Artikel
The correlation of microscopic intraoperative aspects, histological and radiological diagnostics in surgery of brain metastases
Korrelation von radiologischen, histologischen und mikroskopisch intraoperativen Befunden bei der Resektion von Hirnmetastasen
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Autoren
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Lena Dybowski
- Universitätsklinikum Carl Gustav Carus Dresden, Klinik für Neurochirurgie, Dresden, Deutschland
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Kay Engellandt
- Universitätsklinikum Carl Gustav Carus Dresden, Institut für Neuroradiologie, Dresden, Deutschland
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Matthias Meinhardt
- Universitätsklinikum Carl Gustav Carus Dresden, Institut für Pathologie, Dresden, Deutschland
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Dietmar Krex
- Universitätsklinikum Carl Gustav Carus Dresden, Klinik für Neurochirurgie, Dresden, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Metastases are the most frequent malignant brain tumors with an even rapidly increasing incidence. While chemo-immunotherapy gets more and more important primarily in the therapy of the underlying disease but also for brain metastasis treatment in general, the standard of care is an interdisciplinary therapeutically approach consisting of surgical resection of single or up to three metastasis followed by focal radiation in case of incomplete resection. Therefore, the postoperative MRI diagnosis is crucial. However, we frequently envisage questionable findings where a complete resection versus tumor remnant cannot be distinguished. In the present analysis we tried to address that issue.
Methods: Retrospective analysis of 100 patients with supratentorial metastasis of any origin. In addition to documentation of basic clinical data the focus was laid on the surgeon’s estimation (SE) of the extent of resection according to the surgical report, the report from early postoperative MRI diagnosis (MRI) and the histological analysis of probes (HA) taken from the tumor border zone. Follow-up MRI were recorded, also. Further, all pre- and early postoperative MRI were re-reviewed by an experienced neuroradiologist.
Results: In a primary cohort of 40 patients we found a correlation between SE and MRI in 48%. A discrepancy between MRI and second review by a neuroradiologist was found in 16% of cases. There were no more tumor-cells found in the HA of the border zone in 63%. A correlation between detection of tumor cells in HA and MRI was found in 75%. In the follow-up analysis, 39% of the patients with a tumor-remnant in MRI developed a local recurrence. 22% of patients with no remnant in MRI developed no recurrent tumor, while 18% did.
Conclusion: Taken that the data from our primary population of brain metastasis patients are confirmed by the analysis of the entire cohort, there is a surprisingly low sensitivity and specificity in the diagnosis of a postoperative local status when SE, MRI and HA are taken into account either in combination or each item alone. This clearly needs to be improved for example by consequent histopathological analysis of the tumor border zone and novel MRI protocols.
