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Nag A, Khetan V. Retinoblastoma - A comprehensive review, update and recent advances. Indian J Ophthalmol 2024; 72:778-788. [PMID: 38804799 PMCID: PMC11232864 DOI: 10.4103/ijo.ijo_2414_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 05/29/2024] Open
Abstract
Retinoblastoma is the most common pediatric ocular malignancy. It is triggered by a biallelic mutation in the RB1 gene or MYCN oncogene amplification. Retinoblastomas can be unilateral (60%-70%) or bilateral (30%-40%); bilateral tumors are always heritable and present at an earlier age as compared to unilateral ones (18-24 months vs. 36 months in India). High prevalence rates, delayed presentation, and inaccessibility to healthcare lead to worse outcomes in developing countries. The past few decades have seen a paradigm change in the treatment of retinoblastomas, shifting from enucleation and external beam radiotherapy to less aggressive modalities for eye salvage. Multimodality treatment is now the standard of care and includes intraarterial or intravenous chemotherapy along with focal consolidation therapies such as transpupillary thermotherapy, cryotherapy, and laser photocoagulation. Intravitreal and intracameral chemotherapy can help in controlling intraocular seeds. Advanced extraocular or metastatic tumors still have a poor prognosis. Genetic testing, counseling, and screening of at-risk family members must be incorporated as essential parts of management. A better understanding of the genetics and molecular basis of retinoblastoma has opened up the path for potential targeted therapy in the future. Novel recent advances such as liquid biopsy, prenatal diagnosis, prognostic biomarkers, tylectomy, and chemoplaque point to promising future directions.
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Affiliation(s)
- Adwaita Nag
- Ocular Oncology Service, Department of Ophthalmology and Vision Sciences, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vikas Khetan
- Formerly at Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
- Professor, Department of Ophthalmology, Flaum Eye Institute, Rochester, NY, USA
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2
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Yousef YA, AlHabahbeh O, Mohammad M, Halalsheh H, Mehyar M, Toro MD, AlNawaiseh I. Optimizing Surgical Management for Rhegmatogenous Retinal Detachment in Eyes with Active Retinoblastoma: A Safety-Driven Approach. J Clin Med 2024; 13:2511. [PMID: 38731040 PMCID: PMC11084380 DOI: 10.3390/jcm13092511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12-180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Omar AlHabahbeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Hadeel Halalsheh
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
- Eye Clinic, Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan; (O.A.); (M.M.); (M.M.)
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3
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Pai V, Muthusami P, Ertl-Wagner B, Shroff MM, Parra-Fariñas C, Sainani K, Kletke S, Brundler MA, Mallipatna A. Diagnostic Imaging for Retinoblastoma Cancer Staging: Guide for Providing Essential Insights for Ophthalmologists and Oncologists. Radiographics 2024; 44:e230125. [PMID: 38451848 DOI: 10.1148/rg.230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Retinoblastoma is the most common cause of all intraocular pediatric malignancies. It is caused by the loss of RB1 tumor suppressor gene function, although some tumors occur due to MYCN oncogene amplification with normal RB1 genes. Nearly half of all retinoblastomas occur due to a hereditary germline RB1 pathogenic variant, most of which manifest with bilateral tumors. This germline RB1 mutation also predisposes to intracranial midline embryonal tumors. Accurate staging of retinoblastoma is crucial in providing optimal vision-, eye-, and life-saving treatment. The AJCC Cancer Staging Manual has undergone significant changes, resulting in a universally accepted system with a multidisciplinary approach for managing retinoblastoma. The authors discuss the role of MRI and other diagnostic imaging techniques in the pretreatment assessment and staging of retinoblastoma. A thorough overview of the prevailing imaging standards and evidence-based perspectives on the benefits and drawbacks of these techniques is provided. Published under a CC BY 4.0 license. Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Vivek Pai
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Prakash Muthusami
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Birgit Ertl-Wagner
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Manohar M Shroff
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Carmen Parra-Fariñas
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Kanchan Sainani
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Stephanie Kletke
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Marie-Anne Brundler
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Ashwin Mallipatna
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
