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Gong Z, Xu T, Peng N, Cheng X, Niu C, Wiestler B, Hong F, Li HB. A Multi-Center, Multi-Parametric MRI Dataset of Primary and Secondary Brain Tumors. Sci Data 2024; 11:789. [PMID: 39019912 PMCID: PMC11255278 DOI: 10.1038/s41597-024-03634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
Brain metastases (BMs) and high-grade gliomas (HGGs) are the most common and aggressive types of malignant brain tumors in adults, with often poor prognosis and short survival. As their clinical symptoms and image appearances on conventional magnetic resonance imaging (MRI) can be astonishingly similar, their accurate differentiation based solely on clinical and radiological information can be very challenging, particularly for "cancer of unknown primary", where no systemic malignancy is known or found. Non-invasive multiparametric MRI and radiomics offer the potential to identify these distinct biological properties, aiding in the characterization and differentiation of HGGs and BMs. However, there is a scarcity of publicly available multi-origin brain tumor imaging data for tumor characterization. In this paper, we introduce a multi-center, multi-origin brain tumor MRI (MOTUM) imaging dataset obtained from 67 patients: 29 with high-grade gliomas, 20 with lung metastases, 10 with breast metastases, 2 with gastric metastasis, 4 with ovarian metastasis, and 2 with melanoma metastasis. This dataset includes anonymized DICOM files alongside processed FLAIR, T1-weighted, contrast-enhanced T1-weighted, T2-weighted sequences images, segmentation masks of two tumor regions, and clinical data. Our data-sharing initiative is to support the benchmarking of automated tumor segmentation, multi-modal machine learning, and disease differentiation of multi-origin brain tumors in a multi-center setting.
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Affiliation(s)
- Zhenyu Gong
- Department of Neurosurgery, Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tao Xu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Nan Peng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xing Cheng
- Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Spine Surgery, Orthopedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Chen Niu
- PET/CT center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fan Hong
- Department of Neurosurgery, Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China.
| | - Hongwei Bran Li
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Li Y, Yu R, Chang H, Yan W, Wang D, Li F, Cui Y, Wang Y, Wang X, Yan Q, Liu X, Jia W, Zeng Q. Identifying Pathological Subtypes of Brain Metastasis from Lung Cancer Using MRI-Based Deep Learning Approach: A Multicenter Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:976-987. [PMID: 38347392 PMCID: PMC11169103 DOI: 10.1007/s10278-024-00988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 06/13/2024]
Abstract
The aim of this study was to investigate the feasibility of deep learning (DL) based on multiparametric MRI to differentiate the pathological subtypes of brain metastasis (BM) in lung cancer patients. This retrospective analysis collected 246 patients (456 BMs) from five medical centers from July 2016 to June 2022. The BMs were from small-cell lung cancer (SCLC, n = 230) and non-small-cell lung cancer (NSCLC, n = 226; 119 adenocarcinoma and 107 squamous cell carcinoma). Patients from four medical centers were assigned to training set and internal validation set with a ratio of 4:1, and we selected another medical center as an external test set. An attention-guided residual fusion network (ARFN) model for T1WI, T2WI, T2-FLAIR, DWI, and contrast-enhanced T1WI based on the ResNet-18 basic network was developed. The area under the receiver operating characteristic curve (AUC) was used to assess the classification performance. Compared with models based on five single-sequence and other combinations, a multiparametric MRI model based on five sequences had higher specificity in distinguishing BMs from different types of lung cancer. In the internal validation and external test sets, AUCs of the model for the classification of SCLC and NSCLC brain metastasis were 0.796 and 0.751, respectively; in terms of differentiating adenocarcinoma from squamous cell carcinoma BMs, the AUC values of the prediction models combining the five sequences were 0.771 and 0.738, respectively. DL together with multiparametric MRI has discriminatory feasibility in identifying pathology type of BM from lung cancer.
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Affiliation(s)
- Yuting Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ruize Yu
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Huan Chang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China
| | - Wanying Yan
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Dawei Wang
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Fuyan Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yong Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiao Wang
- Department of Radiology, Jining No. 1 People's Hospital, Jining, China
| | - Qingqing Yan
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China
| | - Xinhui Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China
| | - Wenjing Jia
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Qianfoshan Hospital, Shandong, Jinan, China.
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Mohamed AA, Sargent E, Williams C, Karve Z, Nair K, Lucke-Wold B. Advancements in Neurosurgical Intraoperative Histology. Tomography 2024; 10:693-704. [PMID: 38787014 PMCID: PMC11125713 DOI: 10.3390/tomography10050054] [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: 03/16/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Despite their relatively low incidence globally, central nervous system (CNS) tumors remain amongst the most lethal cancers, with only a few other malignancies surpassing them in 5-year mortality rates. Treatment decisions for brain tumors heavily rely on histopathological analysis, particularly intraoperatively, to guide surgical interventions and optimize patient outcomes. Frozen sectioning has emerged as a vital intraoperative technique, allowing for highly accurate, rapid analysis of tissue samples, although it poses challenges regarding interpretive errors and tissue distortion. Raman histology, based on Raman spectroscopy, has shown great promise in providing label-free, molecular information for accurate intraoperative diagnosis, aiding in tumor resection and the identification of neurodegenerative disease. Techniques including Stimulated Raman Scattering (SRS), Coherent Anti-Stokes Raman Scattering (CARS), Surface-Enhanced Raman Scattering (SERS), and Tip-Enhanced Raman Scattering (TERS) have profoundly enhanced the speed and resolution of Raman imaging. Similarly, Confocal Laser Endomicroscopy (CLE) allows for real-time imaging and the rapid intraoperative histologic evaluation of specimens. While CLE is primarily utilized in gastrointestinal procedures, its application in neurosurgery is promising, particularly in the context of gliomas and meningiomas. This review focuses on discussing the immense progress in intraoperative histology within neurosurgery and provides insight into the impact of these advancements on enhancing patient outcomes.
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Affiliation(s)
- Ali A. Mohamed
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
- College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Emma Sargent
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Cooper Williams
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Zev Karve
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Karthik Nair
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
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Pillar N, Li Y, Zhang Y, Ozcan A. Virtual Staining of Nonfixed Tissue Histology. Mod Pathol 2024; 37:100444. [PMID: 38325706 DOI: 10.1016/j.modpat.2024.100444] [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: 11/02/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Surgical pathology workflow involves multiple labor-intensive steps, such as tissue removal, fixation, embedding, sectioning, staining, and microscopic examination. This process is time-consuming and costly and requires skilled technicians. In certain clinical scenarios, such as intraoperative consultations, there is a need for faster histologic evaluation to provide real-time surgical guidance. Currently, frozen section techniques involving hematoxylin and eosin (H&E) staining are used for intraoperative pathology consultations. However, these techniques have limitations, including a turnaround time of 20 to 30 minutes, staining artifacts, and potential tissue loss, negatively impacting accurate diagnosis. To address these challenges, researchers are exploring alternative optical imaging modalities for rapid microscopic tissue imaging. These modalities differ in optical characteristics, tissue preparation requirements, imaging equipment, and output image quality and format. Some of these imaging methods have been combined with computational algorithms to generate H&E-like images, which could greatly facilitate their adoption by pathologists. Here, we provide a comprehensive, organ-specific review of the latest advancements in emerging imaging modalities applied to nonfixed human tissue. We focused on studies that generated H&E-like images evaluated by pathologists. By presenting up-to-date research progress and clinical utility, this review serves as a valuable resource for scholars and clinicians, covering some of the major technical developments in this rapidly evolving field. It also offers insights into the potential benefits and drawbacks of alternative imaging modalities and their implications for improving patient care.
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Affiliation(s)
- Nir Pillar
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yuzhu Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, California; Bioengineering Department, University of California, Los Angeles, California; California NanoSystems Institute (CNSI), University of California, Los Angeles, California.
