xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.23262, Wiley Online Library on [02/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

41

ICAR SINONASAL TUMORS

& Rhinology , and revised accordingly until approved by all parties. Naturally, the LOE was highly variable across sections. For lesser researched concepts and/or very rare patholo gies, a literature review was designated as appropriate. For topics with moderate, but nevertheless limited, LOE, an EBR without recommendations was assigned. Finally, for those topics with sufficient evidence to inform clinical care, an EBRR was assigned. Following this, a primary contributing author who is a recognized expert on the topic was assigned to author each section. Contributing authors were selected based on publication history and track record of academic contribu tions to the field of sinonasal tumors. To emphasize the multidisciplinary and collaborative spirit of this field and thus this document, the primary contributing author rep resenting an institution and/or consortium was permitted to invite a predetermined, section-specific number of team members and collaborators to contribute to the section. The team members could recommend any relevant spe cialty (e.g., rhinology, head and neck surgery, radiation oncology, medical oncology), needed not be from the same institution, and the author was recommended to invite col laborators in a particular area in which the point person is familiar with their work. Each author team was permit ted to include one or two consultant authors to help with drafting the section. Following commitment to the project, instructions for completing the sections were distributed to the authors, again with a focus on assessing the available literature as opposed to providing expert opinion. The specific section methodology follows that of a systematic review using the PRISMA standardized guidelines. 8 The recommended search for each topic was conducted using Ovid MED LINE (National Library of Medicine, 1946—November 2021), EMBASE (Elsevier, 1947—November 2021), and the Cochrane review database (1993—November 2021). Consistent with PRISMA guidelines and the prior ICAR statements, the systematic review of each topic began with the identification of prior published systemic reviews or guidelines. Authors were instructed to identify the highest levels of evidence first (systematic reviews and meta-analyses, randomized controlled trials), then con sider descending levels (observational, then case series) as appropriate based on what exists in the literature. Authors were also asked to submit PRISMA flow diagrams for their section prior to drafting their sections, which was then reviewed by the editorial team to ensure that the literature search followed the proposed methodology. For histopathology-specific sections, appropriate inclusion of background information, such as those related to epi demiology, imaging, and histopathology, was requested in

order to add context to the individual biological entities for the readership. Additionally, authors were recommended to include only studies with a minimum sample size to ensure consistency in evidence quality, though this was dependent on the rarity of the tumor and/or technique. Specifically, unless of highly unusual but relevant value, case reports and case series with n < 5 were excluded. On the other hand, if there was sufficient literature to sup port a high standard (e.g., SCC), it was deemed reasonable to exclude case series of low sample size or even all case series. In EBR and EBRR sections, all included studies were presented in a standardized table format per prior ICAR guidelines (study with name of lead author, year of publica tion, LOE, study design, study groups, clinical endpoints, and conclusion). The 2011 Oxford Level of Evidence (Lev els 1–5) was utilized to grade the quality of each study (Table III.1). 18 LOE was determined by authors and may be downgraded based on numerous factors, and this was secondarily reviewed by the editorial leadership to ensure appropriate reasoning and consistency across the entire document, whenever possible. Once this was complete, an aggregate grade of evidence (A–D) was determined based upon the guidelines from the AAP SCQIM, and the number of studies of each LOE utilized to make this deter mination was reported (Table III.2). 9 For EBRR sections, a standardized reporting of recommendations based on benefits, harms, costs, and other relevant judgments was included after each subtopic review (Table III.3). B Iterative review Once the section was completed and submitted per instruc tions, it then underwent a two-stage iterative review process by two associate editors. Associate editors were tasked to review each section for accurate and compre hensive inclusion of relevant literature, appropriateness of aggregate grade of evidence (AGE) and recommenda tions, adherence to the methodology and formatting, and coherence and flow throughout the document. Following review by both associate editors, the section was returned to the author team for revisions, and this process contin ued across all parties until all changes were agreed upon (consensus). C ICSNT statement development Once the section was iteratively reviewed and consensus was reached, the primary editor (ECK) reviewed the sec tion and synthetized all sections into the ICSNT document.