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Jabbarli L, Göricke S, Stumbaum P, Rating P, Lever M, Kiefer T, Ting S, Junker A, Bornfeld N, Schoenberger S, Bechrakis NE, Ketteler P, Biewald E. Preoperative Detection of Local Tumor Extent in Patients with Advanced Retinoblastoma: Predictive Value of MRI and Clinical Findings. Klin Monbl Augenheilkd 2023. [PMID: 38134910 DOI: 10.1055/a-2198-7630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Before planned enucleation, local tumor extension in advanced retinoblastoma is routinely assessed preoperatively using high-resolution magnetic resonance imaging (MRI). The aim of our study was to analyse the predictive value of MRI and clinical characteristics for predicting tumor extent, as confirmed by histopathology postoperatively. PATIENTS AND METHODS All consecutive patients were included who underwent primary enucleation for advanced retinoblastoma after high-resolution MRI examination in our hospital between January 2011 and December 2021. The primary study endpoint was the evaluation of the predictability of histopathological risk factors on preoperative MRI examination. The sensitivity and specificity of the MRI examination with respect to clinically relevant optic nerve infiltration and choroidal infiltration were determined. RESULTS The mean age of the 209 included patients was 1.6 years (range 1 month to 4.7 years). MRI indicated optic nerve infiltration in 46 (22%) patients, extensive choroidal infiltration in 78 (40.2%) patients, and scleral infiltration in one patient (2.6%). Histopathological examination demonstrated postlaminar optic infiltration in 25 (12%) patients and extensive choroidal infiltration in 17 (8.1%) cases. Scleral infiltration was evident in 8 (3.8%) patients. In the final multivariate analysis, MRI findings of tumor infiltration and a preoperative intraocular pressure ≥ 20 mmHg were independently associated with histopathological evidence of clinically relevant optic nerve (p = 0.033/p = 0.011) and choroidal infiltration (p = 0.005/p = 0.029). The diagnostic accuracy of the prediction models based on the multivariate analysis for the identification of the clinically relevant optic nerve (AUC = 0.755) and choroidal infiltration (AUC = 0.798) was greater than that of purely MRI-based prediction (respectively 0.659 and 0.742). The sensitivity and specificity of MRI examination for determining histopathological risk factors in our cohort were 64% and 65% for clinically relevant optic infiltration and 87% and 64% for clinically relevant choroidal infiltration. CONCLUSION The local tumor extent of retinoblastoma with infiltration of the optic nerve and choroid can be well estimated based on radiological and clinical characteristics before treatment initiation. The combination of clinical and radiological risk factors supports the possibility of early treatment stratification in retinoblastoma patients.
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Affiliation(s)
- Leyla Jabbarli
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Sophia Göricke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Deutschland
| | - Paulina Stumbaum
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Philipp Rating
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Mael Lever
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Tobias Kiefer
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Saskia Ting
- Institut für Pathologie Nordhessen, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
| | - Andreas Junker
- Institut für Neuropathologie, Universitätsklinikum Essen, Deutschland
| | - Norbert Bornfeld
- Facharztzentrum für Augenheilkunde, Düsseldorf, Universität Duisburg-Essen, Duisburg, Deutschland
| | | | | | - Petra Ketteler
- Klinik für pädiatrische Hämatologie und Onkologie, Universitätsklinikum Essen, Deutschland
| | - Eva Biewald
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
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5
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Bilbeisi T, Almasry R, Obeidat M, Mohammad M, Jaradat I, Halalsheh H, Alni’mat A, Ahmad DK, Alsaket N, Mehyar M, Al-Nawaiseh I, Yousef YA. Causes of death and survival analysis for patients with retinoblastoma in Jordan. Front Med (Lausanne) 2023; 10:1244308. [PMID: 37731722 PMCID: PMC10507250 DOI: 10.3389/fmed.2023.1244308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose To analyze causes and prognostic factors for death among Retinoblastoma (Rb) patients treated at a single specialized tertiary cancer center in Jordan. Methods We reviewed the mortality causes for all Rb patients who have been treated at the King Hussein Cancer Center between 2003 and 2019 and were followed for at least 3 years after diagnosis. The main outcome measures included demographics, laterality, tumor stage, treatment modalities, metastasis, survival, and causes of death. Results Twenty-four (5%) of the 478 patients died from retinoblastoma and 5-year survival was 94%. The mean age at diagnosis was 15 months (median, 18 months; range, 4-38 months); eight (33%) received diagnoses within the first year of life. Eleven (46%) were boys, 16 (67%) had bilateral disease, and 3 (13%) had a positive family history. The stage for the worst eye was C for 1 (4%) patient, D in 6 (25%) patients, and E (T3) in 15 (63%) patients. Two patients had extraocular Rb at diagnosis, and four of the patients who had intraocular Rb at diagnosis refused treatment and then came back with extraocular Rb. In total, extraocular disease was encountered in six eyes (six patients). After a 120-month median follow-up period, 24 patients (5%) died of second neoplasms (n = 3) or metastases (n = 21). Significant predictive factors for metastasis and death included advanced IIRC tumor stage (p < 0.0001), the presence of high-risk pathological features in the enucleated eyes (p = 0.013), parental refusal of the recommended primary treatment plan (p < 0.0001), and extraocular extension (p < 0.0001). Conclusion The 5-year survival rates of Rb patients in Jordan are as high as those in high-income countries. However, 5% are still dying from metastatic disease, prompting the need for awareness campaigns to educate the public about the high cure rates and to prevent treatment abandonment.
