The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.

The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.

World Neurosurg. 2018 Apr 06;:

Authors: Ravn Munkvold BK, Jakola AS, Reinertsen I, Sagberg LM, Unsgård G, Solheim O

Abstract
OBJECTIVE: In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.
METHODS: 144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.
RESULTS: Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).
CONCLUSION: The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.

PMID: 29631086 [PubMed - as supplied by publisher]

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