Department of Neurosurgery, Medstar Georgetown Hospital, Washington, DC, USA.
Georgetown University School of Medicine, Washington, DC, USA.
J Neurooncol. 2023 Dec;165(3):449-458. doi: 10.1007/s11060-023-04493-2. Epub 2023 Nov 28.
There is a growing body of literature documenting glioma heterogeneity in terms of radiographic, histologic, molecular, and genetic characteristics. Incomplete spatial specification of intraoperative tumor samples may contribute to variability in the results of pathological and biological investigations. We have developed a system, termed geo-tagging, for routine intraoperative linkage of each tumor sample to its location via neuronavigation.
This is a single-institution, IRB approved, prospective database of undergoing clinically indicated surgery. We evaluated relevant factors affecting data collection by this registry, including tumor and surgical factors (e.g. tumor volume, location, grade and surgeon).
Over a 2-year period, 487 patients underwent craniotomy for an intra-axial tumor. Of those, 214 underwent surgery for a newly diagnosed or recurrent glioma. There was significant variation in the average number of samples collected per registered case, with a range of samples from 2.53 to 4.75 per tumor type. Histology and grade impacted on sampling with a range of 2.0 samples per tumor in Grade four, IDH-WT gliomas to 4.5 samples in grade four, IDH-mutant gliomas. The range of cases with sampling per surgeon was 6 to 99 with a mean of 47.6 cases and there was a statistically significant differences between surgeons. Tumor grade did not have a statistically significant impact on number of samples per case. No significant correlation was found between the number of samples collected and enhancing tumor volume, EOR, or volume of tumor resected.
We are using the results of this analysis to develop a prospective sample collection protocol.
越来越多的文献记录了神经胶质瘤在影像学、组织学、分子和遗传学特征方面的异质性。术中肿瘤样本的空间定位不完整，可能导致病理和生物学研究结果的变异性。我们开发了一种系统，称为地理标记，用于通过神经导航对每个肿瘤样本进行常规术中定位。
这是一项单机构、经 IRB 批准的、正在进行的临床手术适应证数据库。我们评估了该登记处收集数据的相关因素，包括肿瘤和手术因素（例如肿瘤体积、位置、分级和外科医生）。
在 2 年期间，487 名患者因颅内肿瘤接受了开颅手术。其中，214 名患者因新发或复发性神经胶质瘤接受了手术。每个登记病例的平均样本采集数量存在显著差异，样本范围从每种肿瘤类型的 2.53 到 4.75 个不等。组织学和分级对采样有影响，四级 IDH-WT 神经胶质瘤的采样范围为每个肿瘤 2.0 个样本，四级 IDH 突变神经胶质瘤的采样范围为 4.5 个样本。每位外科医生的样本采集范围为 6 到 99 例，平均为 47.6 例，外科医生之间存在统计学上的显著差异。肿瘤分级对每个病例的样本数量没有统计学上的显著影响。没有发现收集的样本数量与增强肿瘤体积、EOR 或切除的肿瘤体积之间存在显著相关性。
我们正在利用这些分析结果制定前瞻性样本采集方案。
