Artikel
High interobserver agreement in the semiquantitative classification of 5-ALA fluorescence levels in newly diagnosed glioblastomas
Hohe Interobserver-Übereinstimmung in der semiquantitativen Klassifikation der 5-ALA Fluoreszenzlevel in neu-diagnostizierten Glioblastomen
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Autoren
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Mario Mischkulnig
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Barbara Kiesel
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Martin Borkovec
- Ludwig-Maximilians-Universität München, Abteilung für Statistik, München, Deutschland
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Lisa Wadiura
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Dimitri Benner
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Arthur Hosmann
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Shawn Hervey-Jumper
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA, United States
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Engelbert Knosp
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Karl Rössler
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
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Mitchel S. Berger
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA, United States
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Georg Widhalm
- Medizinische Universität Innsbruck, Abteilung für Neurochirurgie, Wien, Austria
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
Text
Objective: Fluorescence-guided resection of glioblastomas (GBM) using 5-aminolevulinic acid (5-ALA) improves intraoperative tumor visualization and is thus widely used nowadays. During resection, different fluorescence levels can usually be distinguished within the same tumor. Recently, we demonstrated that strong, vague, and no fluorescence correspond to distinct histopathological characteristics in newly diagnosed GBM. However, the semiquantitative fluorescence classification by the neurosurgeon is subjective and currently no comprehensive data on interobserver variability is available. The aim of this study was thus to investigate the interobserver variability in the classification of 5-ALA fluorescence levels in newly diagnosed GBM in a large cohort.
Methods: A questionnaire investigating the interobserver variability in 5-ALA fluorescence quantification was performed at a nation-wide neurosurgical oncology meeting. The participants involved in the neurosurgical/neurooncological field were asked to categorize 30 cases of 5-ALA fluorescence images derived from GBM resection according to the widely used three-tier fluorescence classification scheme (negative, vague or strong fluorescence). Additionally, participants were asked for information on their medical background such as specialty, level of training and experience with fluorescence-guided procedures. Interobserver agreement was defined as the calculated mean kappa values for each observer.
Results: A total of 36 questionnaires were included in the final analysis. The mean average kappa value in fluorescence classification within the entire cohort was 0.71+/-0.12 and 29 (81%) participants had a substantial or almost perfect interobserver agreement (kappa values 0.6-1.0). Interobserver agreement was significantly higher in neurosurgeons (mean kappa: 0.83) as compared to non-neurosurgeons involved in the neurooncological field (mean kappa: 0.52; p<0.001). Furthermore, interobserver agreement was significantly higher in participants who had experience with at least 25 5-ALA fluorescence-guided surgeries (mean kappa: 0.87) compared to less experienced colleagues (mean kappa: 0.82; p=0.039).
Conclusion: Our study found a high interobserver agreement in the semiquantitative classification of different 5-ALA fluorescence levels in newly diagnosed GBM. Interobserver agreement increases significantly in more experienced participants and therefore a high level of experience is crucial for reliable intraoperative fluorescence classification.