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Hayashi T, Tateishi K, Matsuyama S, Iwashita H, Miyake Y, Oshima A, Honma H, Sasame J, Takabayashi K, Sugino K, Hirata E, Udaka N, Matsushita Y, Kato I, Hayashi H, Nakamura T, Ikegaya N, Takayama Y, Sonoda M, Oka C, Sato M, Isoda M, Kato M, Uchiyama K, Tanaka T, Muramatsu T, Miyake S, Suzuki R, Takadera M, Tatezuki J, Ayabe J, Suenaga J, Matsunaga S, Miyahara K, Manaka H, Murata H, Yokoyama T, Tanaka Y, Shuto T, Ichimura K, Kato S, Yamanaka S, Cahill DP, Fujii S, Shankar GM, Yamamoto T. Intraoperative Integrated Diagnostic System for Malignant Central Nervous System Tumors. Clin Cancer Res 2024; 30:116-126. [PMID: 37851071 DOI: 10.1158/1078-0432.ccr-23-1660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/19/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors uses an integrated approach involving histopathology and molecular profiling. Because majority of adult malignant brain tumors are gliomas and primary CNS lymphomas (PCNSL), rapid differentiation of these diseases is required for therapeutic decisions. In addition, diffuse gliomas require molecular information on single-nucleotide variants (SNV), such as IDH1/2. Here, we report an intraoperative integrated diagnostic (i-ID) system to classify CNS malignant tumors, which updates legacy frozen-section (FS) diagnosis through incorporation of a qPCR-based genotyping assay. EXPERIMENTAL DESIGN FS evaluation, including GFAP and CD20 rapid IHC, was performed on adult malignant CNS tumors. PCNSL was diagnosed through positive CD20 and negative GFAP immunostaining. For suspected glioma, genotyping for IDH1/2, TERT SNV, and CDKN2A copy-number alteration was routinely performed, whereas H3F3A and BRAF SNV were assessed for selected cases. i-ID was determined on the basis of the 2021 WHO classification and compared with the permanent integrated diagnosis (p-ID) to assess its reliability. RESULTS After retrospectively analyzing 153 cases, 101 cases were prospectively examined using the i-ID system. Assessment of IDH1/2, TERT, H3F3AK27M, BRAFV600E, and CDKN2A alterations with i-ID and permanent genomic analysis was concordant in 100%, 100%, 100%, 100%, and 96.4%, respectively. Combination with FS and intraoperative genotyping assay improved diagnostic accuracy in gliomas. Overall, i-ID matched with p-ID in 80/82 (97.6%) patients with glioma and 18/19 (94.7%) with PCNSL. CONCLUSIONS The i-ID system provides reliable integrated diagnosis of adult malignant CNS tumors.
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Affiliation(s)
- Takahiro Hayashi
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Laboratory of Biopharmaceutical and Regenerative Science, Graduate School of Medical Science, Yokohama City University, Yokohama, Japan
| | - Shinichiro Matsuyama
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Hiromichi Iwashita
- Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yohei Miyake
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Akito Oshima
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Hirokuni Honma
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Jo Sasame
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Katsuhiro Takabayashi
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Kyoka Sugino
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Laboratory of Biopharmaceutical and Regenerative Science, Graduate School of Medical Science, Yokohama City University, Yokohama, Japan
| | - Emi Hirata
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Naoko Udaka
- Department of Diagnostic Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuko Matsushita
- Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ikuma Kato
- Department of Molecular Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiroaki Hayashi
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Department of Pediatrics, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Naoki Ikegaya
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Masaki Sonoda
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Chihiro Oka
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Mitsuru Sato
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Masataka Isoda
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Miyui Kato
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Laboratory of Biopharmaceutical and Regenerative Science, Graduate School of Medical Science, Yokohama City University, Yokohama, Japan
| | - Kaho Uchiyama
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
- Laboratory of Biopharmaceutical and Regenerative Science, Graduate School of Medical Science, Yokohama City University, Yokohama, Japan
| | - Tamon Tanaka
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Toshiki Muramatsu
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Shigeta Miyake
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Ryosuke Suzuki
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Department of Neurosurgery, Odawara Municipal Hospital, Odawara, Japan
| | - Mutsumi Takadera
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Junya Tatezuki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Junichi Ayabe
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Shigeo Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kosuke Miyahara
- Department of Neurosurgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | | | - Yoshihide Tanaka
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shingo Kato
- Department of Clinical Cancer Genomics, Yokohama City University, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Diagnostic Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Satoshi Fujii
- Department of Diagnostic Pathology, Yokohama City University Hospital, Yokohama, Japan
- Department of Molecular Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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Wu W, Xie B, Zhang X, Zheng C, Sun H, Jiang M, Hu T, Liu X, Zhang N, He K. Application of a Novel Miniaturized Histopathologic Microscope for Ex Vivo Identifying Cerebral Glioma Margins Rapidly During Surgery: A Parallel Control Study. J Craniofac Surg 2024; 35:228-232. [PMID: 37889070 DOI: 10.1097/scs.0000000000009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The purpose of our study is to assess the clinical performance of the DiveScope, a novel handheld histopathologic microscope in rapidly differentiating glioma from normal brain tissue during neurosurgery. METHODS Thirty-two ex vivo specimens from 18 patients were included in the present study. The excised suspicious tissue was sequentially stained with sodium fluorescein and methylene blue and scanned with DiveScope during surgery. The adjacent tissue was sent to the department of pathology for frozen section examination. They would eventually be sent to the pathology department later for hematoxylin and eosin staining for final confirmation. The positive likelihood ratio, negative likelihood ratio, sensitivity, specificity, and area under the curve of the device were calculated. In addition, the difference in time usage between DiveScope and frozen sections was compared for the initial judgment. RESULTS The sensitivity and specificity of the DiveScope after analyzing hematoxylin and eosin -staining sections, were 88.29% and 100%, respectively. In contrast, the sensitivity and specificity of the frozen sections histopathology were 100% and 75%, respectively. The area under the curve of the DiveScope and the frozen sections histopathology was not significant ( P =0.578). Concerning time usage, DiveScope is significantly much faster than the frozen sections histopathology no matter the size of tissue. CONCLUSION Compared with traditional pathological frozen sections, DiveScope was faster and displayed an equal accuracy for judging tumor margins intraoperatively.
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Affiliation(s)
- Weichi Wu
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baoshu Xie
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaowei Zhang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chen Zheng
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huixin Sun
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mingyang Jiang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | - Xinman Liu
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nu Zhang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kejun He
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
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7
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Li K, Wu Q, Feng S, Zhao H, Jin W, Qiu H, Gu Y, Chen D. In situ detection of human glioma based on tissue optical properties using diffuse reflectance spectroscopy. JOURNAL OF BIOPHOTONICS 2023; 16:e202300195. [PMID: 37589177 DOI: 10.1002/jbio.202300195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 08/18/2023]
Abstract
Safely maximizing brain cancer removal without injuring adjacent healthy tissue is crucial for optimal treatment outcomes. However, it is challenging to distinguish cancer from noncancer intraoperatively. This study aimed to explore the feasibility of diffuse reflectance spectroscopy (DRS) as a label-free and real-time detection technology for discrimination between brain cancer and noncancer tissues. Fifty-five fresh cancer and noncancer specimens from 19 brain surgeries were measured with DRS, and the results were compared with co-registered clinical standard histopathology. Tissue optical properties were quantitatively obtained from the diffuse reflectance spectra and compared among different types of brain tissues. A machine learning-based classifier was trained to differentiate cancerous versus noncancerous tissues. Our method could achieve a sensitivity of 93% and specificity of 95% for discriminating high-grade glioma from normal white matter. Our results showed that DRS has the potential to be used for label-free, real-time in vivo cancer detection during brain surgery.
