High-grade glioma: combined use of 5-aminolevulinic acid and intraoperative ultrasound for resection and a predictor algorithm for detection.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Juan Ángel Aibar-Durán, Rosa M Mirapeix, Alberto Gallardo Alcañiz, Laura Salgado-López, Berta Freixer-Palau, Vicente Casitas Hernando, Fernando Muñoz Hernández, Cristian de Quintana-Schmidt
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引用次数: 0

Abstract

Objective: The primary goal in neuro-oncology is the maximally safe resection of high-grade glioma (HGG). A more extensive resection improves both overall and disease-free survival, while a complication-free surgery enables better tolerance to adjuvant therapies such as chemotherapy and radiotherapy. Techniques such as 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative ultrasound (ioUS) are valuable for safe resection and cost-effective. However, the benefits of combining these techniques remain undocumented. The aim of this study was to investigate outcomes when combining 5-ALA and ioUS.

Methods: From January 2019 to January 2024, 72 patients (mean age 62.2 years, 62.5% male) underwent HGG resection at a single hospital. Tumor histology included glioblastoma (90.3%), grade IV astrocytoma (4.1%), grade III astrocytoma (2.8%), and grade III oligodendroglioma (2.8%). Tumor resection was performed under natural light, followed by using 5-ALA and ioUS to detect residual tumor. Biopsies from the surgical bed were analyzed for tumor presence and categorized based on 5-ALA and ioUS results. Results of 5-ALA and ioUS were classified into positive, weak/doubtful, or negative. Histological findings of the biopsies were categorized into solid tumor, infiltration, or no tumor. Sensitivity, specificity, and predictive values for both techniques, separately and combined, were calculated. A machine learning algorithm (HGGPredictor) was developed to predict tumor presence in biopsies.

Results: The overall sensitivities of 5-ALA and ioUS were 84.9% and 76%, with specificities of 57.8% and 84.5%, respectively. The combination of both methods in a positive/positive scenario yielded the highest performance, achieving a sensitivity of 91% and specificity of 86%. The positive/doubtful combination followed, with sensitivity of 67.9% and specificity of 95.2%. Area under the curve analysis indicated superior performance when both techniques were combined, in comparison to each method used individually. Additionally, the HGGPredictor tool effectively estimated the quantity of tumor cells in surgical margins.

Conclusions: Combining 5-ALA and ioUS enhanced diagnostic accuracy for HGG resection, suggesting a new surgical standard. An intraoperative predictive algorithm could further automate decision-making.

高级别胶质瘤:5-氨基乙酰丙酸联合术中超声切除及预测算法检测。
目的:神经肿瘤学的主要目标是最大限度地安全切除高级别胶质瘤(HGG)。更广泛的切除可以提高总体生存率和无病生存率,而无并发症的手术可以提高对化疗和放疗等辅助治疗的耐受性。5-氨基乙酰丙酸(5-ALA)荧光和术中超声(iou)等技术对于安全切除和成本效益有价值。然而,结合这些技术的好处仍然没有记录。本研究的目的是调查5-ALA和白条联合使用的结果。方法:2019年1月至2024年1月,72例患者(平均年龄62.2岁,男性62.5%)在同一家医院行HGG切除术。肿瘤组织学包括胶质母细胞瘤(90.3%)、IV级星形细胞瘤(4.1%)、III级星形细胞瘤(2.8%)和III级少突胶质细胞瘤(2.8%)。在自然光下切除肿瘤,然后用5-ALA和iou检测残余肿瘤。分析手术床活检是否存在肿瘤,并根据5-ALA和iou结果进行分类。5-ALA和借据的检测结果分为阳性、弱/可疑和阴性。活检组织学表现分为实体瘤、浸润、无瘤。分别和联合计算两种技术的敏感性、特异性和预测值。开发了一种机器学习算法(HGGPredictor)来预测活检中肿瘤的存在。结果:5-ALA和iou的总敏感性分别为84.9%和76%,特异性分别为57.8%和84.5%。在阳性/阳性情况下,两种方法的结合产生了最高的性能,达到了91%的灵敏度和86%的特异性。其次是阳性/可疑组合,敏感性为67.9%,特异性为95.2%。曲线下面积分析表明,与单独使用每种方法相比,两种技术结合使用的效果更好。此外,HGGPredictor工具可以有效地估计手术边缘的肿瘤细胞数量。结论:5-ALA联合白条可提高HGG切除术的诊断准确性,提示新的手术标准。术中预测算法可以进一步实现决策的自动化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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