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Affiliation(s)
- Tharwa Bilbeisi
- FedEx Institute of Technology, University of Memphis, Memphis, TN, United States
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Razaq Almasry
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mariam Obeidat
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department of Pediatrics Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ayat Alni’mat
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Danah Kanj Ahmad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Nour Alsaket
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
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6
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Tomar AS, Finger PT, Gallie B, Kivelä TT, Mallipatna A, Zhang C, Zhao J, Wilson MW, Brennan RC, Burges M, Kim J, Berry JL, Jubran R, Khetan V, Ganesan S, Yarovoy A, Yarovaya V, Kotova E, Volodin D, Yousef YA, Nummi K, Ushakova TL, Yugay OV, Polyakov VG, Ramirez-Ortiz MA, Esparza-Aguiar E, Chantada G, Schaiquevich P, Fandino A, Yam JC, Lau WW, Lam CP, Sharwood P, Moorthy S, Long QB, Essuman VA, Renner LA, Semenova E, Català-Mora J, Correa-Llano G, Carreras E. High-risk Pathologic Features Based on Presenting Findings in Advanced Intraocular Retinoblastoma: A Multicenter, International Data-Sharing American Joint Committee on Cancer Study. Ophthalmology 2022; 129:923-932. [PMID: 35436535 PMCID: PMC9329269 DOI: 10.1016/j.ophtha.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the value of clinical features for advanced intraocular retinoblastoma as defined by the eighth edition of the American Joint Committee on Cancer (AJCC) cT3 category and AJCC Ophthalmic Oncology Task Force (OOTF) Size Groups to predict the high-risk pathologic features. DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS Eighteen ophthalmic oncology centers from 13 countries over 6 continents shared evaluations of 942 eyes enucleated as primary treatment for AJCC cT3 and, for comparison, cT2 retinoblastoma. METHODS International, multicenter, registry-based data were pooled from patients enrolled between 2001 and 2013. High-risk pathologic features were defined as AJCC categories pT3 and pT4. In addition, AJCC OOTF Size Groups were defined as follows: (1) less than half, (2) more than half but less than two thirds, (3) more than two thirds of globe volume involved, and (4) diffuse infiltrating retinoblastoma. MAIN OUTCOME MEASURES Statistical risk of high-risk pathologic features corresponding to AJCC cT3 subcategories and AJCC OOTF Size Groups. RESULTS Of 942 retinoblastoma eyes treated by primary enucleation, 282 (30%) showed high-risk pathologic features. Both cT subcategories and AJCC OOTF Size Groups (P < 0.001 for both) were associated with high-risk pathologic features. On logistic regression analysis, cT3c (iris neovascularization with glaucoma), cT3d (intraocular hemorrhage), and cT3e (aseptic orbital cellulitis) were predictive factors for high-risk pathologic features when compared with cT2a with an odds ratio of 2.3 (P = 0.002), 2.5 (P = 0.002), and 3.3 (P = 0.019), respectively. Size Group 3 (more than two-thirds globe volume) and 4 (diffuse infiltrative retinoblastoma) were the best predictive factors with an odds ratio of 3.3 and 4.1 (P < 0.001 for both), respectively, for high-risk pathologic features when compared with Size Groups 1 (i.e., < 50% of globe volume). CONCLUSIONS The AJCC retinoblastoma staging clinical cT3c-e subcategories (glaucoma, intraocular hemorrhage, and aseptic orbital cellulitis, respectively) as well as the AJCC OOTF Size Groups 3 (tumor more than two thirds of globe volume) and 4 (diffuse infiltrative retinoblastoma) both allowed stratification of clinical risk factors that can be used to predict the presence of high-risk pathologic features and thus facilitate treatment decisions.