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Affiliation(s)
- Kerui Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Qijia Wu
- Department of Neurosurgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Shiyu Feng
- Department of Neurosurgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Hongyou Zhao
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Wei Jin
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Haixia Qiu
- Department of Laser Medicine, First Medical Center of PLA General Hospital, Beijing, China
| | - Ying Gu
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
- Department of Laser Medicine, First Medical Center of PLA General Hospital, Beijing, China
- Precision Laser Medical Diagnosis and Treatment Innovation Unit, Chinese Academy of Medical Sciences, Beijing, China
| | - Defu Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
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Shakir M, Altaf A, Hussain H, Abidi SMA, Petitt Z, Tariq M, Gilani A, Enam SA. Unveiling the potential application of intraoperative brain smear for brain tumor diagnosis in low-middle-income countries: A comprehensive systematic review. Surg Neurol Int 2023; 14:325. [PMID: 37810296 PMCID: PMC10559528 DOI: 10.25259/sni_491_2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Methods A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The data was extracted, processed, and organized using Microsoft Excel. Results A total of 59 out of 553 articles screened were included in the final analysis. The sensitivity and specificity of the intraoperative smear of brain tumors were found to be over 90% in most studies. The PPV was consistently above 90% in 11 studies, reaching 100% in one study and the NPV varied, ranging from 63% to 100%, and the accuracy was found to be >80% in most studies. One recurrent theme in the majority of the included studies was that an intraoperative brain smear is a cost-effective, quick, accessible, and accurate method of diagnosing brain tumors, requiring minimal training and infrastructure. Conclusion Intraoperative brain smear is a simple, rapid, cost-effective, and highly sensitive diagnostic modality for brain tumors. It can be a viable and accessible alternative to more traditional methods such as frozen sections and can be incorporated into neurosurgical practice in LMICs as a reliable and efficient diagnostic tool.
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Affiliation(s)
- Muhammad Shakir
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Altaf
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hawra Hussain
- Medical School, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Zoey Petitt
- Duke University School of Medicine, Durham, North Carolina, United States
| | - Mahnoor Tariq
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Gilani
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
| | - S. Ather Enam
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Cai S, Xing H, Wang Y, Wang Y, Ma W, Jiang Y, Li J, Wang H. Intraoperative shear-wave elastography and superb microvascular imaging contribute to the glioma grading. J Clin Neurosci 2023; 110:92-99. [PMID: 36848737 DOI: 10.1016/j.jocn.2023.02.012] [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: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND To explore the diagnostic value and feasibility of shear wave elastography and superb microvascular imaging in the grading diagnosis of glioma intraoperatively. MATERIALS AND METHODS Forty-nine patients with glioma were included in this study. B-mode ultrasonography, Young's modulus in shear-wave elastography (SWE) and vascular architecture in superb microvascular imaging(SMI) of tumor tissue and peritumoral tissue were analyzed. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic effect of SWE. Logistic regression model was used to calculate the prediction probability of HGG diagnosis. RESULTS Compared with LGG, HGG was often characterized by peritumoral edema in B mode (P < 0.05). There was a significant difference in Young's modulus between HGG and LGG; the diagnostic threshold of HGG and LGG was 13.05 kPa, the sensitivity was 78.3%, and the specificity was 76.9%. The vascular architectures of the tumor tissue and peritumoral tissues of HGG and LGG were significantly different (P < 0.05). The vascular architectures of peritumoral tissue in HGG often characterized by distorted blood flow signals surrounding the tumor (14/26,53.8%); in the tumor tissue, HGG often presents as dilated and bent vessels(19/26,73.1%). The elasticity value of SWE and the tumor vascular architectures of SMI were correlated with the diagnosis of HGG. CONCLUSION Intraoperative ultrasound (ioUS), especially SWE, and SMI are beneficial for the differentiation of HGG and LGG and may help optimize clinical surgical procedures.
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Affiliation(s)
- Siman Cai
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hao Xing
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuekun Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Yu Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Wenbin Ma
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Jianchu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hongyan Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
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Hong DH, Kim JH, Won JK, Kim H, Kim C, Park KJ, Hwang K, Jeong KH, Kang SH. Clinical feasibility of miniaturized Lissajous scanning confocal laser endomicroscopy for indocyanine green-enhanced brain tumor diagnosis. Front Oncol 2023; 12:994054. [PMID: 36713547 PMCID: PMC9880156 DOI: 10.3389/fonc.2022.994054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Background Intraoperative real-time confocal laser endomicroscopy (CLE) is an alternative modality for frozen tissue histology that enables visualization of the cytoarchitecture of living tissues with spatial resolution at the cellular level. We developed a new CLE with a "Lissajous scanning pattern" and conducted a study to identify its feasibility for fluorescence-guided brain tumor diagnosis. Materials and methods Conventional hematoxylin and eosin (H&E) histological images were compared with indocyanine green (ICG)-enhanced CLE images in two settings (1): experimental study with in vitro tumor cells and ex vivo glial tumors of mice, and (2) clinical evaluation with surgically resected human brain tumors. First, CLE images were obtained from cultured U87 and GL261 glioma cells. Then, U87 and GL261 tumor cells were implanted into the mouse brain, and H&E staining was compared with CLE images of normal and tumor tissues ex vivo. To determine the invasion of the normal brain, two types of patient-derived glioma cells (CSC2 and X01) were used for orthotopic intracranial tumor formation and compared using two methods (CLE vs. H&E staining). Second, in human brain tumors, tissue specimens from 69 patients were prospectively obtained after elective surgical resection and were also compared using two methods, namely, CLE and H&E staining. The comparison was performed by an experienced neuropathologist. Results When ICG was incubated in vitro, U87 and GL261 cell morphologies were well-defined in the CLE images and depended on dimethyl sulfoxide. Ex vivo examination of xenograft glioma tissues revealed dense and heterogeneous glioma cell cores and peritumoral necrosis using both methods. CLE images also detected invasive tumor cell clusters in the normal brain of the patient-derived glioma xenograft model, which corresponded to H&E staining. In human tissue specimens, CLE images effectively visualized the cytoarchitecture of the normal brain and tumors. In addition, pathognomonic microstructures according to tumor subtype were also clearly observed. Interestingly, in gliomas, the cellularity of the tumor and the density of streak-like patterns were significantly associated with tumor grade in the CLE images. Finally, panoramic view reconstruction was successfully conducted for visualizing a gross tissue morphology. Conclusion In conclusion, the newly developed CLE with Lissajous laser scanning can be a helpful intraoperative device for the diagnosis, detection of tumor-free margins, and maximal safe resection of brain tumors.
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Affiliation(s)
- Duk Hyun Hong
- Department of Neurosurgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Hun Kim
- Department of Neurosurgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyungsin Kim
- Department of Neurosurgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chayeon Kim
- VPIX Medical Inc., Daejeon, Republic of Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Ki-Hun Jeong
- Department of Bio and Brain Engineering, KAIST Institute for Health Science and Technology (KIHST), Korea Advanced Institute of Science and Technology (KAIST), Seoul, Republic of Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Differentiating Primary Tumors for Brain Metastasis with Integrated Radiomics from Multiple Imaging Modalities. DISEASE MARKERS 2022; 2022:5147085. [PMID: 36199819 PMCID: PMC9529469 DOI: 10.1155/2022/5147085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Objectives. To differentiate the primary site of brain metastases (BMs) is of high clinical value for the successful management of patients with BM. The purpose of this study is to investigate a combined radiomics model with computer tomography (CT) and magnetic resonance imaging (MRI) images in differentiating BMs originated from lung and breast cancer. Methods. Pretreatment cerebral contrast enhanced CT and T1-weighted MRI images of 78 patients with 179 BMs from primary lung and breast cancer were retrospectively analyzed. Radiomic features were extracted from contoured BM lesions and selected using the Mann–Whitney
test and the least absolute shrinkage and selection operator (LASSO) logistic regression. Binary logistic regression (BLR) and support vector machine (SVM) models were built and evaluated based on selected radiomic features from CT alone, MRI alone, and combined images to differentiate BMs originated from lung and breast cancer. Results. A total of 10 and 6 optimal radiomic features were screened out of 1288 CT and 1197 MRI features, respectively. The mean area under the curves (AUCs) of the BLR and SVM models using fivefolds cross-validation were 0.703 vs. 0.751, 0.718 vs. 0.754, and 0.781 vs. 0.803 in the training dataset and 0.708 vs. 0.763, 0.715 vs. 0.717, and 0.771 vs. 0.805 in the testing dataset for models with CT alone, MRI alone, and combined CT and MRI radiomic features, respectively. Conclusions. Radiomics model based on combined CT and MRI features is feasible and accurate in the differentiation of the primary site of BMs from lung and breast cancer.
