Critical review of clinical practice guidelines for evaluation of neck mass in adults

Chorath, Kevin; Prasad, Aman; Luu, Neil N.; Go, Beatrice; Moreira, Alvaro; Rajasekaran, Karthik

doi:10.1016/j.bjorl.2021.03.005

Cited by 10 publications

(6 citation statements)

References 36 publications

(35 reference statements)

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Section: Discussionsupporting

confidence: 79%

“…The findings in this study are in accordance with previous literature utilizing the AGREE II instrument to assess CPGs for a wide variety of interdisciplinary topics involving otolaryngology. [27][28][29] In reviewing 22 CPGs encompassing both RAI indications in DTC as well as the diagnosis and treatment of RAI-R DTC, we sought to complete one of the largest AGREE II guideline evaluations to date on a single topic. Overall, a significant proportion (in this study 90.9%) of guidelines did not meet the "high quality" threshold of >60% in 5 or more domains of quality, indicating substantial shortcomings in the developmental process.…”

Section: Discussionmentioning

confidence: 99%

“…The Appraisal of Guidelines Research and Evaluation (AGREE II) tool is an effective tool for assessing the quality of CPGs 26 . In otorhinolaryngology, the literature has assessed CPGs for a variety of conditions ranging from medullary thyroid carcinoma to evaluation of neck masses, and temporomandibular joint disorder 27‐29 . In this study we sought to (1) conduct a systematic review of all CPGs related to RAI indications in DTC and (2) comprehensively evaluate the development process and methodological quality of these guidelines using the AGREE II instrument.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal

Monos,

Fritz,

Harris

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveIdentify 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.Data SourcesMEDLINE (Pubmed), Ovid (EMBASE), and Scopus.Review MethodsA 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.ResultsSixteen 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%).ConclusionOf 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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal

Monos,

Fritz,

Harris

et al. 2023

Otolaryngol.--head neck surg.

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“…Se han elaborado y difundido varias guías de práctica clínica (GPC) para la evaluación de una masa en el cuello. Sin embargo, hasta la fecha no se ha valorado la calidad y el rigor metodológico de estas guías 11 . La publicación de Chorath et al 11 se propuso identificar y evaluar la calidad metodológica de las guías nacionales e internacionales para la evaluación y manejo de masas en el cuello en adultos.…”

Section: B Aunclassified

Aprendizaje radiológico basado en problema clínico específico: linfadenopatía cervical, tips clínicos y de imagen para facilitar su tipificación

Motta-Ramírez,

Almazán-Santiago,

Gallegos-Reséndiz

2024

ARM

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Objective:The clinical evaluation of palpable neck masses usually underestimates or overestimates their extension. A neck mass is defined as any increase in volume that forms in the cervical region, of congenital or acquired origin and that is visible, palpable, or identified by means of an imaging study. Method: An extensive bibliographic review was carried out in the PubMed database, where recent bibliographic information was inquired using the following keywords: cervical mass in adults, neck mass in adults, cervical lymphadenopathy in adults, as well as on evaluation methods such as ultrasound (US) and computed tomography, including original studies, and bibliographic reviews. Results:The manuscript indicates the CRISPS mnemonic, the CLN-RADS (Cervical Lymph Node Imaging Reporting and Data System for ultrasound of Cervical Lymphadenopathy) as well as the proposal of the UNN-RADS (Ultrasound Neck Node Reporting and Data System) classification, and how US examination of the neck should be performed with a systematic approach, organized to evaluate, and report cervical lymph nodes and do not omit any ganglionic chain. In current medical practice, there is often no defined clinical picture when a neck mass appears in adults and reflects a severe abnormality. Conclusion: A new persistent neck mass in an adult patient should be considered malignant until proven otherwise. Any neck mass, particularly unilateral, asymptomatic, in cervical lymph node group topography, should be considered a metastatic lesion, until proven otherwise.

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“…Subjective image interpretation, lack of effective quantification, and persistent intra-and interobserver variability remain the main dilemmas faced in US examinations. Consequently, a significant proportion of patients with unexplained CLA are frequently misdiagnosed and subsequently subjected to unnecessary investigations and inappropriate treatment [16].…”

Section: Introductionmentioning

confidence: 99%

Deep learning radiomics of dual-modality ultrasound images for hierarchical diagnosis of unexplained cervical lymphadenopathy

Zhu

Meng

Xiao

et al. 2022

BMC Med

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Background Accurate diagnosis of unexplained cervical lymphadenopathy (CLA) using medical images heavily relies on the experience of radiologists, which is even worse for CLA patients in underdeveloped countries and regions, because of lack of expertise and reliable medical history. This study aimed to develop a deep learning (DL) radiomics model based on B-mode and color Doppler ultrasound images for assisting radiologists to improve their diagnoses of the etiology of unexplained CLA. Methods Patients with unexplained CLA who received ultrasound examinations from three hospitals located in underdeveloped areas of China were retrospectively enrolled. They were all pathologically confirmed with reactive hyperplasia, tuberculous lymphadenitis, lymphoma, or metastatic carcinoma. By mimicking the diagnosis logic of radiologists, three DL sub-models were developed to achieve the primary diagnosis of benign and malignant, the secondary diagnosis of reactive hyperplasia and tuberculous lymphadenitis in benign candidates, and of lymphoma and metastatic carcinoma in malignant candidates, respectively. Then, a CLA hierarchical diagnostic model (CLA-HDM) integrating all sub-models was proposed to classify the specific etiology of each unexplained CLA. The assistant effectiveness of CLA-HDM was assessed by comparing six radiologists between without and with using the DL-based classification and heatmap guidance. Results A total of 763 patients with unexplained CLA were enrolled and were split into the training cohort (n=395), internal testing cohort (n=171), and external testing cohorts 1 (n=105) and 2 (n=92). The CLA-HDM for diagnosing four common etiologies of unexplained CLA achieved AUCs of 0.873 (95% CI: 0.838–0.908), 0.837 (95% CI: 0.789–0.889), and 0.840 (95% CI: 0.789–0.898) in the three testing cohorts, respectively, which was systematically more accurate than all the participating radiologists. With its assistance, the accuracy, sensitivity, and specificity of six radiologists with different levels of experience were generally improved, reducing the false-negative rate of 2.2–10% and the false-positive rate of 0.7–3.1%. Conclusions Multi-cohort testing demonstrated our DL model integrating dual-modality ultrasound images achieved accurate diagnosis of unexplained CLA. With its assistance, the gap between radiologists with different levels of experience was narrowed, which is potentially of great significance for benefiting CLA patients in underdeveloped countries and regions worldwide.

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Critical review of clinical practice guidelines for evaluation of neck mass in adults

Cited by 10 publications

References 36 publications

Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal

Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal

Aprendizaje radiológico basado en problema clínico específico: linfadenopatía cervical, tips clínicos y de imagen para facilitar su tipificación

Deep learning radiomics of dual-modality ultrasound images for hierarchical diagnosis of unexplained cervical lymphadenopathy

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