目的:系统评价用于正电子发射断层扫描(PET)成像指南的方法,并比较这些建议的一致性。
方法:我们搜索了PubMed,EMBASE,四个指南数据库,和谷歌学者确定有关使用PET的循证临床实践指南,PET/计算机断层扫描(CT),或常规实践中的PET/磁共振。我们使用研究和评估II评估指南评估了每个指南的质量,并比较了有关18F-氟代脱氧葡萄糖(FDG)PET/CT适应症的建议。
结果:35个PET成像指南,包括在2008年至2021年之间发布的。这些指南在范围和目的领域表现良好(中位数为80.6%,四分位数间距[IQR]77.8-83.3%)和显示清晰度(中位数75%,IQR69.4-83.3%),但适用性较差(中位数为27.1%,IQR22.9-37.5%)。比较了13种癌症中48种适应症的建议。在与8种癌症类型有关的10种(20.1%)适应症中,在是否支持使用FDGPET/CT的方向上观察到相当大的不一致:头颈部癌(治疗反应评估),结直肠癌(I-III期患者的分期),食管癌(分期),乳腺癌(重新分类和治疗反应评估),宫颈癌(IB2期患者的分期和治疗反应评估),卵巢癌(复述),胰腺癌(诊断),和肉瘤(治疗反应评估)。
结论:目前的PET成像指南在方法学质量上存在差异,并提供了相当不一致的建议。需要努力提高对指导方针制定方法的遵守,合成高质量的证据,并采用标准术语。
■PROSPEROCRD42020184965。
结论:PET成像指南提供了相当不一致的建议,方法学质量也各不相同。建议临床医生在实践中应用这些建议时要对这些建议持批评态度,指南开发人员采用更严格的开发方法,研究人员优先考虑当前指南确定的研究差距。
结论:•PET指南的方法学质量各不相同,并提供了不一致的建议。需要努力改进方法,合成高质量的证据,规范术语。·在AGREEII工具评估的六个方法学质量领域中,PET成像指南在范围和目的上表现良好(中位数为80.6%,四分位数间距77.8-83.3%)和表示清晰度(75%,69.4-83.3%),但适用性较差(27.1%,22.9-37.5%)。•在比较的48项建议(针对13种癌症类型)中,在是否支持FDGPET/CT使用的方向上的冲突在10个(20.1%)中观察到,对于8种癌症类型(即,头部和颈部,结直肠,食道,乳房,子宫颈,卵巢,胰腺,和肉瘤)。
OBJECTIVE: To systematically appraise the methodologies used for
guidelines for positron emission tomography (PET) imaging and to compare the consistency of these recommendations.
METHODS: We searched PubMed, EMBASE, four
guideline databases, and Google Scholar to identify evidence-based clinical practice guidelines pertaining to the use of PET, PET/computed tomography (CT), or PET/magnetic resonance in routine practice. We assessed the quality of each
guideline using the Appraisal of
Guidelines for Research and Evaluation II instrument and compared recommendations regarding indications for 18F-fluorodeoxyglucose (FDG) PET/CT.
RESULTS: Thirty-five guidelines for PET imaging, published between 2008 and 2021, were included. These guidelines performed well in the domains of scope and purpose (median 80.6%, inter-quartile range [IQR] 77.8-83.3%) and clarity of presentation (median 75%, IQR 69.4-83.3%), but poorly in applicability (median 27.1%, IQR 22.9-37.5%). Recommendations for 48 indications in 13 cancers were compared. Considerable inconsistencies in the direction of whether to support the use of FDG PET/CT were observed in 10 (20.1%) indications pertaining to 8 cancer types: head and neck cancer (treatment response assessment), colorectal cancer (staging in patients with stages I-III disease), esophageal cancer (staging), breast cancer (restaging and treatment response assessment), cervical cancer (staging in patients with stage < IB2 disease and treatment response assessment), ovarian cancer (restaging), pancreatic cancer (diagnosis), and sarcoma (treatment response assessment).
CONCLUSIONS: Current guidelines for PET imaging vary in methodological quality and provided considerably inconsistent recommendations. Efforts are needed to improve adherence to
guideline development methodologies, to synthesis high-quality evidence, and to adopt standard terminologies.
UNASSIGNED: PROSPERO CRD42020184965.
CONCLUSIONS: Guidelines for PET imaging provide considerably inconsistent recommendations and vary in methodological quality. It is suggested that clinicians be critical of these recommendations when applying them in practice, that
guideline developers adopt more rigorous development methodologies, and that researchers prioritize research gaps identified by current guidelines.
CONCLUSIONS: • PET guidelines vary in methodological quality and provided inconsistent recommendations. Efforts are needed to improve methodologies, synthesize high-quality evidence, and standardize terminologies. • Among six domains of methodological quality assessed by the AGREE II tool, guidelines for PET imaging performed well in scope and purpose (median 80.6%, inter-quartile range 77.8-83.3%) and clarity of presentation (75%, 69.4-83.3%), but poorly in applicability (27.1%, 22.9-37.5%). • Among the 48 recommendations (for 13 cancer types) compared, conflicts in the direction of whether to support FDG PET/CT use were observed in 10 (20.1%), for 8 cancer types (i.e., head and neck, colorectal, esophageal, breast, cervical, ovarian, pancreatic, and sarcoma).