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Evidence-based Guideline Principles

Our Pathology and Laboratory Quality Center for Evidence-based Guidelines (Center) develops guideline recommendations by following the National Academy of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines to ensure transparency and reduce bias.

Establishing Transparency

We produce guidelines alone or in conjunction with stakeholder partners. No industry funds are accepted.

Management of Conflict of Interest

We uphold guideline integrity by avoiding or actively managing conflict of interest, real or perceived, which could influence or be perceived as influencing guideline decisions. Panel members are often leaders within their field and may have associations with industry. We strive to balance the panel with knowledgeable subject matter members while ensuring that majority of the panel is free from conflicts of interest. Disclosure is required throughout the guideline process, shared with all panel members, and cited in the manuscript.

Group Composition

We compose multidisciplinary panels to include a methodologist, major stakeholder representation, and as appropriate, patient advocates.

Systematic Review

We ensure guideline integrity via a systematic review of the published medical literature using guideline development best practices. The panel also considers professional input not documented in literature (eg, grey literature) based on its scientific merit and expert opinion.

Rating Strength of Recommendations

Beginning in 2019, we adopted the use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We assess the quality, quantity, and consistency of the totality of the evidence along with other factors, such as benefits/harms, values, cost, and feedback from the open comment period.

Articulating Recommendations

Our guidelines clearly articulate recommendations such that users may take appropriate action and implementation can be measured.

External Review

  • We invite review and comment of our draft recommendations during an open comment period. The panel considers all comments during finalization of the recommendations.
  • We use an independent review process for guideline and guideline revision approval. The Independent Review Panel (IRP) consists of subject matter experts vetted through the conflicts of interest process and not previously involved in guideline development.


Our guidelines are reviewed every four years or earlier with the publication of substantive and high-quality medical evidence that could potentially alter the original guideline recommendations.