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Yadav M, Sharma P, Singh V, Tewari R, Mishra PS, Roy K. An Audit of Diagnostic Disparity between Intraoperative Frozen Section Diagnosis and Final Histopathological Diagnosis of Central Nervous System Lesions at a Tertiary Care Center. J Lab Physicians 2022; 14:384-393. [DOI: 10.1055/s-0042-1750064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Introduction Evaluation of intraoperative squash smear and frozen section (FS) in central nervous system (CNS) neoplasms is consistently practiced for rapid assessment and has several advantages to its credence. It is an invaluable tool to ensure adequacy of tissue obtained to establish the diagnosis. Moreover, it aids in guiding the surgeon for critical decisions regarding the extent of resection. Although molecular markers have been integrated with morphology in the revised 2016 World Health Organization classification of brain tumors, precise morphological assessment still remains the foundation for the diagnosis and rapid intraoperative assessment of morphological details is equally critical and rewarding.
Objective This study aims to audit the diagnostic disparity between intraoperative diagnoses based on a combination of squash cytology and FS in cases of CNS lesions with gold standard, final diagnosis based on examination of formalin fixed paraffin embedded hematoxylin, and eosin-stained tissue sections.
Materials and Methods All intraoperative squash cytology and FS reported for CNS lesions from January 2017 to December 2020 were reviewed. The cases were categorized into three groups—group 1: when diagnosis of intraoperative diagnosis based on a combination of squash cytology and FS was same as the final histopathological diagnosis (concordant), group 2: partially concordant, and group 3: discordant cases.
Statistical Analysis Descriptive statistics was used to classify the data and diagnostic accuracy was calculated.
Results Complete concordance was present in 69.96% (191/273) cases, 20.1% (55/273) cases showed partial concordance, and 9.89% (27/273) cases were discordant with histopathological diagnosis. Out of the 27 discordant cases, misclassification of tumor type was the most common category (11 cases, 40%), followed by grading mismatch (7 cases, 25.9%), and misdiagnosis of tumor versus nontumor conditions (9 cases, 33.3%).
Conclusion Our study shows that combination of intraoperative squash cytology and FS shows a high percentage of accuracy in arriving at intraoperative diagnosis in cases of intracranial lesions. Regular audits of discordant cases should be conducted by surgeons and pathologists as part of a quality assurance measure to sensitize themselves with the potential pitfalls, minimizing misinterpretation and helping in providing a more conclusive opinion to the operating surgeons.
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Affiliation(s)
- Meghna Yadav
- Department of Pathology, Army Hospital (Research and Referral), New Delhi, India
| | - Pragya Sharma
- Department of Pathology, Army Hospital (Research and Referral), New Delhi, India
| | - Vikram Singh
- Department of Pathology, Army Hospital (Research and Referral), New Delhi, India
| | - Rohit Tewari
- Department of Pathology, Army Hospital (Research and Referral), New Delhi, India
| | | | - Kaushik Roy
- Department of Preventive and Social Medicine, Army Hospital (Research and Referral), New Delhi, India
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Albiña P, Solis A, Lorenzoni J, Henny P, Manriquez M. Primary germinoma of the medulla oblongata: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21315. [PMID: 35733824 PMCID: PMC9204933 DOI: 10.3171/case21315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors’ knowledge. OBSERVATIONS Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.
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Affiliation(s)
- Pablo Albiña
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Neurosurgery, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Aracelly Solis
- Intensive Care Unit, National Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Jose Lorenzoni
- Department of Neurosurgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Henny
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Interdisciplinary Center for Neuroscience, NeuroUC, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - María Manriquez
- Department of Pathology, Military Hospital of Santiago, Santiago, Chile
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Differentiating solitary brain metastases from glioblastoma by radiomics features derived from MRI and 18F-FDG-PET and the combined application of multiple models. Sci Rep 2022; 12:5722. [PMID: 35388124 PMCID: PMC8986767 DOI: 10.1038/s41598-022-09803-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022] Open
Abstract
This study aimed to explore the ability of radiomics derived from both MRI and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) images to differentiate glioblastoma (GBM) from solitary brain metastases (SBM) and to investigate the combined application of multiple models. The imaging data of 100 patients with brain tumours (50 GBMs and 50 SBMs) were retrospectively analysed. Three model sets were built on MRI, 18F-FDG-PET, and MRI combined with 18F-FDG-PET using five feature selection methods and five classification algorithms. The model set with the highest average AUC value was selected, in which some models were selected and divided into Groups A, B, and C. Individual and joint voting predictions were performed in each group for the entire data. The model set based on MRI combined with 18F-FDG-PET had the highest average AUC compared with isolated MRI or 18F-FDG-PET. Joint voting prediction showed better performance than the individual prediction when all models reached an agreement. In conclusion, radiomics derived from MRI and 18F-FDG-PET could help differentiate GBM from SBM preoperatively. The combined application of multiple models can provide greater benefits.
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Yan F, Zhuang J, Yu Q, Dou Z, Jiang X, Tan S, Han Y, Wu X, Zang Y, Li C, Li J, Chen H, Hu L, Li X, Chen G. Strategy of De Novo Design toward First-In-Class Imaging Agents for Simultaneously Differentiating Glioma Boundary and Grades. ACS Sens 2021; 6:3330-3339. [PMID: 34448576 DOI: 10.1021/acssensors.1c01168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The extent of resection and tumor grade are two predominant prognostic factors for glioma. Fluorescent imaging is promising to facilitate accurate resection and simultaneous tumor grading. However, no probe fulfilling this task has been reported. Herein, we proposed a strategy of de novo design toward first-in-class fluorescent probes for simultaneously differentiating glioma boundary and grades. By bioinformatics analysis in combination with experimental validation, platelet-derived growth factor receptor β (PDGFRβ) was revealed as a promising biomarker for glioma imaging and grading. Then, fluorogenic probe PDGFP 1 was designed, guided by the structure-activity relationship study. Finally, the probe was demonstrated to stain glioma cells and tissues in the mice orthotopic glioma model with high selectivity over normal brain cells or tissues. Meanwhile, ex vivo experiments using patient-derived samples indicated that the fluorescence was significantly positively correlated with the tumor grades. This result highlighted the feasibility of the three-step de novo probe design strategy and suggested PDGFP 1 as a promising probe for simultaneously differentiating glioma boundary and grades, showing prospects of clinical translation.
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Affiliation(s)
- Feng Yan
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Jianfeng Zhuang
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Qian Yu
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhangqi Dou
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xuefeng Jiang
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Shuyu Tan
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yifeng Han
- Department of Chemistry, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Xinyan Wu
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yi Zang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Cong Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Jia Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Huaijun Chen
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Libin Hu
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xin Li
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Gao Chen
- College of Pharmaceutical Sciences, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
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Kalogeraki A, Tamiolakis D, Zoi I, Segredakis J, Vakis A. Intraoperative squash Cytology of diffuse glioma not otherwise specified, of the Cerebellum. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021108. [PMID: 34212924 PMCID: PMC8343735 DOI: 10.23750/abm.v92i3.10392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Diffuse glioma arises anywhere in the CNS, but most frequent in the cerebral hemispheres. The tumor tends to be seen in children and in younger adults aged 20-30. We report one such case in an older female patient presenting the intraoperative cytology of the tumor. CASE REPORT A 48-year-old female was diagnosed by MRI with a tumor of cerebellum. Cytologic material was obtained during the resection of the tumor and diagnosed cytologically as glioma. CONCLUSION This case is presented to focus the ability of the intraoperative cytology in diagnosis of the glioma, using immunocytology and confirmed by histo- immunohistology.
