Overview
The American College of Chest Physicians (ACCP) chose the Duke University Center for Clinical Health Policy Research to perform formal systematic reviews of the current evidence in the five new non-small cell lung cancer (NSCLC) topic areas, as well as to provide a search for the existing guidelines, systematic reviews, and meta-analyses in all of the topics areas. In addition, the Agency for Healthcare Quality and Research) AHRQ agreed to fund the BlueCross BlueShield Association Technology Evaluation Center to perform the formal systematic review of literature on small cell lung cancer (SCLC). The Health Outcomes Research Group of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering Cancer Center conducted a full-scale review of the literature since the first set of guidelines in the area of screening for lung cancer to assist that particular writing group.
The formal systematic reviews of the five new topic areas were guided by the appropriate chapter editors and their writing committees, in concert with the Executive Committee of the panel.
The two EPC research teams conducted a variety of systematic computerized bibliographic database searches including the following: (1) a search for systematic reviews, guidelines, and meta-analyses published since the last ACCP lung cancer guideline (MEDLINE, The Cochrane Library, National Guidelines Clearinghouse); (2) targeted searches for reviews in each of five selected treatment sections (solitary pulmonary nodules, stage I and II, stage IIIA, stage IIIB, stage IV); these searches, run in OVID version of MEDLINE, were performed in July and August 2005 and were limited to publication years since 1995, English language, and human subjects; and (3) searches related to SCLC are described in the evidence chapter on SCLC. Search terms included the medical subject heading terms lung neoplasms (exploded) and bronchial neoplasms for the lung cancer concept. Each topic search utilized key words specific to the key questions of interest (complete search strategies are available on request from the authors).
Strategy Specific for Bronchioloalveolar Carcinoma (BAC)
The clinical questions in this guideline were chosen to focus on areas in which there are important differences between BAC and other forms of NSCLC. These guidelines are restricted to patients with known or suspected "pure BAC" as defined in the 1999 World Health Organization (WHO) revised classification for lung tumors. This classification system requires that the term bronchioloalveolar carcinoma be reserved for a more narrowly defined histologic appearance of cells growing in a lepidic pattern with no stromal, vascular, or pleural invasion. Articles dealing with the prognosis, treatment, and positron emission tomography (PET) characteristics of BAC were chosen from literature searches. Many articles were selected for review on the basis of their presence in the bibliographies of initially selected papers. Meeting abstracts were searched from the last 5 years of meetings of the American Society of Clinical Oncology. Except when needed to illustrate differences over time, articles were chosen preferably when published after 1999 to reflect data using the most current WHO definition of BAC.