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Affiliation(s)
- Ankit Singh Tomar
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Paul T. Finger
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Brenda Gallie
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada
| | - Tero T. Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashwin Mallipatna
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada.,Department of Ocular Oncology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Chengyue Zhang
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing, China
| | - Junyang Zhao
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing, China
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rachel C. Brennan
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michala Burges
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jonathan Kim
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Jesse L. Berry
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Rima Jubran
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Vikas Khetan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suganeswari Ganesan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Andrey Yarovoy
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Vera Yarovaya
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Elena Kotova
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Denis Volodin
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Kalle Nummi
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatiana L. Ushakova
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation.,Department of Ophthalmology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Olga V. Yugay
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
| | - Vladimir G. Polyakov
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation.,Department of Ophthalmology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Marco A. Ramirez-Ortiz
- Department of Ophthalmology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Guillermo Chantada
- Precision Medicine Coordination Hospital JP Garrahan, and CONICET, National Scientific and Technical Research Council, Buenos Aires, Argentina.,Hemato-Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Paula Schaiquevich
- Precision Medicine Coordination Hospital JP Garrahan, and CONICET, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Adriana Fandino
- Ophthalmology Service, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Winnie W. Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Carol P. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Phillipa Sharwood
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sonia Moorthy
- KK Women’s and Children’s Hospital, Singapore, Republic of Singapore
| | - Quah Boon Long
- KK Women’s and Children’s Hospital, Singapore, Republic of Singapore
| | - Vera Adobea Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lorna A. Renner
- Department of Child Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ekaterina Semenova
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Jaume Català-Mora
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Genoveva Correa-Llano
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elisa Carreras
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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7
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Li Z, Guo J, Xu X, Wei W, Xian J. MRI-based radiomics model can improve the predictive performance of postlaminar optic nerve invasion in retinoblastoma. Br J Radiol 2022; 95:20211027. [PMID: 34826253 PMCID: PMC8822570 DOI: 10.1259/bjr.20211027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To develop an MRI-based radiomics model to predict postlaminar optic nerve invasion (PLONI) in retinoblastoma (RB) and compare its predictive performance with subjective radiologists' assessment. METHODS We retrospectively enrolled 124 patients with pathologically proven RB (90 in training set and 34 in validation set) who had MRI scans before surgery. A radiomics model for predicting PLONI was developed by extracting quantitative imaging features from axial T2W images and contrast-enhanced T1W images in the training set. The Kruskal-Wallis test, least absolute shrinkage and selection operator regression, and recursive feature elimination were used for feature selection, where upon a radiomics model was built with a logistic regression (LR) classifier. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and the accuracy were assessed to evaluate the predictive performance in the training and validation set. The performance of the radiomics model was compared to radiologists' assessment by DeLong test. RESULTS The AUC of the radiomics model for the prediction of PLONI was 0.928 in the training set and 0.841 in the validation set. Radiomics model produced better sensitivity than radiologists' assessment (81.1% vs 43.2% in training set, 82.4vs 52.9% in validation set). In all 124 patients, the AUC of the radiomics model was 0.897, while that of radiologists' assessment was 0.674 (p < 0.001, DeLong test). CONCLUSION MRI-based radiomics model to predict PLONI in RB patients was shown to be superior to visual assessment with improved sensitivity and AUC, and may serve as a potential tool to guide personalized treatment.