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Ziebart A, Stadniczuk D, Roos V, Ratliff M, von Deimling A, Hänggi D, Enders F. Deep Neural Network for Differentiation of Brain Tumor Tissue Displayed by Confocal Laser Endomicroscopy. Front Oncol 2021; 11:668273. [PMID: 34046358 PMCID: PMC8147727 DOI: 10.3389/fonc.2021.668273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/09/2021] [Indexed: 01/31/2023] Open
Abstract
Background Reliable on site classification of resected tumor specimens remains a challenge. Implementation of high-resolution confocal laser endoscopic techniques (CLEs) during fluorescence-guided brain tumor surgery is a new tool for intraoperative tumor tissue visualization. To overcome observer dependent errors, we aimed to predict tumor type by applying a deep learning model to image data obtained by CLE. Methods Human brain tumor specimens from 25 patients with brain metastasis, glioblastoma, and meningioma were evaluated within this study. In addition to routine histopathological analysis, tissue samples were stained with fluorescein ex vivo and analyzed with CLE. We trained two convolutional neural networks and built a predictive level for the outputs. Results Multiple CLE images were obtained from each specimen with a total number of 13,972 fluorescein based images. Test accuracy of 90.9% was achieved after applying a two-class prediction for glioblastomas and brain metastases with an area under the curve (AUC) value of 0.92. For three class predictions, our model achieved a ratio of correct predicted label of 85.8% in the test set, which was confirmed with five-fold cross validation, without definition of confidence. Applying a confidence rate of 0.999 increased the prediction accuracy to 98.6% when images with substantial artifacts were excluded before the analysis. 36.3% of total images met the output criteria. Conclusions We trained a residual network model that allows automated, on site analysis of resected tumor specimens based on CLE image datasets. Further in vivo studies are required to assess the clinical benefit CLE can have.
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Affiliation(s)
- Andreas Ziebart
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Denis Stadniczuk
- Department of Software Engineering, Clevertech Inc., New York, NY, United States
| | - Veronika Roos
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Miriam Ratliff
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, and CCU Neuropathology, DKFZ, Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Cepeda S, García-García S, Arrese I, Fernández-Pérez G, Velasco-Casares M, Fajardo-Puentes M, Zamora T, Sarabia R. Comparison of Intraoperative Ultrasound B-Mode and Strain Elastography for the Differentiation of Glioblastomas From Solitary Brain Metastases. An Automated Deep Learning Approach for Image Analysis. Front Oncol 2021; 10:590756. [PMID: 33604286 PMCID: PMC7884775 DOI: 10.3389/fonc.2020.590756] [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] [Received: 08/02/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022] Open
Abstract
Background The differential diagnosis of glioblastomas (GBM) from solitary brain metastases (SBM) is essential because the surgical strategy varies according to the histopathological diagnosis. Intraoperative ultrasound elastography (IOUS-E) is a relatively novel technique implemented in the surgical management of brain tumors that provides additional information about the elasticity of tissues. This study compares the discriminative capacity of intraoperative ultrasound B-mode and strain elastography to differentiate GBM from SBM. Methods We performed a retrospective analysis of patients who underwent craniotomy between March 2018 to June 2020 with glioblastoma (GBM) and solitary brain metastases (SBM) diagnoses. Cases with an intraoperative ultrasound study were included. Images were acquired before dural opening, first in B-mode, and then using the strain elastography module. After image pre-processing, an analysis based on deep learning was conducted using the open-source software Orange. We have trained an existing neural network to classify tumors into GBM and SBM via the transfer learning method using Inception V3. Then, logistic regression (LR) with LASSO (least absolute shrinkage and selection operator) regularization, support vector machine (SVM), random forest (RF), neural network (NN), and k-nearest neighbor (kNN) were used as classification algorithms. After the models’ training, ten-fold stratified cross-validation was performed. The models were evaluated using the area under the curve (AUC), classification accuracy, and precision. Results A total of 36 patients were included in the analysis, 26 GBM and 10 SBM. Models were built using a total of 812 ultrasound images, 435 of B-mode, 265 (60.92%) corresponded to GBM and 170 (39.8%) to metastases. In addition, 377 elastograms, 232 (61.54%) GBM and 145 (38.46%) metastases were analyzed. For B-mode, AUC and accuracy values of the classification algorithms ranged from 0.790 to 0.943 and from 72 to 89%, respectively. For elastography, AUC and accuracy values ranged from 0.847 to 0.985 and from 79% to 95%, respectively. Conclusion Automated processing of ultrasound images through deep learning can generate high-precision classification algorithms that differentiate glioblastomas from metastases using intraoperative ultrasound. The best performance regarding AUC was achieved by the elastography-based model supporting the additional diagnostic value that this technique provides.
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Affiliation(s)
- Santiago Cepeda
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
| | | | - Ignacio Arrese
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
| | | | | | | | - Tomás Zamora
- Pathology Department, University Hospital Río Hortega, Valladolid, Spain
| | - Rosario Sarabia
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
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Zulkarnain S, Yunus N, Kandasamy R, Zun AB, Mat Zin AA. Evaluation Study of Intraoperative Cytology Smear and Frozen Section of Glioma. Asian Pac J Cancer Prev 2020; 21:3085-3091. [PMID: 33112571 PMCID: PMC7798172 DOI: 10.31557/apjcp.2020.21.10.3085] [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: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient’s future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques. Methods: A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis. Results: The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05). Conclusion: Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.
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Affiliation(s)
- Sarah Zulkarnain
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
| | - Norhayati Yunus
- Department of Pathology, Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan, Malaysia
| | - Regunath Kandasamy
- Department of Neuroscience, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
| | - Ahmad Badruridzwanullah Zun
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
| | - Anani Aila Mat Zin
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
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20
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Khurana U, Shrivastava A, Jain R, Goel G, Joshi D, Kapoor N. Squash smear cytology of pituitary granular cell tumor: A case report and review of literature with special emphasis on cytological differential diagnosis in pituitary region. Diagn Cytopathol 2020; 49:E119-E124. [PMID: 32926559 DOI: 10.1002/dc.24612] [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: 02/27/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022]
Abstract
Neurohypophysis granular cell tumor (NGCT) is a rare entity and is classified under thyroid transcription factor 1 (TTF-1) expressing tumors of pituitary. It is considered as an uncommon differential during sellar and suprasellar mass evaluation. Its intraoperative squash cytology is distinct and has rarely been reported in literature. A 65-year-old female presented with reduced vision of right eye and history of seizures. Radiological findings revealed a sellar/suprasellar mass with mass effect on optic chiasma. Intraoperative squash neurocytology examination showed a spindle cell lesion with abundant granular cytoplasm in tumor cells. Subsequent histopathology and immunohistochemistry confirmed the diagnosis of granular cell tumor. Granular cell tumor remains one of the sellar/suprasellar surprises. Its intraoperative neurocytology is unique and should be considered while evaluating a sellar/suprasellar mass. A case of sellar granular cell tumor with its intraoperative squash cytology, histopathology along with a review of literature is being presented with special emphasis on cytological differential diagnosis in pituitary region.
