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A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology

Lookup NU author(s): Dr Fiona CampbellORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.

Publication metadata

Author(s): Colling R, Indave I, Del Aguila J, Jimenez RC, Campbell F, Chechlinska M, Kowalewska M, Holdenrieder S, Trulson I, Worf K, Pollan M, Plans-Beriso E, Perez-Gomez B, Craciun O, Garcia-Ovejero E, Michalek IM, Maslova K, Rymkiewicz G, Didkowska J, Tan PH, Md Nasir ND, Myles N, Goldman-Levy G, Lokuhetty D, Cree IA

Publication type: Article

Publication status: Published

Journal: Modern Pathology

Year: 2024

Volume: 37

Issue: 1

Print publication date: 01/01/2024

Online publication date: 20/10/2023

Acceptance date: 15/10/2023

Date deposited: 05/02/2024

ISSN (print): 0893-3952

ISSN (electronic): 1530-0285

Publisher: Elsevier BV


DOI: 10.1016/j.modpat.2023.100357

PubMed id: 37866639


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Funder referenceFunder name
European Commission