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Affiliation(s)
- Zhenzhen Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
| | - Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
| | - Xiaolin Xu
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
- Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wenbin Wei
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
- Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, China
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8
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Zhao J, Feng Z, Leung G, Gallie BL. Retinoblastoma Survival Following Primary Enucleation by AJCC Staging. Cancers (Basel) 2021; 13:cancers13246240. [PMID: 34944860 PMCID: PMC8699512 DOI: 10.3390/cancers13246240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Primary enucleation of the eye with retinoblastoma is a widely accessible, life-saving treatment for retinoblastoma. This study evaluated the survival of patients following primary enucleation based on AJCC 8th edition staging. Included were 700 consecutive patients (700 eyes) treated with primary enucleation at 29 Chinese treatment centers between 2006 and 2015. Excluded were patients with less than one year follow-up, bilateral retinoblastoma, clinical evidence of extraocular disease at diagnosis, or prior focal or systemic therapy. The 5-year overall survival was 95.5%, and 5-year disease-specific survival (DSS) was 95.7%. Survival was better when enucleation was <26 days from diagnosis than delayed >26 days (96.1% vs. 86.9%; p = 0.017). Patients with eyes presenting with raised intraocular pressure with neovascularization and/or buphthalmos (cT3c) had worse 5-year DSS (87.1%) than those without (cT2b, 99.1%; cT3b, 98.7%; cT3d, 97.2%) (p < 0.05). The 5-year DSS based on pathological staging was pT1 (99.5%), pT2a (95.5%), pT3a (100%), pT3b (93.0%), pT3c/d (92.3%), and pT4 (40.9%). Patients with pT3 pathology who received six cycles of adjuvant chemotherapy had better 5-year DSS (97.7%) than those with no chemotherapy (88.1%; p = 0.06) and those who underwent 1–3 cycles (86.9%, p = 0.02) or 4–5 cycles (89.3%, p = 0.06). Patients with pT4 pathology who received six cycles of chemotherapy had better 5-year DSS than those with 0–5 cycles (63.6% vs. 16.7%; p = 0.02). Prompt primary enucleation yielded high long-term survival for children with retinoblastoma. The AJCC 8th edition staging is predictive of survival.
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Affiliation(s)
- Junyang Zhao
- Department of Pediatric Oncology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
| | - Zhaoxun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1L 8L6, Canada; (Z.F.); (G.L.)
| | - Gareth Leung
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1L 8L6, Canada; (Z.F.); (G.L.)
| | - Brenda L. Gallie
- Department of Ophthalmology and Vision Science, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada
- Techna Institutes, University Health Network, Toronto, ON M5T 2S8, Canada
- Departments of Ophthalmology and Vision Science, Molecular Genetics, and Medical Biophysics, University of Toronto, Toronto, ON M5T 3A9, Canada
- Correspondence: ; Tel.: +1-41-6294-9729
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9
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Kaliki S, Shields CL, Cassoux N, Munier FL, Chantada G, Grossniklaus HE, Yoshikawa H, Fabian ID, Berry JL, McKenzie JD, Kimani K, Reddy MA, Parulekar M, Tanabe M, Furuta M, Grigorovski N, Chevez-Barrios P, Scanlan P, Eagle RC, Rashid R, Coronado RD, Sultana S, Staffieri S, Frenkel S, Suzuki S, Ushakova TL, Ji X. Defining High-Risk Retinoblastoma: A Multicenter Global Survey. JAMA Ophthalmol 2021; 140:30-36. [PMID: 34762098 DOI: 10.1001/jamaophthalmol.2021.4732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance High-risk histopathologic features of retinoblastoma are useful to assess the risk of systemic metastasis. In this era of globe salvage treatments for retinoblastoma, the definition of high-risk retinoblastoma is evolving. Objective To evaluate variations in the definition of high-risk histopathologic features for metastasis of retinoblastoma in different ocular oncology practices around the world. Design, Setting, and Participants An electronic web-based, nonvalidated 10-question survey was sent in December 2020 to 52 oncologists and pathologists treating retinoblastoma at referral retinoblastoma centers. Intervention Anonymized survey about the definition of high-risk histopathologic features for metastasis of retinoblastoma. Main Outcomes and Measures High-risk histopathologic features that determine further treatment with adjuvant systemic chemotherapy to prevent metastasis. Results Among the 52 survey recipients, the results are based on the responses from 27 individuals (52%) from 24 different retinoblastoma practices across 16 countries in 6 continents. The following were considered to be high-risk features: postlaminar optic nerve infiltration (27 [100%]), involvement of optic nerve transection (27 [100%]), extrascleral tissue infiltration (27 [100%]), massive (≥3 mm) choroidal invasion (25 [93%]), microscopic scleral infiltration (23 [85%]), ciliary body infiltration (20 [74%]), trabecular meshwork invasion (18 [67%]), iris infiltration (17 [63%]), anterior chamber seeds (14 [52%]), laminar optic nerve infiltration (13 [48%]), combination of prelaminar and laminar optic nerve infiltration and minor choroidal invasion (11 [41%]), minor (<3 mm) choroidal invasion (5 [19%]), and