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Assessment of the Scandinavian guidelines on papillary thyroid cancer using the AGREE II instrument

Sonesson O'Neill, Maria LU ; Areklätt, Tilda ; Rygård, Sofie Louise ; Shakir, Ban ; Brauckhoff, Katrin ; Londero, Stefano ; Tjellaug, Endre Vedvik and Almquist, Martin LU (2026) In European Journal of Surgical Oncology p.1-6
Abstract

BACKGROUND: Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version).

METHODS: Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after... (More)

BACKGROUND: Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version).

METHODS: Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after treatment, along with the evidence cited to support these recommendations, were compared across the four guidelines.

RESULTS: Overall, the ATA guidelines had the highest quality, with a score of over 70 % in four domains, and the highest score in five of six domains. The Danish and Swedish guidelines each reached a score of over 70 % in only one domain, while the Norwegian guidelines did not reach that score in any domain. The overall score was 83 % for the ATA guidelines, 50 % for the Danish, 44 % for the Swedish, and 28 % for the Norwegian. Recommendations varied widely, particularly regarding extent of surgery and indications for radioiodine treatment. The ATA guidelines had the highest number of references supporting the recommendations.

CONCLUSION: The quality of clinical practice guidelines and recommendations on treatment for PTC differed between the Scandinavian countries and the ATA, with the ATA having the highest quality.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Journal of Surgical Oncology
article number
111876
pages
1 - 6
publisher
Elsevier
external identifiers
  • pmid:42173704
  • scopus:105039687371
ISSN
1532-2157
DOI
10.1016/j.ejso.2026.111876
language
English
LU publication?
yes
additional info
Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.
id
0844d918-8827-4a12-82a3-b8d740517d92
date added to LUP
2026-08-25 09:32:14
date last changed
2026-09-09 04:48:49
@article{0844d918-8827-4a12-82a3-b8d740517d92,
  abstract     = {{<p>BACKGROUND: Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version).</p><p>METHODS: Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after treatment, along with the evidence cited to support these recommendations, were compared across the four guidelines.</p><p>RESULTS: Overall, the ATA guidelines had the highest quality, with a score of over 70 % in four domains, and the highest score in five of six domains. The Danish and Swedish guidelines each reached a score of over 70 % in only one domain, while the Norwegian guidelines did not reach that score in any domain. The overall score was 83 % for the ATA guidelines, 50 % for the Danish, 44 % for the Swedish, and 28 % for the Norwegian. Recommendations varied widely, particularly regarding extent of surgery and indications for radioiodine treatment. The ATA guidelines had the highest number of references supporting the recommendations.</p><p>CONCLUSION: The quality of clinical practice guidelines and recommendations on treatment for PTC differed between the Scandinavian countries and the ATA, with the ATA having the highest quality.</p>}},
  author       = {{Sonesson O'Neill, Maria and Areklätt, Tilda and Rygård, Sofie Louise and Shakir, Ban and Brauckhoff, Katrin and Londero, Stefano and Tjellaug, Endre Vedvik and Almquist, Martin}},
  issn         = {{1532-2157}},
  language     = {{eng}},
  month        = {{05}},
  pages        = {{1--6}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Assessment of the Scandinavian guidelines on papillary thyroid cancer using the AGREE II instrument}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2026.111876}},
  doi          = {{10.1016/j.ejso.2026.111876}},
  year         = {{2026}},
}