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Affiliation(s)
- Ujjawal Khurana
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
| | - Rubal Jain
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
| | - Garima Goel
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
| | - Deepti Joshi
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
| | - Neelkamal Kapoor
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, 462024, India
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21
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Malinova V, von Eckardstein K, Mielke D, Rohde V. Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis. J Neurooncol 2020; 149:315-323. [PMID: 32852725 DOI: 10.1007/s11060-020-03608-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Stereotactic biopsies are routinely used to establish a histological diagnosis of unclear cerebral pathologies. Intraoperatively, frozen-section analysis often confirms diagnostic tissue but also exhibits methodological pitfalls. Intraoperative five-aminolevulinic acid (5-ALA)-fluorescence has been described not only in gliomas but also in other cerebral pathologies. In this study, we assessed the 5-ALA contribution to the intraoperative confirmation of diagnostic tissue in frame-based stereotactic biopsies of unclear intracerebral lesions in direct comparison with frozen-section analysis. METHODS Patients scheduled for stereotactic biopsies of unclear intracerebral pathologies received 5-ALA preoperatively. Obtained samples were intraoperatively analyzed for the presence of 5-ALA-fluorescence. One sample was used for frozen-section and a second one for permanent histopathological analysis. The diagnostic yield of frozen-section and intraoperative 5-ALA-fluorescence was calculated. The inclusion criteria for this retrospective analysis were unclear intracerebral lesions with inconclusive imaging findings and several differential diagnoses. RESULTS A total of 39 patients with 122 obtained specimens were included. The overall diagnostic yield was 92.3%. 5-ALA-positive samples were obtained in 74.3% (29/39) of patients and all these samples contained diagnostic tissue. 5-ALA-fluorescence confirmed diagnostic tissue with a sensitivity of 100%, a specificity of 27%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 100%. A clear diagnosis could be predicted by frozen section with a sensitivity of 80%, a specificity of 100%, a PPV of 100%, and NPV of 30%; Fisher's exact test p = 0.01. CONCLUSION The 5-ALA-fluorescence in stereotactic biopsies of unclear intracerebral pathologies exhibits a high PPV/NPV for intraoperative confirmation of diagnostic tissue and might increase the diagnostic yield of the procedure by overcoming some of the limitations of frozen-section.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Kajetan von Eckardstein
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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22
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Zhang J, Jin J, Ai Y, Zhu K, Xiao C, Xie C, Jin X. Differentiating the pathological subtypes of primary lung cancer for patients with brain metastases based on radiomics features from brain CT images. Eur Radiol 2020; 31:1022-1028. [PMID: 32822055 DOI: 10.1007/s00330-020-07183-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM). The purpose of this study is to investigate the feasibility and accuracy of differentiating the primary adenocarcinoma (AD) and squamous cell carcinoma (SCC) of non-small-cell lung cancer (NSCLC) for patients with BM based on radiomics from brain contrast-enhanced computer tomography (CECT) images. METHODS A total of 144 BM patients (94 male, 50 female) were enrolled in this study with 102 with primary lung AD and 42 with SCC, respectively. Radiomics features from manually contoured tumors were extracted using python. Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) logistic regression were applied to select relative radiomics features. Binary logistic regression and support vector machines (SVM) were applied to build models with radiomics features alone and with radiomics features plus age and sex. RESULTS Fourteen features were selected from a total of 105 radiomics features for the final model building. The area under the curves (AUCs) and accuracy of SVM and binary logistic regression models were 0.765 vs. 0.769, 0.795 vs.0.828, and 0.716 vs. 0.726, 0.768 vs. 0.758, respectively, for models with radiomics features alone and models with radiomics features plus sex and age. CONCLUSIONS Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC. KEY POINTS • It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM) to define the prognosis and treatment. • Few studies had investigated the feasibility and accuracy of differentiating the pathological subtypes of primary non-small-cell lung cancer between adenocarcinoma (AD) and squamous cell carcinoma (SCC) for patients with BM based on radiomics from brain contrast-enhanced CT (CECT) images, although CECT images are often the initial imaging modality to screen for metastases and are recommended on equal footing with MRI for the detection of cerebral metastases. • Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC with a highest area under the curve (AUC) of 0.828 and an accuracy of 0.758, respectively.
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Affiliation(s)
- Ji Zhang
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Juebin Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yao Ai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kecheng Zhu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chengjian Xiao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,Department of Radiation and Medical Oncology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, 325000, China.
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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23
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Georges J, Qi X, Liu X, Zhou Y, Woolf EC, Valeri A, Al-Atrache Z, Belykh E, Feuerstein BG, Preul M, Scheck AC, Reiser M, Anderson T, Gopez J, Appelt D, Yocom S, Eschbacher J, Yan H, Nakaji P. Provision of rapid and specific ex vivo diagnosis of central nervous system lymphoma from rodent xenograft biopsies by a fluorescent aptamer. J Neurosurg 2020; 134:1783-1790. [PMID: 32707545 DOI: 10.3171/2020.4.jns192476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Differentiating central nervous system (CNS) lymphoma from other intracranial malignancies remains a clinical challenge in surgical neuro-oncology. Advances in clinical fluorescence imaging contrast agents and devices may mitigate this challenge. Aptamers are a class of nanomolecules engineered to bind cellular targets with antibody-like specificity in a fraction of the staining time. Here, the authors determine if immediate ex vivo fluorescence imaging with a lymphoma-specific aptamer can rapidly and specifically diagnose xenografted orthotopic human CNS lymphoma at the time of biopsy. METHODS The authors synthesized a fluorescent CNS lymphoma-specific aptamer by conjugating a lymphoma-specific aptamer with Alexa Fluor 488 (TD05-488). They modified human U251 glioma cells and Ramos lymphoma cells with a lentivirus for constitutive expression of red fluorescent protein and implanted them intracranially into athymic nude mice. Three to 4 weeks postimplantation, acute slices (biopsies, n = 28) from the xenografts were collected, placed in aptamer solution, and imaged with a Zeiss fluorescence microscope. Three aptamer staining concentrations (0.3, 1.0, and 3.0 μM) and three staining times (5, 10, and 20 minutes) followed by a 1-minute wash were tested. A file of randomly selected images was distributed to neurosurgeons and neuropathologists, and their ability to distinguish CNS lymphoma from negative controls was assessed. RESULTS The three staining times and concentrations of TD05-488 were tested to determine the diagnostic accuracy of CNS lymphoma within a frozen section time frame. An 11-minute staining protocol with 1.0-μM TD05-488 was most efficient, labeling 77% of positive control lymphoma cells and less than 1% of negative control glioma cells (p < 0.001). This protocol permitted clinicians to positively identify all positive control lymphoma images without misdiagnosing negative control images from astrocytoma and normal brain. CONCLUSIONS Ex vivo fluorescence imaging is an emerging technique for generating rapid histopathological diagnoses. Ex vivo imaging with a novel aptamer-based fluorescent nanomolecule could provide an intraoperative tumor-specific diagnosis of CNS lymphoma within 11 minutes of biopsy. Neurosurgeons and neuropathologists interpreted images generated with this molecular probe with high sensitivity and specificity. Clinical application of TD05-488 may permit specific intraoperative diagnosis of CNS lymphoma in a fraction of the time required for antibody staining.
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Affiliation(s)
- Joseph Georges
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey.,9Department of Neurosurgery
| | - Xiaodong Qi
- 4The Biodesign Institute.,5School of Molecular Sciences
| | | | - Yu Zhou
- 4The Biodesign Institute.,5School of Molecular Sciences
| | | | - Amber Valeri
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey
| | - Zein Al-Atrache
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | | | - Burt G Feuerstein
- 2Neurology, and.,3Child Health, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Mark Preul
- 9Department of Neurosurgery.,10Neuro-Oncology Research
| | - Adrienne C Scheck
- 3Child Health, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Mark Reiser
- 6School of Mathematics and Statistical Sciences, Arizona State University, Tempe, Arizona
| | | | - Jonas Gopez
- 12Department of Neurosurgery, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | - Denah Appelt
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Steven Yocom
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey
| | - Jennifer Eschbacher
- 11Division of Neuropathology, Barrow Neurological Institute, Phoenix, Arizona; and
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24
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Tanik C, Kabukcuoglu F. Intraoperative Imprint-squash Methods in Central Nervous System Tumors. SISLI ETFAL HASTANESI TIP BULTENI 2020; 54:245-251. [PMID: 32617067 PMCID: PMC7326685 DOI: 10.14744/semb.2020.08466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Central nervous system (CNS) tumors constitute 1.3% of all cancers in adults and are the seventh leading cause of death in developed countries. CNS tumors are very soft and have a gelatin-like texture. Smear technique is a very simple and fast method for the diagnosis of brain tumors. METHODS In this study, we evaluated the imprint and squash cytology of 100 cases sent to the pathology clinic. The sections of the paraffin blocks were prepared after the operation in the neurosurgery clinic of the SBU Hamidiye Şişli Efal Training and Research Hospital. The accuracy rate was 90% in the differential diagnosis of malignant tumors from the benign ones. CONCLUSION Cytological samples were taken from 100 cases of intracranial tumors that were operated in the neurosurgery clinic of Şişli Etfal Hospital, and the paraffin sections prepared from the biopsy materials were examined. The cases with misdiagnosis were usually differentiated from solid-hard tumors, epithelial-grade cystic structures, and medulloblastoma localized in the posterior fossa, medulloblastoma and ependymoma. However, this method has been found to be very convenient in practice due to its ease technically, low cost and equipment savings.