prelaminar optic nerve infiltration (2 [7%]). The other histopathologic features considered high risk included Schlemm canal invasion (4 [15%]) and severe anaplasia (1 [4%]). Four respondents (15%) said that the presence of more than 1 high-risk feature, especially a combination of massive peripapillary choroidal invasion and postlaminar optic nerve infiltration, should be considered very high risk for metastasis. Conclusions and Relevance Responses to this nonvalidated survey conducted in 2020-2021 showed little uniformity in the definition of high-risk retinoblastoma. Postlaminar optic nerve infiltration, involvement of optic nerve transection, and extrascleral tumor extension were the only features uniformly considered as high risk for metastasis across all oncology practices. These findings suggest that the relevance about their value in the current scenario with advanced disease being treated conservatively needs further evaluation; there is also a need to arrive at consensus definitions and conduct prospective multicenter studies to understand their relevance.
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Affiliation(s)
- Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute India, Hyderabad, India
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathalie Cassoux
- Department of Surgical Oncology, Insitut Curie Université de Paris, Paris, France
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | | | - Hans E Grossniklaus
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Hiroshi Yoshikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ido Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Jesse L Berry
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles
| | - John D McKenzie
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - M Ashwin Reddy
- Retinoblastoma Service, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Manoj Parulekar
- Retinoblastoma Service, Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Mika Tanabe
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Minoru Furuta
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Natalia Grigorovski
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | | | - Patricia Scanlan
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | | | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sandra Staffieri
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Retinoblastoma Service, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Shahar Frenkel
- Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatiana L Ushakova
- Department of Pediatric Oncology and Hematology, N. N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russia.,Retinoblastoma Service, Medical Academy of Postgraduate Education, Moscow, Russia
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Nagesh CP, Rao R, Hiremath SB, Honavar SG. Magnetic resonance imaging of the orbit, Part 2: Characterization of orbital pathologies. Indian J Ophthalmol 2021; 69:2585-2616. [PMID: 34571598 PMCID: PMC8597442 DOI: 10.4103/ijo.ijo_904_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this article we focus on a systematic approach to assess common orbital lesions on magnetic resonance imaging (MRI). The identification of the probable compartment or structure of origin helps narrow the differential diagnosis of a lesion. Analyzing the morphology, appearance, and signal intensity on various sequences, the pattern, and degree of contrast enhancement are key to characterize lesions on MRI. Imaging features suggesting cellularity and vascularity can also be determined to help plan for biopsy or surgery of these lesions. MRI can also distinguish active from chronic disease in certain pathologies and aids in selecting appropriate medical management. MRI may thus serve as a diagnostic tool and help in guiding therapeutic strategies and posttreatment follow-up.
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Affiliation(s)
- Chinmay P Nagesh
- Neurovascular and Interventional Radiology, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Raksha Rao
- Orbit & Oculoplasty, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Shivaprakash B Hiremath
- Division of Neuroradiology, Department of Medical Imaging, The Ottawa Hospital - Civic Campus, Ottawa, Canada
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11
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Silvera VM, Guerin JB, Brinjikji W, Dalvin LA. Retinoblastoma: What the Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2021; 42:618-626. [PMID: 33509920 DOI: 10.3174/ajnr.a6949] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Retinoblastoma is the most common primary intraocular tumor of childhood. Accurate diagnosis at an early stage is important to maximize patient survival, globe salvage, and visual acuity. Management of retinoblastoma is individualized based on the presenting clinical and imaging features of the tumor, and a multidisciplinary team is required to optimize patient outcomes. The neuroradiologist is a key member of the retinoblastoma care team and should be familiar with characteristic diagnostic and prognostic imaging features of this disease. Furthermore, with the adoption of intra-arterial chemotherapy as a standard of care option for globe salvage therapy in many centers, the interventional neuroradiologist may play an active role in retinoblastoma treatment. In this review, we discuss the clinical presentation of retinoblastoma, ophthalmic imaging modalities, neuroradiology imaging features, and current treatment options.
