A critical appraisal of the quality of 18F-FDG PET/CT guidelines in oncology using the AGREE II tool: A EuroAIM initiative

Purpose: to assess the quality of guidelines on clinical indications for the use of 18F-FDG PET/CT in oncology using the AGREE II tool. Method: from March to May 2019, the current literature was searched to identify guidelines focused on clinical indications for the use of18F-FDG PET/CT in oncology. The quality of the selected guidelines was then assessed by four independent appraisers using the AGREE II tool, which is organized in six quality domains accounting for a total of 23 items. The agreement among appraisers was measured using the intraclass correlation coefficient (ICC) analysis. Results: four guidelines were selected. Of these, one resulted of high quality (mean score 86.5 %), another showed an average quality (mean score 61.8 %), and the remaining two proved to be of low quality (mean scores of 53.3 and 45.7, respectively). With the exception of the high-quality guideline, critical domains were Domain 2 “Stakeholder involvement” (total mean score 56.28 + 15.9), Domain 3 “Rigor of development” (total mean score 43.48 + 27.6), Domain 5 “Applicability” (total mean score 46.90 + 19.4) and Domain 6 “Editorial independence” (total mean score 50.55 + 35.7). ICC values ranged from 0.939 to 0.995, indicating very good agreement among the four appraisers. Conclusions: a heterogeneous quality of guidelines dealing with clinical indications for the use of 18F-FDG PET/CT in oncology emerged from our analysis. Further efforts should be made to improve the reporting of the applied methodology as well as to promote the applicability of guidelines into clinical practice.