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Affiliation(s)
- Canan Tanik
- Department of Pathology, Health Sciences University, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fevziye Kabukcuoglu
- Department of Pathology, Health Sciences University, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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25
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Chakrabarty D, Chaudhuri S, Maity P, Chatterjee U, Ghosh S. Utility of Squash Cytology in Spinal Lesions with Special Reference to Ki67 Immunostain. Acta Cytol 2019; 63:424-430. [PMID: 31234167 DOI: 10.1159/000500681] [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: 07/05/2018] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Squash cytology is of significant importance in intraoperative consultation of central nervous system (CNS) pathology. There are several studies on squash cytology of CNS lesions, and only a few of them deal with spinal lesions alone. AIMS (1) To evaluate intraoperative squash cytology of spinal lesions. (2) To correlate cytological diagnosis with histopathological diagnosis and assess the diagnostic accuracy. (3) To study Ki67 expression on squash smears and determine whether it can assist in grading spinal tumours on cytology. MATERIALS AND METHODS A prospective study was conducted on 68 patients with clinico-radiologically diagnosed lesions of the spine. Intraoperative squash smears were stained with haematoxylin-eosin (H&E) stain, Papanicolaou (Pap) stain, and May-Grünwald-Giemsa (MGG) stain. Subsequently, histological diagnosis was made. Ki67 immunostaining was performed on squash smears and histology sections. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of squash cytology in spinal lesions were 84.6, 100, 100, 23.1, and 80.88%, respectively. On immunocytochemistry, the mean Ki67 labelling indices for grade I, II, and III tumours were 0, 0.33 and 9%, respectively. CONCLUSION Squash smear cytology is a rapid intraoperative technique for diagnosing spinal lesions, with high specificity and high positive predictive value. It is more effective in diagnosing neoplasms than non-neoplastic lesions. Ki67 immunostaining can be done on cytology smears to effectively differentiate between WHO grade I and grade II spinal tumours.
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Affiliation(s)
| | - Shubhamitra Chaudhuri
- Department of Neurosurgery, IPGME&R and SSKM Hospital and Bangur Institute of Neurosciences, Kolkata, India
| | - Priyanka Maity
- Department of Pathology, IPGME&R and SSKM Hospital, Kolkata, India,
| | | | - Subhasis Ghosh
- Department of Neurosurgery, IPGME&R and SSKM Hospital and Bangur Institute of Neurosciences, Kolkata, India
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Soni N, Priya S, Bathla G. Texture Analysis in Cerebral Gliomas: A Review of the Literature. AJNR Am J Neuroradiol 2019; 40:928-934. [PMID: 31122918 DOI: 10.3174/ajnr.a6075] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022]
Abstract
Texture analysis is a continuously evolving, noninvasive radiomics technique to quantify macroscopic tissue heterogeneity indirectly linked to microscopic tissue heterogeneity beyond human visual perception. In recent years, systemic oncologic applications of texture analysis have been increasingly explored. Here we discuss the basic concepts and methodologies of texture analysis, along with a review of various MR imaging texture analysis applications in glioma imaging. We also discuss MR imaging texture analysis limitations and the technical challenges that impede its widespread clinical implementation. With continued advancement in computational processing, MR imaging texture analysis could potentially develop into a valuable clinical tool in routine oncologic imaging.
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Affiliation(s)
- N Soni
- From the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - S Priya
- From the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - G Bathla
- From the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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27
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Balsimelli LBDS, Oliveira JCD, Adorno FÁ, Brites CA, Bublitz GS, Tavares LCDC, Coelho KMDPA, Stall J, França PHCD. Accuracy of Intraoperative Examination in Central Nervous System Lesions: A Study of 133 Cases. Acta Cytol 2019; 63:224-232. [PMID: 30982032 DOI: 10.1159/000495175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intraoperative examination is a highly valuable tool for the evaluation of central nervous system (CNS) lesions, helping the neurosurgeon to determine the best surgical management. This study aimed to evaluate the accuracy and to analyze the diagnostic disagreements and pitfalls of the intraoperative examinations through correlation with the final histopathological diagnosis in CNS lesions. STUDY DESIGN Retrospective analysis of intraoperative examination of CNS lesions and their final diagnosis obtained during 16 consecutive years. All diagnoses were reviewed and classified according to World Health Organization (WHO) grading for CNS tumors. Squash was performed in 119 cases, while frozen section and both methods were done in 7 cases each. RESULTS Among the 133 intraoperative examinations considered, 114 (85.7%) presented concordance and 19 (14.3%) diagnostic disagreement when compared with subsequent histopathological examinations. The sensitivity and specificity for the detection of neoplasia in intraoperative examination was 98 and 94%, respectively. The positive and negative predictive values were 99 and 88%, respectively. The accuracy for neoplastic and nonneoplastic disease was 85.7%. Disagreements were more frequent among low-grade (WHO grades I and II) neoplasms and nonmalignant cases. CONCLUSIONS Our results showed good accuracy of the intraoperative assessments for diagnosis of CNS lesions, particularly in high-grade (grades III and IV) lesions and metastatic neoplasms.
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Affiliation(s)
- Ludmila Barbosa de Souza Balsimelli
- Pathology Residency Program, Hospital Municipal São José, Joinville, Brazil,
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil,
| | - Jamille Costa de Oliveira
- Pathology Residency Program, Hospital Municipal São José, Joinville, Brazil
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil
| | - Flora Ávila Adorno
- Pathology Residency Program, Hospital Municipal São José, Joinville, Brazil
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil
| | - Clarissa Almeida Brites
- Pathology Residency Program, Hospital Municipal São José, Joinville, Brazil
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil
| | - Giuliano Stefanello Bublitz
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil
- Department of Medicine, Universidade da Região de Joinville - UNIVILLE, Joinville, Brazil
| | | | | | - Jaqueline Stall
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Joinville, Brazil
- Department of Medicine, Universidade da Região de Joinville - UNIVILLE, Joinville, Brazil
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28
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Mat Zin AA, Zulkarnain S. Diagnostic Accuracy of Cytology Smear and Frozen Section in Glioma. Asian Pac J Cancer Prev 2019; 20:321-325. [PMID: 30803189 PMCID: PMC6897032 DOI: 10.31557/apjcp.2019.20.2.321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Glioma is the commonest primary intracranial tumour and it has been the most predominant tumour in many studies. It accounts for 24.7% of all primary brain tumour and 74.6% of malignant brain tumour. Intraoperative diagnosis plays a crucial role in determining the patient management. Frozen section has been the established technique in providing rapid and accurate intraoperative diagnosis. However due to some disadvantages like ice crystal artefact, high expenditure and requirement of skilled technician, there is increase usage of cytology smear either replacing or supplementing frozen section technique. The aim of this review is to determine the diagnostic accuracy of cytology smear and frozen section in glioma and to see whether there is significant difference between those techniques. The overall diagnostic accuracy for frozen section in glioma ranging from 78.4% to 95% while for cytology smear, the diagnostic accuracy ranging from 50% to 100%. Based on certain literatures, no statistically difference was observed in diagnostic accuracy of cytology smear and frozen section. Thus, cytology smear provides an alternative method in establishing intraoperative diagnosis. Both cytology smear and frozen section are complimentary to each other. It is recommended to use both techniques to improve the diagnostic accuracy in addition with adequate knowledge, clinical history, neuroimaging and intraoperative findings.
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Affiliation(s)
- Anani Aila Mat Zin
- Department of Pathology, School of Medical Science, Health Campus, University Sains Malaysia, Kelantan, Malaysia.
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29
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Kang M, Chung DH, Kim NR, Cho HY, Ha SY, Lee S, An J, Seok JY, Yie GT, Yoo CJ, Lee SG, Kim EY, Kim WK, Son S, Sym SJ, Shin DB, Hwang HY, Kim EY, Lee KC. Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis. J Pathol Transl Med 2019; 53:104-111. [PMID: 30636391 PMCID: PMC6435984 DOI: 10.4132/jptm.2018.11.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/10/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.
