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Salmon MK, Fritz CG, Barrette LX, Romeo D, Suresh NV, Ng JJ, Balar E, Prasad A, Moreira A, Rajasekaran K. Quality appraisal of clinical practice guidelines for the evaluation and management of primary hyperparathyroidism. Endocrine 2024; 85:864-872. [PMID: 38551756 PMCID: PMC11291579 DOI: 10.1007/s12020-024-03790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/17/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Multiple groups have created clinical practice guidelines (CPGs) for the management of primary hyperparathyroidism (PHPT). This report provides a rigorous quality assessment using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) to identify high-performing guidelines and areas for improvement. METHODS A systematic review was conducted to isolate CPGs addressing the management of PHPT. Guideline data was extracted and quality ratings were assigned by four independent reviewers. Intraclass correlation coefficients (ICC) were calculated to ensure interrater reliability. RESULTS Twelve guidelines were assessed. The American Association of Endocrine Surgeons (AAES) guideline had the highest mean scaled score across all domains (73.6 ± 31.4%). No other published guideline achieved a "high" quality designation. The highest scoring domain was "clarity of presentation" (mean 60.5 ± 26.5%). The lowest scoring domain was "applicability" (mean 19.8 ± 18.2%). Scoring reliability was excellent, with ICC ≥ 0.89 for all AGREE II 6 domains. CONCLUSION Although several working groups have developed guidelines to address PHPT management, only those published by the AAES meet all methodologic quality criteria necessary to ensure incorporation of recommendations into clinical practice. Future guidelines would benefit from the development of tools, resources, monitoring criteria that enhance applicability.
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Affiliation(s)
- Mandy K Salmon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Christian G Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Louis-Xavier Barrette
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Dominic Romeo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Neeraj V Suresh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jinggang J Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Eesha Balar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Aman Prasad
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Walter LB, Fernandes PM, Strieder DL, Scheinpflug AL, Zanella AB, Faccin CS, Farenzena M, Xavier LF, Zorzi BDC, Graudenz MS, Scheffel RS, Dora JM, Goemann IM, Maia AL. Age-related variation in malignant cytology rates of thyroid nodules: insights from a retrospective observational study assessing the ACR TI-RADS. Eur J Endocrinol 2023; 189:584-589. [PMID: 38033287 DOI: 10.1093/ejendo/lvad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The influence of age on the malignant cytology rate of thyroid nodules remains uncertain. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is currently used to guide subsequent investigations of thyroid nodules, regardless of clinical variables. This study aimed to investigate the impact of age on the malignant cytology rates of thyroid nodules and the diagnostic performance of ACR TI-RADS across different age groups. DESIGN A retrospective, single-center, observational study. METHODS Patients aged ≥ 20 years with thyroid nodules, who underwent fine-needle aspiration biopsy between 2012 and 2019 were evaluated. Ultrasound images were used to obtain the TI-RADS data. Malignancy was determined based on suspicious for malignancy (Bethesda V) and malignant (Bethesda VI) cytology results or malignancy in cell block analysis. RESULTS A total of 1023 nodules from 921 patients (88.2% female) were analyzed. The median age was 58.5 (interquartile range [IQR], 41.1-66.6) years, and the median nodule size was 2.4 (IQR, 1.7-3.6) cm. Stratification by age revealed a decreasing prevalence of malignant cytology across subgroups of 20-39, 40-59, and ≥60 years (10.7%, 8.5%, and 3.7%, respectively; P = .002). After adjusting for sex, multinodularity, nodule size, and ACR TI-RADS category, we observed that each year of age reduced the OR for malignant cytology by 3.0% (95% CI: 0.7%-5.3%; P = .011). When comparing the subgroups of 20-39 and ≥60 years, the malignant cytology rate decreased by half in TI-RADS 4 (from 21.4% to 10.4%) and two-thirds in TI-RADS 5 (from 64.7% to 22.6%). CONCLUSIONS Our study demonstrated that as patient age increased, the rate of malignant cytology in thyroid nodules decreased. Moreover, age significantly influences the malignancy rates of thyroid nodules classified according to the ACR TI-RADS.
