1002/ohn.508. Epub 2023 Sep 11.
Identify and appraise clinical practice guidelines (CPGs) for radioactive iodine (RAI) indications in differentiated thyroid carcinoma (DTC), and the treatment for radioactive iodine refractory (RAI-R) DTC using the Appraisal of Guidelines for Research and Evaluation II tool.
MEDLINE (Pubmed), Ovid (EMBASE), and Scopus.
A systematic literature search was conducted to identify CPGs addressing RAI in DTC. CPGs were appraised by 4 independent reviewers in 6 distinct areas of quality. Scaled domain scores were subsequently calculated for each domain. Intraclass correlation coefficients were calculated for each domain to assess interrater reliability.
Sixteen guidelines were found addressing RAI indications for DTC. Of these 16, 9 also addressed the treatment of RAI-R DTC. A further 6 unique guidelines were identified that exclusively address RAI-R DTC, bringing the total number of guidelines to 22. The American Thyroid Association (ATA) guidelines for adult thyroid cancer were the highest scoring with a mean score of 83.5%. Two guidelines scored >60% in 5 or more domains, qualifying as "high" quality: ATA and British Thyroid Association. The highest scoring domain was domain 4: clarity of presentation (80.4%) while the lowest scoring domain was domain 5: applicability (38.6%).
Of the 22 guidelines identified, only two were "high quality." CPGs exclusively addressing the treatment of RAI-R DTC were weak with most guidelines scoring in the "low" quality range. This report reveals an unmet need for rigorously developed guidelines addressing indications for RAI in DTC, as well as the treatment for RAI-R DTC.
使用评估研究和评估指南 II 工具，确定和评估分化型甲状腺癌 (DTC) 放射性碘 (RAI) 适应证的临床实践指南 (CPG)，以及治疗放射性碘难治性 (RAI-R) DTC。
MEDLINE（PubMed）、Ovid（EMBASE）和 Scopus。
系统地检索了针对 DTC 中 RAI 的 CPG。4 名独立评审员对 6 个不同质量领域的 CPG 进行了评估。随后为每个领域计算了规模域评分。计算每个领域的组内相关系数以评估评分者间的可靠性。
发现 16 条指南涉及 DTC 的 RAI 适应证。其中 16 条指南还涉及 RAI-R DTC 的治疗。进一步确定了 6 条专门针对 RAI-R DTC 的独特指南，使指南总数达到 22 条。美国甲状腺协会 (ATA) 成人甲状腺癌指南的得分最高，平均得分为 83.5%。有两条指南在 5 个或更多领域的得分超过 60%，被评为“高质量”：ATA 和英国甲状腺协会。得分最高的领域是第 4 个领域：演示的清晰度 (80.4%)，得分最低的领域是第 5 个领域：适用性 (38.6%)。
在所确定的 22 条指南中，只有两条是“高质量”。专门针对 RAI-R DTC 治疗的 CPG 质量较差，大多数指南的评分都在“低”质量范围内。本报告揭示了一个未满足的需求，即需要制定严格的指南来确定 DTC 中 RAI 的适应证，以及治疗 RAI-R DTC。
