Assessing the quality of lung cancer screening guidelines: a systematic review and critical appraisal

<bold>Background:</bold> The Strengthening the screening of Lung Cancer in Europe (SOLACE) initiative, funded under the EU4Health Framework, aims to develop new guidelines for lung cancer screening (LCS) in EU Member States. We conducted a systematic review and critical appraisal to identify and assess existing guidelines addressing all stages of the LCS pathway. <bold>Methods:</bold> We searched Medline, Embase, CINAHL and Cochrane library from 2009 through 2024 for recommendations addressing LCS, diagnosis, or staging. We also performed a hand search of gray literature. Guideline recommendations were analyzed through mapping onto key topic areas. Guideline appraisal was performed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Domain scores were calculated according to the AGREE handbook and summarized using descriptive statistics. <bold>Results:</bold> Of 14,357 documents identified, 156 met inclusion criteria. We extracted and categorized 2,460 recommendation statements. The most commonly addressed topic was diagnosis of lung cancer with 754 recommendations, followed by pathology (n=356), screening program requirements (n=322), and nodule management (n=316). Overall, median domain scores in our sample ranged from 0.17 (IQR 0.08-0.30) to 0.69 (IQR 0.56-0.81). Across categories, guidelines addressing smoking cessation, shared decision-making, screening protocols, and eligibility for screening generally had the highest median domain scores. <bold>Conclusion:</bold> Future priorities in lung cancer guideline development may be guided by topical areas with fewer high-quality guidelines available. These include the choice of LCS modality, nodule management and diagnostics.