A systematic review and critical appraisal of current recommendations for lung cancer screening.

Abstract

e20124 Background: Strengthening the screening of Lung Cancer in Europe (SOLACE) is an initiative funded by the European Union (EU) under the EU4Health Framework. In order to develop new guidelines for lung cancer screening (LCS) in EU Member States, we conducted a systematic review and critical appraisal of guidelines reporting recommendations addressing all stages of the LCS pathway from identification of people who should undergo screening through lung cancer (LC) diagnosis and staging. Methods: We searched Medline, Embase, CINAHL and Cochrane library from 2009 through 2024 for any guidelines addressing LCS, diagnosis, or staging. We also searched websites of guideline-producing organizations and government entities. Eligible documents were available in English or any European language and made at least one recommendation addressing LCS, diagnosis, or staging. Document characteristics and recommendation text, strength, and certainty (where available) were extracted from studies in duplicate and synthesized by mapping recommendations onto key topic areas identified during a prior narrative review of the LCS pathway. Guideline appraisal was performed by at least two researchers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results: Our search identified 14,357 documents, from which 156 were included. Recommendations addressed all pre-specified stages of the LCS and LC diagnosis/staging pathway. Most of the recommendations were developed in either North America (39%) or Europe (34%), and a majority were developed by professional societies (83%). Documents in our sample scored the lowest in the AGREE II domains assessing “applicability” (median 0.17; interquartile range [IQR] 0.08 to 0.30), “stakeholder involvement” (median 0.28; IQR 0.14 to 0.42), and “rigor of development” (median 0.25; IQR 0.14 to 0.40). Documents scored the highest in the “clarity of presentation” domain (median 0.69; IQR 0.56 to 0.81). Conclusions: The impact of LCS guidelines can be improved by addressing implementation and evaluation, inclusion of multidisciplinary panel members, and basing the recommendations on systematic reviews of the evidence. Exhaustive mapping of LCS recommendations will inform priorities for future LCS guideline development. Summary of AGREE II domain scores. AGREE Domain AGREE Score N = 156 * Scope & Purpose 0.59 (0.47, 0.75) Stakeholder Involvement 0.28 (0.14, 0.42) Rigor of Development 0.25 (0.14, 0.40) Clarity of Presentation 0.69 (0.56, 0.81) Applicability 0.17 (0.08, 0.30) Editorial Independence 0.50 (0.33, 0.70) *Median (IQR).