Using Histopathology to Assess the Reliability With Which Intraoperative MRI Identifies Residual Brain Tumor: Results From a Multicenter Study. (16th November 2020)

• Record Type: Journal Article
• Authors: Yahanda, Alexander T; Shah, Amar S; Sylvester, Peter; Evans, John; Dunn, Gavin P; Jensen, Randy L; Honeycutt, John H; Cahill, Daniel P; Sutherland, Garnette R; Oswood, Mark C; Shah, Mitesh V; 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 R; Chicoine, Michael R
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_914
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Intraoperative MRI (iMRI) may be a powerful tool for guiding brain tumor resections, provided that it is reliable in identifying residual tumor after initial resection. METHODS: Data from a multicenter database was used to determine the odds of additional resection during the same surgery for grade I-IV gliomas and pituitary adenomas. The reliability of iMRI for identifying residual tumor was assessed using histopathology of additional 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 = 0.98), grade III (72/81, 88.9%) (p = 0.95), or grade IV gliomas (149/160, 93.1%) (p = 0.33). 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 = 0.83). Forty-nine cases had histopathology taken from additional resection after iMRI that was negative for residual tumor. Of the histopathological samples taken from these negative pathology cases, 55.9% revealed normal brain tissue. CONCLUSION: Histopathological analysis of tissue resected after use of iMRI for grade I-IV gliomas and pituitary adenomas demonstrates that iMRI is highly reliable for identifying residual tumor, with a high positive predictive value.