Using Histopathology to Assess the Reliability of Intraoperative Magnetic Resonance Imaging in Guiding Additional Brain Tumor Resection: A Multicenter Study. Issue 1 (17th August 2020)

• Record Type: Journal Article
• Authors: Shah, Amar S; Yahanda, Alexander T; Sylvester, Peter T; Evans, John; Dunn, Gavin P; Jensen, Randy L; Honeycutt, John; Cahill, Daniel P; Sutherland, Garnette R; Oswood, Mark; Shah, Mitesh; Abram, Steven R; Rich, Keith M; Dowling, Joshua L; Leuthardt, Eric C; Dacey, Ralph G; Kim, Albert H; Zipfel, Gregory J; Limbrick, David D; Smyth, Matthew D; Leonard, Jeffrey; Chicoine, Michael R
• Is Part Of: Neurosurgery. Volume 88:Issue 1(2021)
• Page Start: E49
• Page End: E59
• Publication Date: 2020-08-17
• Subjects: iMRI -- Glioma -- Pituitary -- Resection -- Histopathology -- Intraoperative MRI -- Pituitary adenoma -- Tumor -- Additional resection; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa338
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Intraoperative magnetic resonance imaging (iMRI) is a powerful tool for guiding brain tumor resections, provided that it accurately discerns residual tumor. OBJECTIVE: To use histopathology to assess how reliably iMRI may discern additional tumor for a variety of tumor types, independent of the indications for iMRI. METHODS: A multicenter database was used to calculate the odds of additional resection during the same surgical session for grade I to IV gliomas and pituitary adenomas. The reliability of iMRI for identifying residual tumor was assessed using histopathology of tissue resected after iMRI. RESULTS: Gliomas (904/1517 cases, 59.6%) were more likely than pituitary adenomas (176/515, 34.2%) to receive additional resection after iMRI ( P < .001), but these tumors were equally likely to have additional tissue sent for histopathology (398/904, 44.4% vs 66/176, 37.5%; P = .11). Tissue samples were available for resections after iMRI for 464 cases, with 415 (89.4%) positive for tumor. Additional resections after iMRI for gliomas (361/398, 90.7%) were more likely to yield additional tumor compared to pituitary adenomas (54/66, 81.8%) ( P = .03). There were no significant differences in resection after iMRI yielding histopathologically positive tumor between grade I (58/65 cases, 89.2%; referent), grade II (82/92, 89.1%) ( P = .98), grade III (72/81, 88.9%) ( P = .95), or grade IV gliomas (149/160, 93.1%) ( P = .33). Additional resection for previously resected tumors (122/135 cases, 90.4%) was equally likely to yield histopathologically confirmed tumor compared to newly-diagnosed tumors (293/329, 89.0%) ( P = .83). CONCLUSION: Histopathological analysis of tissue resected after use of iMRI for grade I to IV gliomas and pituitary adenomas demonstrates that iMRI is highly reliable for identifying residual tumor. Graphical Abstract: