NIPPLE DISCHARGE

A comprehensive search for guidelines was undertaken to identify the most relevant guidelines to consider for adaptation.

inclusion/exclusion criteria followed in the search and retrieval of guidelines to be adapted:

•    Selecting only evidence-based guidelines (guideline must include a report on systematic literature searches and explicit links between individual recommendations and their supporting evidence)

•  Selecting only national and/or international guidelines

•   Specific range of dates for publication (using Guidelines published or updated 2015 and later)

•   Selecting peer reviewed publications only

•   Selecting guidelines written in English  language

•   Excluding guidelines written by a single author not on behalf of an organization in order to be valid and comprehensive, a guideline ideally requires multidisciplinary input.

•   Excluding guidelines published without references as the panel needs to know whether a thorough literature review was conducted and whether current evidence was used in the preparation of the recommendations.

The following characteristics of the retrieved guidelines were summarized in a table:

•  Developing organisation/authors

•  Date of publication, posting, and release

•   Country/language of publication

•   Date of posting and/or release

•   Dates of the search used by the source guideline developers

All retrieved Guidelines were screened and appraised using AGREE II instrument (www.agreetrust.org) by at least two members. the panel decided a cut-off point or rank the guidelines  (any guideline scoring above 50% on the rigour dimension was retained). These guidelines were adapted mainly from American College of Radiology ACR Appropriateness Criteria®, Evaluation of Nipple Discharge update in 2022 with partial incorporation of insights from reputable sources to enhance its comprehensiveness and applicability (1,2).