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Affiliation(s)
- Myunghee Kang
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Hae Chung
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Na Rae Kim
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hyun Yee Cho
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung Yeon Ha
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sangho Lee
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jungsuk An
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Gie-Taek Yie
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sun Jin Sym
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Bok Shin
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hee Young Hwang
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyu Chan Lee
- Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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30
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Artzi M, Bressler I, Ben Bashat D. Differentiation between glioblastoma, brain metastasis and subtypes using radiomics analysis. J Magn Reson Imaging 2019; 50:519-528. [PMID: 30635952 DOI: 10.1002/jmri.26643] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Differentiation between glioblastoma and brain metastasis is highly important due to differing medical treatment strategies. While MRI is the modality of choice for the assessment of patients with brain tumors, differentiation between glioblastoma and solitary brain metastasis may be challenging due to their similar appearance on MRI. PURPOSE To differentiate between glioblastoma and brain metastasis subtypes using radiomics analysis based on conventional post-contrast T1 -weighted (T1 W) MRI. STUDY TYPE Retrospective. SUBJECTS Data were acquired from 439 patients: 212 patients with glioblastoma and 227 patients with brain metastasis (breast, lung, and others). FIELD STRENGTH/SEQUENCE Post-contrast 3D T1 W gradient echo images, acquired with 1.5 and 3.0 T MR systems. ASSESSMENT Analysis included image preprocessing, segmentation of tumor area, and features extraction including: patients' clinical information, tumor location, first- and second-order statistical, morphological, wavelet features, and bag-of-features. Following dimension reduction, classification was performed using various machine-learning algorithms including support-vector machine (SVM), k-nearest neighbor, decision trees, and ensemble classifiers. STATISTICAL TESTS For classification, the data were divided into training (80%) and testing datasets (20%). Following optimization of the classifiers, mean sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS For the testing dataset, the best results for differentiation of glioblastoma from brain metastasis were obtained using the SVM classifier with mean accuracy = 0.85, sensitivity = 0.86, specificity = 0.85, and AUC = 0.96. The best classification results between glioblastoma and brain metastasis subtypes were obtained using SVM classifier with mean accuracy = 0.85, 0.89, 0.75, 0.90; sensitivity = 1.00, 0.60, 0.57, 0.11; specificity = 0.76, 0.92, 0.87, 0.99; and AUC = 0.98, 0.81, 0.83, 0.57 for the glioblastoma, breast, lung, and other brain metastases, respectively. DATA CONCLUSION Differentiation between glioblastoma and brain metastasis showed a high success rate based on postcontrast T1 W MRI. Classification between glioblastoma and brain metastasis subtypes may require additional MR sequences with other tissue contrasts. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:519-528.
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Affiliation(s)
- Moran Artzi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Idan Bressler
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,The Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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31
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Sugiyama T, Tajiri T, Fujita H, Hiraiwa S, Toguchi S, Nomura N, Machida T, Nakamura Y, Nakagawa T, Yamada S, Iwazaki M, Nakamura N. Diagnostic utility and pitfalls of intraoperative pulmonary imprint cytology based on final pathological diagnoses. Cytopathology 2018; 30:74-81. [DOI: 10.1111/cyt.12649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoko Sugiyama
- Department of Diagnostic Pathology; Tokai University Hachioji Hospital; Tokyo Japan
| | - Takuma Tajiri
- Department of Diagnostic Pathology; Tokai University Hachioji Hospital; Tokyo Japan
| | - Hirotaka Fujita
- Department of Laboratory Medicine; Tokai University Hachioji Hospital; Tokyo Japan
| | - Shinichiro Hiraiwa
- Department of Diagnostic Pathology; Tokai University Hachioji Hospital; Tokyo Japan
| | - Suguru Toguchi
- Department of Laboratory Medicine; Tokai University Hachioji Hospital; Tokyo Japan
| | - Nozomi Nomura
- Department of Laboratory Medicine; Tokai University Hachioji Hospital; Tokyo Japan
| | - Tomohisa Machida
- Department of Laboratory Medicine; Tokai University Hachioji Hospital; Tokyo Japan
| | - Yusuke Nakamura
- Department of General Thoracic Surgery; Tokai University Hachioji Hospital; Tokyo Japan
| | - Tomoki Nakagawa
- Department of General Thoracic Surgery; Tokai University Hachioji Hospital; Tokyo Japan
| | - Shunsuke Yamada
- Department of General Thoracic Surgery; Tokai University Hachioji Hospital; Tokyo Japan
| | - Masayuki Iwazaki
- Department of Thoracic Surgery; Tokai University School of Medicine; Isehara Japan
| | - Naoya Nakamura
- Department of Pathology; Tokai University School of Medicine; Isehara Japan
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Kolakshyapati M, Takeda M, Mitsuhara T, Yamaguchi S, Abiko M, Matsuda S, Kurisu K. Isolated Tuberculoma Mimicking Foramen Magnum Meningioma in the Absence of Primary Tuberculosis: A Case Report. Neurospine 2018; 15:277-282. [PMID: 30145853 PMCID: PMC6226133 DOI: 10.14245/ns.1836034.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/14/2018] [Indexed: 12/02/2022] Open
Abstract
Central nervous system tuberculosis is a devastating complication of systemic tuberculosis. Intradural extramedullary (IDEM) tuberculoma at the foramen magnum is rare, and mimics en plaque meningioma. We report the case of a 53-year-old woman who presented with dysesthesia of the tongue and lower cranial nerve (CN) palsy, with onset 4 months prior to admission. The neurologic examination revealed left upper-limb weakness and hypoesthesia on the sole and dorsum of the left foot. Other physical examinations revealed no features of tubercular infection. Laboratory investigations likewise showed no signs of infection or inflammation. Magnetic resonance imaging of the brain showed an IDEM mass originating from the left intradural surface at the foramen magnum extending to the C2 segment and compressing the brainstem and upper cervical cord. The mass was isointense/hypointense on T1- and T2-weighted images and homogeneously-enhanced on postcontrast images. The lesion also exhibited the dural-tail sign and was preoperatively diagnosed as en plaque meningioma. The patient underwent surgery via the left transcondylar fossa approach with partial laminectomy of the atlas. Intraoperatively, the mass exhibited a dural origin and encased the vertebral artery and lower CNs, with strong adhesions. While the histopathological study of the mass was strongly suggestive of tuberculoma with multifocal granulomas, caseous necrosis, and Langerhans giant cells, extensive diagnostic studies failed to detect Mycobacterium tuberculosis itself. Although the patient had recurrence with multisystem involvement, she responded well to antitubercular treatment. IDEM tuberculoma of the foramen magnum may present as en plaque meningioma. Histopathology is required for a definitive diagnosis. Prompt surgical resection and decompression with adequate antitubercular treatment yield better neurological outcomes.
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Affiliation(s)
- Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaaki Takeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaru Abiko
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Importance and accuracy of intraoperative frozen section diagnosis of the resection margin for effective carmustine wafer implantation. Brain Tumor Pathol 2018; 35:131-140. [DOI: 10.1007/s10014-018-0320-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
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34
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Vartholomatos G, Stefanaki K, Alexiou GA, Batistatou A, Markopoulos GS, Tzoufi M, Sfakianos G, Prodromou N. Pediatric Brain Tumor Grading Based on CD56 Quantification. J Pediatr Neurosci 2018; 13:524-527. [PMID: 30937110 PMCID: PMC6413610 DOI: 10.4103/jpn.jpn_155_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- George Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Kalliopi Stefanaki
- Department of Pathology, Children's Hospital "Agia Sofia", Athens, Greece
| | - George A Alexiou
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios S Markopoulos
- Laboratory of Biology, Faculty of Medicine, University of Ioannina, Ioannina, Greece.,Division of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH University Campus, Ioannina, Greece
| | - Meropi Tzoufi
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - George Sfakianos
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
| | - Neofytos Prodromou
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
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