Appraisal of Guidelines and Consensuses on Management of Pulmonary Nodules

Objective To evaluate the methodological quality of guidelines and consensuses related to the management of pulmonary nodules according to AGREE II (The Appraisal of Guidelines for Research & Evaluation Instrument II).

Methods CNKI, WanFang, VIP, SinoMed, Yiigle, PubMed, Embase, Web of Science databases and the official websites of WHO, GIN, NGC, NICE, National Health Commission of People’s Republic of China, Chinese Medical Association, China Association of Chinese Medicine, Chinese Association of Integrative Medicine, etc. were searched to collect guidelines and consensuses related to the management of pulmonary nodules, supplemented from Medlive, the search period ranged from the conception of the databases to 2023-12-16. The methodological quality of the included guidelines and consensuses was evaluated by four researchers according to AGREE Ⅱ.

Results A total of 37 guidelines and consensuses related to the management of pulmonary nodules were included, including 11 guidelines and 26 consensuses, 22 in Chinese and 15 in English. The mean standardized scores of the 37 included documents in the six domains of AGREE Ⅱ were: scope and purpose (76.28%), stakeholder involvement (41.82%), rigor of development (36.78%), clarity of presentation (71.55%), applicability (34.88%), and editorial independence (48.03%). Subgroup analyses demonstrated no statistically significant difference found between the scores of Chinese and English literatures in any of the six domains; however, in other subgroups, the scores in all six domains were higher for guidelines than for consensuses, evidence-based than for expert opinion-oriented, updated versions than for first editions, and the number of participated experts ≥20 than for the number ≤19.

Conclusion The methodological quality of guidelines and consensuses for the management of pulmonary nodules needs to be improved in terms of stakeholder involvement in the development process, rigor in the process from evidence into recommendations, consideration of intended applicability, and the reporting of editorial independence. It is recommended that domestic and international academic organizations should refer to standards such as AGREE Ⅱ for the development and updating of guidelines and consensuses in the future.