PDF(Pubmed)
Abstract：
Benign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.
A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.
The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.
Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.
A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.
The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.
Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.
摘要：
良性肝肿瘤（BLT）越来越多地被诊断为偶发瘤。在不同类型的BLT中，临床意义和管理各不相同。需要高质量的临床实践指南，因为肿瘤类型的许多细微差别，诊断方式，保守和侵入性管理策略。然而，现有的观察证据需要解释，这可能会导致实践变化。因此,我们旨在系统地搜索有关BLT的可用临床实践指南，批判性地评价它们，并比较管理建议。
在MEDLINE中进行了范围审查，EMBASE,和WebofScience。所有BLT指南都发表在同行评审中，和英语期刊有资格列入。对BLT临床实践指南进行了分析，比较,并使用《评估指南》进行了严格评估，关于肝血管瘤的研究和评估（AGREEII）清单，局灶性结节增生（FNH），和肝细胞腺瘤（HCA）。坚持用于范围审查的系统审查和荟萃分析建议（PRISMA）的首选报告项目。
文献检索产生了独特的367篇论文，348在筛选标题/摘要后被排除在外，全文筛选后16。包括三个指南：美国胃肠病学学院（ACG;2014），巴西肝病学会（SBH;2015），和欧洲肝脏研究协会（EASL;2016）。指南之间的建议分级和严重性的评估方法没有统一。观察到的差异包括：（1）所有三种肿瘤的活检指征；（2）关于避孕药和FNH和HCA随访的建议；（3）使用个性化的HCA方法；（4）缺乏男性HCA治疗建议；（5）磁共振成像中HCA亚型鉴定的方法。
认识到建议中的差异可以帮助协调实践标准并确定研究中未满足的需求。这可能最终有助于改善全球患者护理。
在MEDLINE中进行了范围审查，EMBASE,和WebofScience。所有BLT指南都发表在同行评审中，和英语期刊有资格列入。对BLT临床实践指南进行了分析，比较,并使用《评估指南》进行了严格评估，关于肝血管瘤的研究和评估（AGREEII）清单，局灶性结节增生（FNH），和肝细胞腺瘤（HCA）。坚持用于范围审查的系统审查和荟萃分析建议（PRISMA）的首选报告项目。
文献检索产生了独特的367篇论文，348在筛选标题/摘要后被排除在外，全文筛选后16。包括三个指南：美国胃肠病学学院（ACG;2014），巴西肝病学会（SBH;2015），和欧洲肝脏研究协会（EASL;2016）。指南之间的建议分级和严重性的评估方法没有统一。观察到的差异包括：（1）所有三种肿瘤的活检指征；（2）关于避孕药和FNH和HCA随访的建议；（3）使用个性化的HCA方法；（4）缺乏男性HCA治疗建议；（5）磁共振成像中HCA亚型鉴定的方法。
认识到建议中的差异可以帮助协调实践标准并确定研究中未满足的需求。这可能最终有助于改善全球患者护理。
