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Mapping the Evidence for the WHO Classification of Tumours: a Living Evidence Gap Map by Tumour Type.

Periodic Reporting for period 1 - WCT EVI MAP (Mapping the Evidence for the WHO Classification of Tumours: a Living Evidence Gap Map by Tumour Type.)

Période du rapport: 2022-07-01 au 2023-12-31

Cancer classification is essential for cancer diagnosis and treatment. The WHO Classification of Tumours underpins cancer diagnosis worldwide and sets global standards in cancer classification. Therefore, the use of the WCT as a global reference tool means that it is vital the authors and editorial team make classification decisions based on the best available evidence, whilst avoiding bias and misinformation. Currently, contributing authors are asked to perform structured literature searches to retrieve this evidence, and to evaluate and summarize it in accordance with their knowledge. The current descriptions therefore rely largely on non-systematic literature searches and are performed by these subject experts that contribute on a voluntary basis to the classification. Although most are expert in pathology, genetics or other disciplines, very few have any formal training in Evidence-based Medicine (EBM), public heath, or epidemiology. However, they are nonetheless expected to make an unbiased appraisal of a detailed evidence base in their spare time, often with tight deadlines. This, associated with a lack of reproducibility in the process, is a serious and significant risk unpinning a vital basis for cancer diagnosis and treatment around the world.
Evidence Gap Maps (EGM) are relatively new systematic evidence synthesis tools which summarize and visualize the available evidence for a topic of interest in an easy to interpret map. They demonstrate immediately what the evidence landscape is, and where the gaps are. EGMs are used to summarize the evidence-base in current use, can quickly allow the reader to see the quality and quantity of evidence cited, and identify gaps in the evidence. Thus, EGMs are a useful tool for developing a strategic approach to building the evidence base in a particular sector and a valid starting point to draw recommendations.
The overarching aim of the WCT EVI MAP project is to produce decision-support tools to optimize clinical diagnostic healthcare delivery for cancer by promoting a more evidence-based approach to the decision-making processes in cancer research, policy-making, clinical care, patient involvement and facets of cancer management. The main goal is to provide an overview of the existing evidence for cancer classification and hence diagnosis, with an emphasis mapping existing evidence gaps and identifying pockets of low-level evidence as well as relevant evidence synthesis and a living approach (continuous updating).

This project will ensure access to innovative, sustainable and high-quality health care by developing a data-driven decision-support tool for better health care delivery and policy-making in cancer. The WCT-EVI-MAP tool will align with the WHO Classification of Tumours (which includes all cancers).
1. Development of the basis for a new WHO Classification of Tumours Evidence-Gap Map (WCT-EVI MAP) Tool:

a. To map cited evidence in the 5th edition WHO Classification of Tumours.
b. To create an agreed levels of evidence in pathology using Delphi processes, for tumour classification.
c. To develop a mapping framework for the WCT EVI MAP tool

d. To adapt and/or develop open software to create the evidence maps.

2. Production of evidence-gap maps for the WHO Classification of Tumours:
a. To map and characterize the current available evidence for the WCT.
b. To classify quality and quantity of the current available evidence for the WCT.
c. To identify evidence gaps and pockets of low-level evidence in the WCT.
d. Guide and prioritize future research, informed by a map of existing framework.

3. Creation, launch, update and maintenance of the WCT EVI MAP tool:

a. To design and implement the WCT-EVI-MAP tool for the easy visualization of the evidence-maps.
b. To disseminate results and promote WCT-EVI-MAP tool effectively among cancer researchers.
c. To apply a living approach, by continuously updating the maps and maintaining the tool.
By the end of the project, we will have three products that will set the basis for the promotion of evidence-based pathology and better-informed decisions-making in cancer related problems:
- Adapted hierarchy of levels of evidence for the field of pathology
- Guideline on standards and reporting recommendations for research, particularly for cancer pathology
- The WCT EVI MAP tool, a web-based application to explore continuously updated EGMs of the WHO Classification of Tumours by tumour type and its descriptors

The WCT EVI MAP project has the ambition to use its privileged position in the field to promote the development of an evidence-based pathology strategy that leads to a better understanding of basic concepts such as the hierarchy of evidence levels and the various risks of bias inherent in a study design used in publications read and accessed by pathologists. This aim is reflected in the work packages and activities of the project we outline, with a heavy focus on producing a first tool that permits the incorporation of these basic concepts and related standards to research performed in the field of pathology. The WCT EVI MAP will disseminate findings of the project via the project and IC3R website, related social and electronic media, as well as via traditional open-access peer-reviewed journal publications.
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