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Affiliation(s)
- V M Silvera
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.)
| | - J B Guerin
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.)
| | - W Brinjikji
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.).,Neurosurgery (W.B.)
| | - L A Dalvin
- Ophthalmology (L.A.D.), Mayo Clinic, Rochester, Minnesota
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12
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Abusayf MM, Alkatan HM, Elkhamary S, Almesfer SA, Maktabi AMY. Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma. BMC Ophthalmol 2020; 20:386. [PMID: 32993566 PMCID: PMC7526200 DOI: 10.1186/s12886-020-01654-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background Optic nerve (ON) invasion is an important high-risk feature, and an indicator for neoadjuvant chemotherapy and prognosis. We aim through this study to correlate the detected-ON invasion by Magnetic resonance imaging (MRI) with the corresponding confirmed histopathological level of invasion. Methods A retrospective study of enucleated globes with the diagnosis of retinoblastoma received in the histopathology department(s) from January 2015 to December 2016 (2 years). Slides were reviewed for ON invasion assessment, charts were reviewed for basic demographic data. All patients underwent MRI under sedation upon diagnosis and MRI findings were collected for the above correlation. Results A total of 38 patients were included: 21 males and 17 females. 29 (77.3%) had unilateral involvement, 7 (18.4%) had bilateral involvement and 2 cases had trilateral disease. The overall mean age at diagnosis was 22.63 ± 15.15 months. Histopathological examination revealed ON invasion in 28 cases (74%) distributed as follows: prelaminar (31.6%), laminar (18.4%), and post-laminar (23.7%). MRI confirmed post-laminar ON invasion in 8 cases (true positive) but failed to detect this in 1 case. Additionally, MRI detected another 8 cases of ON invasion that were false positive on histopathology (accuracy: 63.3%; sensitivity: 88.9%; specificity: 72.4%; Positive predictive value (PPV): 50%; Negative predictive value (NPV): 95.5%). Conclusions MRI is found to be less sensitive in evaluating prelaminar and laminar ON invasion (0.0 and 42.9%) compared to post-laminar invasion (88.9%). MRI has generally better specificity in detecting ON invasion irrespective of the invasion level. In our study, obtaining deeper and/or additional histologic sections from the other surface of the tissue block in cases where a post-laminar ON invasion by MRI is found but not confirmed histopathologically in routine sections is essential to avoid missing such an important high-risk feature.
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Affiliation(s)
- Mohammed M Abusayf
- Department of Ophthalmology, College of Medicine, King Saud University, PO Box 18097, Riyadh, postal code 11415, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, PO Box 18097, Riyadh, postal code 11415, Saudi Arabia. .,Department of Pathology, College of Medicine, King Saud University Medical City, PO Box 18097, Riyadh, 11415, Saudi Arabia.
