E5217. Appraisal of Guidelines in the Imaging of Multiple Myeloma Using the AGREE II Instrument
  1. Omer Hamza; University of Khartoum
  2. Mohamed Almahal; University of Khartoum
  3. Rowa Mohamed; University of Khartoum
  4. Abdullah Yousif; University of Khartoum
  5. Mohamed Elrasheed; University of Khartoum
  6. Omer Elmusharaf; University of Khartoum
  7. Kevin Chorath; University of Washington
Multiple myeloma (MM) accounts for 18.7% of hematologic malignancies and 1.8% of all cancers in the United States. Patients with MM can develop several life-threatening complications including renal failure, anemia, bone destruction, and hypercalcemia, which underscores the importance of early diagnosis and treatment. Various imaging guidelines produced by different organizations are now indispensable in the diagnosis of MM; therefore, it is essential to evaluate the merit of these guidelines.

Materials and Methods:
A systematic literature search was performed, and a total of six Clinical Practice Guidelines (CPGs) pertaining to imaging in multiple myeloma were identified. These CPGs were evaluated by four reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, which is a validated guideline appraisal tool used worldwide for guideline evaluation. Scaled domain scores were generated and the threshold used for satisfactory guideline quality was greater than 60%. In addition, the interclass correlation coefficient (ICC) was generated to determine the level of agreement between reviewers.

A total of six CPGs pertaining to imaging in multiple myeloma were identified. The guideline published by the National Institute for Health and Care Excellence (NICE) was the only guideline to achieve over 60% in all six domains with an overall score of 85.2%. “Clarity and Presentation” was the highest scoring domain (72.5 ± 7.4), and the “Rigor of Development” domain received the lowest score (57.1 ± 26.2). ICC analysis showed high magnitude of agreement between reviewers.

In light of our quality assessment, it is evident that there is room for enhancing the quality and methodological rigor of MM imaging guidelines. Our findings also highlight the discrepancies among guidelines in considering the implications of barriers such as cost effectiveness-acceptability, resource limitations and availability, as well as varying clarity on navigating recommendations for initial diagnosis and follow up of this vulnerable patient population. Imaging is taking a central role in the diagnosis of MM, and patient input should be considered, as it is rarely sought after or during guideline development. Financial and logistical barriers to guideline development must be examined as well.