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Affiliation(s)
- Leonardo Barbi Walter
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Paula Martins Fernandes
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Débora Lunkes Strieder
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Anita Lavarda Scheinpflug
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Carlo Sasso Faccin
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Mauricio Farenzena
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Laura Fernandes Xavier
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Bianca Dalla Costa Zorzi
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Marcia Silveira Graudenz
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - José Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Iuri Martin Goemann
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
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Liu G, Xu XKR, Ziegenbein R, Clough A, Parsi Y, Oomens D, Clarke JL. A critical appraisal of chronic venous insufficiency ultrasound guidelines—Views of Australian sonographers. SONOGRAPHY 2022. [DOI: 10.1002/sono.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gaorui Liu
- Western Sydney Vascular Westmead New South Wales Australia
- Discipline of Medical Imaging, Faculty of Medicine and Health, Susan Wakil Health Building University of Sydney Camperdown New South Wales Australia
| | - Xiao Ke Rena Xu
- North Shore Vein Clinic St Leonards New South Wales Australia
| | - Robert Ziegenbein
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Amy Clough
- Department of Vascular Surgery Cabrini Hospital Malvern Victoria Australia
| | - Yana Parsi
- Kuring‐Gai Vascular Ultrasound Hornsby New South Wales Australia
- Sydney Vascular Ultrasound Bankstown New South Wales Australia
| | - Donna Oomens
- Discipline of Medical Imaging, Faculty of Medicine and Health, Susan Wakil Health Building University of Sydney Camperdown New South Wales Australia
- Western Sydney Vascular Norwest Private Hospital Bella Vista New South Wales Australia
| | - Jillian L. Clarke
- Discipline of Medical Imaging, Faculty of Medicine and Health, Susan Wakil Health Building University of Sydney Camperdown New South Wales Australia
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Mauri G, Gitto S, Cantisani V, Vallone G, Schiavone C, Papini E, Sconfienza LM. Use of the Thyroid Imaging Reporting and Data System (TIRADS) in clinical practice: an Italian survey. Endocrine 2020; 68:329-335. [PMID: 31983030 DOI: 10.1007/s12020-020-02199-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To perform an online survey about the use of Thyroid Imaging Reporting and Data System (TIRADS) classification in Italy. METHODS An online questionnaire was administered to all members of the Italian Society of Medical and Interventional Radiology (Società Italiana di Radiologia Medica ed Interventistica, SIRM) and Italian Society of Ultrasound in Medicine and Biology (Società Italiana di Ultrasonologia in Medicina e Biologia, SIUMB). The survey consisted of 14 questions about demographics, knowledge, and the use of TIRADS classification, current job, expertize in thyroid ultrasound and fine needle aspiration biopsy, and work environment. Descriptive and nonparametric statistics were used, with P < 0.05 indicating statistical significance. RESULTS A total of 1544 answers (9.8% out of 15,836) were received. The participants were 45 (36-59) years old [median (25th-75th percentiles)] and mostly (53.6%) familiar with TIRADS classification. Structured reporting (P < 0.001), expertize in thyroid ultrasound (P = 0.005) and fine needle aspiration biopsy (P < 0.001), and work in a multidisciplinary team (P < 0.001) were associated with the use of TIRADS classification. Physicians working in other fields than radiology were more prone to using TIRADS classification than radiologists and radiologists-in-training (P < 0.001). CONCLUSION Most physicians adopt TIRADS classification when performing thyroid ultrasound. TIRADS classification provides recommendations for the management of thyroid nodules and its use has to be encouraged.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia, Milano, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
| | - Vito Cantisani
- Unità operativa di Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italy
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-patologiche, Università degli Studi di Roma "La Sapienza", Roma, Italy
| | - Gianfranco Vallone
- Departimento Vita e Salute "V. Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Cosima Schiavone
- Unità operativa di Ecografia Internistica, Policlinico SS. Annunziata, Chieti, Italy
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università degli Studi di Chieti e Pescara "G. D'Annunzio", Chieti, Italy
| | - Enrico Papini
- Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Critical appraisal of papers reporting recommendation on sarcopenia using the AGREE II tool: a EuroAIM initiative. Eur J Clin Nutr 2020; 74:1164-1172. [PMID: 32341490 DOI: 10.1038/s41430-020-0638-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The growing interest of medical community about sarcopenia resulted in the production of several clinical practice guidelines (CPGs), with an unavoidable variability in terms of the overall quality of those publications. Our aim is to evaluate the quality of CPGs on sarcopenia using the AGREE II instrument. SUBJECTS/METHODS We performed an online literature search for sarcopenia CPGs using different databases. Four independent reviewers evaluated the quality of CPGs using the AGREE II instrument. To classify the quality of each guideline, we defined specific thresholds of final score: high-quality if five or more domains scored >60%; average-quality if three or four domains scored >60%; low-quality if ≤2 domains scored >60%. RESULTS Our literature search yielded 315 articles, and after applying exclusion criteria our final analysis included 19 CPGs. The overall quality of CPGs was remarkable, as 13/19 (68.4%) were considered of "high-quality" CPGs, with more than four domains reached a score higher than 60%. "Scope and Purpose" and "Clarity of Presentations" had the best domain results (78.4% and 73.8%, respectively), while the two domains with the lowest scores were "Rigor of Development" and "Applicability" (61.5% and 58.7%, respectively). Interobserver variability ranged between moderate (0.624) and fair (0.275). CONCLUSIONS Our study showed that the overall quality of CPGs about sarcopenia was noteworthy, as more than two-third of paper obtained a "high-quality" score. The domain "applicability" had the lowest score, suggesting that emphasis should be put on possible strategies for helping other doctors to implement guideline recommendations in clinical practice.
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Alexander AA. US-based risk stratification "guidelines" for thyroid nodules: Quō Vādis? JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:127-133. [PMID: 31957032 DOI: 10.1002/jcu.22803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/08/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE This rapid scoping review addresses the commentary titled the ACR TI-RADS™: An Advance in the Management of Thyroid Nodules or Pandora's Box of Surveillance? suggesting that the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™-2017) adds to a plethora of existing guidelines, incorporates an inconsistent lexicon, and potentially contradicts recommendations. MATERIALS AND METHODS The author performed a rapid scoping review using a combination of English keywords to identify and review peer reviewed articles contained in electronic databases (e-databases) comparing 2 or more guidelines for managing adult thyroid nodules (GMTNs) with (UGMTNs) and without (non-UGMTNs) ultrasound. E-databases included Medline (PubMed), EBSCO, Google, and Google Scholar published (2010-2019). RESULTS The search returned 28 articles, where the author identified 12 different guidelines. Most articles evaluated diagnostic performance (N = 26), not quality (N = 2) measures. The most commonly reviewed UGMTNs were in descending order ATA-2015, ACR TI-RADS™-2017, South Korean, and EU TI-RADS. No article reviewed all GMTNs or identified a generally accepted UGMTNs or non-UGMTNs. Primary origin continents were: North America (U.S.A), Asia (Japan, South Korea, Thailand), Europe (France, Italy, U.K.), and South America (Chile). CONCLUSION A plethora of UGMTNs may exist. No guideline enjoys general acceptance and evaluations of performance and quality vary.
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Affiliation(s)
- Archie A Alexander
- Dept. of Health Admin, Louisiana State University-Shreveport (LSUS), Shreveport, Los Angels
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