| | - Sahar Elkhamary
- Radiology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Saleh A Almesfer
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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13
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Cho SJ, Kim JH, Baik SH, Sunwoo L, Bae YJ, Choi BS. Diagnostic performance of MRI of post-laminar optic nerve invasion detection in retinoblastoma: A systematic review and meta-analysis. Neuroradiology 2020; 63:499-509. [PMID: 32865636 DOI: 10.1007/s00234-020-02538-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Preoperative MRI detection of post-laminar optic nerve invasion (PLONI) offers guidance in assessing the probability of total tumor resection, an estimation of the extent of surgery, and screening of candidates for eye-preserving therapies or neoadjuvant chemotherapies in the patients with retinoblastoma (RB). The purpose of this systematic review and meta-analysis was to evaluate the diagnostic performance of MRI for detecting PLONI in patients with RB and to demonstrate the factors that may influence the diagnostic performance. METHODS Ovid-MEDLINE and EMBASE databases were searched up to January 11, 2020, for studies identifying the diagnostic performance of MRI for detecting PLONI in patients with RB. The pooled sensitivity and specificity of all studies were calculated followed by meta-regression analysis. RESULTS Twelve (1240 patients, 1255 enucleated globes) studies were included. The pooled sensitivity was 61%, and the pooled specificity was 88%. Higgins I2 statistic demonstrated moderate heterogeneity in the sensitivity (I2 = 72.23%) and specificity (I2 = 78.11%). Spearman correlation coefficient indicated the presence of a threshold effect. In the meta-regression, higher magnetic field strength (3 T than 1.5 T), performing fat suppression, and thinner slice thickness (< 3 mm) were factors causing heterogeneity and enhancing diagnostic power across the included studies. CONCLUSIONS MR imaging was demonstrated to have acceptable diagnostic performance in detecting PLONI in patients with RB. The variation in the magnetic field strength and protocols was the main factor behind the heterogeneity across the included studies. Therefore, there is room for developing and optimizing the MR protocols for patients with RB.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
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14
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Yousef YA, Al-Nawaiseh I, Mehyar M, Sultan I, Al-Hussaini M, Jaradat I, Mohammad M, AlJabari R, Abu-Yaghi N, Rodriguez-Galindo C, Qaddoumi I, Wilson M. How Telemedicine and Centralized Care Changed the Natural History of Retinoblastoma in a Developing Country: Analysis of 478 Patients. Ophthalmology 2020; 128:130-137. [PMID: 32682835 DOI: 10.1016/j.ophtha.2020.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the efficacy of integrating a telemedicine-based twinning partnership and centralized care for retinoblastoma on survival and eye salvage. DESIGN Four hundred seventy-eight retinoblastoma patients treated at a tertiary referral cancer center (King Hussein Cancer Centre [KHCC]) from 2003 through 2019. PARTICIPANTS Four hundred seventy-eight retinoblastoma patients treated at KHCC after implementing a telemedicine-based program with St. Jude Children's Research Hospital. METHODS We reviewed the outcomes of retinoblastoma patients who were treated at KHCC after implementing a telemedicine-based eye salvage program with St. Jude Children's Research Hospital, and we compared that with outcomes for retinoblastoma patients who were treated before implementing a telemedicine-based retinoblastoma service at KHCC. MAIN OUTCOME MEASURES We analyzed patient demographics, clinical characteristics, treatments received, consultation type and duration, and long-term patient outcomes before and after implementing the twinning program. RESULTS Over 17 years, 813 eyes from 478 children with retinoblastoma were treated at KHCC. Three hundred thirty-five patients (70%) had bilateral disease. Six patients (4%) with unilateral disease and 66 patients (20%) with bilateral disease had a family history of retinoblastoma. After the twinning program was established in 2003, the mortality rate decreased from 38% to 5% (P < 0.0001), and the overall eye salvage rate increased from 4% to 61% (98% for group A, 93% for group B, 81% for group C, and 48% for group D; P < 0.0001). Initially, all cases were discussed via telemedicine, but as knowledge transfer increased, the proportion of cases that required discussion decreased to less than 3% 10 years later. Similarly, treatment changes based on consultations decreased from 70% to 7% after 10 years. Both survival and eye-salvage rates were comparable at the early and later stages of implementing the twinning program. At a median follow-up of 120 months, 5% of patients had died of metastases or secondary neoplasms, 81% were alive, and 14% were lost to follow-up. CONCLUSIONS Centralization of care at a single center in developing countries can achieve patient outcomes comparable with those of developed countries via twinning and telemedicine. This benefit can extend to a large region because two thirds of patients treated at KHCC were non-Jordanians.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | | | | | | | - Matthew Wilson
- St. Jude Children's Research Hospital, Memphis, Tennessee; Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
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15
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Clinical Predictors at Diagnosis of Low-Risk Histopathology in Unilateral Advanced Retinoblastoma. Ophthalmology 2019; 126:1306-1314. [DOI: 10.1016/j.ophtha.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
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