Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study

Adam M. Sonabend; Brad E. Zacharia; Michael B. Cloney; Aarón Sonabend; Christopher Showers; Victoria Ebiana; Matthew Nazarian; Kristin R. Swanson; Anne Baldock; Henry Brem; Jeffrey N. Bruce; William Butler; Daniel P. Cahill; Bob Carter; Daniel A. Orringer; David W. Roberts; Oren Sagher; Nader Sanai; Theodore H. Schwartz; Daniel L. Silbergeld; Michael B. Sisti; Reid C. Thompson; Allen E. Waziri; Guy McKhann

doi:10.1227/NEU.0000000000001374

Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study

Adam M. Sonabend^*, Brad E. Zacharia, Michael B. Cloney, Aarón Sonabend, Christopher Showers, Victoria Ebiana, Matthew Nazarian, Kristin R. Swanson, Anne Baldock, Henry Brem, Jeffrey N. Bruce, William Butler, Daniel P. Cahill, Bob Carter, Daniel A. Orringer, David W. Roberts, Oren Sagher, Nader Sanai, Theodore H. Schwartz, Daniel L. SilbergeldMichael B. Sisti, Reid C. Thompson, Allen E. Waziri, Guy McKhann

^*Corresponding author for this work

Neurological Surgery

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

Abstract

BACKGROUND:: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE:: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS:: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a “resectability index” for each lesion by pooling responses from all 13 surgeons. RESULTS:: Neurosurgeons’ individual surgical goals varied significantly (P = .015), but the resectability index calculated from the surgeons’ pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor (R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes (P < .01) and nonresectable residual (P < .01), but not resectable residual. CONCLUSION:: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials. ABBREVIATIONS:: AI, aggressiveness indexANOVA, analysis of varianceBx, biopsyDICOM, digital imaging and communications in medicineEOR, extent of resectionGBM, glioblastomaGTR, gross total resectionKPS, Karnofsky Performance ScaleMSM, motor-speech-middle cerebral arteryNIH score, National Institutes of Health Recurrent GBM ScoreRI, resectability indexSTR, subtotal resection

Original language	English (US)
Pages (from-to)	590-601
Number of pages	12
Journal	Neurosurgery
Volume	80
Issue number	4
DOIs	https://doi.org/10.1227/NEU.0000000000001374
State	Accepted/In press - Aug 4 2016

Funding

This work was funded by the NIH Office of the Director, Award Number 1DP5OD021356-01, and a Diversity Recruitment Award by the Office of Senior Associate Provost for Faculty Diversity and Inclusion, Columbia University. This work was funded by the NIH Office of the Director, Award Number 1DP5OD021356-01, and a Diversity Recruitment Award by the Office of Senior Associate Provost for Faculty Diversity and Inclusion, Columbia University. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1227/NEU.0000000000001374

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Sonabend, A. M., Zacharia, B. E., Cloney, M. B., Sonabend, A., Showers, C., Ebiana, V., Nazarian, M., Swanson, K. R., Baldock, A., Brem, H., Bruce, J. N., Butler, W., Cahill, D. P., Carter, B., Orringer, D. A., Roberts, D. W., Sagher, O., Sanai, N., Schwartz, T. H., ... McKhann, G. (Accepted/In press). Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study. Neurosurgery, 80(4), 590-601. https://doi.org/10.1227/NEU.0000000000001374

@article{e1a7b797ab5547c2adb335c81f12712d,

title = "Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study",

abstract = "BACKGROUND:: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE:: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS:: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a “resectability index” for each lesion by pooling responses from all 13 surgeons. RESULTS:: Neurosurgeons{\textquoteright} individual surgical goals varied significantly (P = .015), but the resectability index calculated from the surgeons{\textquoteright} pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor (R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes (P < .01) and nonresectable residual (P < .01), but not resectable residual. CONCLUSION:: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials. ABBREVIATIONS:: AI, aggressiveness indexANOVA, analysis of varianceBx, biopsyDICOM, digital imaging and communications in medicineEOR, extent of resectionGBM, glioblastomaGTR, gross total resectionKPS, Karnofsky Performance ScaleMSM, motor-speech-middle cerebral arteryNIH score, National Institutes of Health Recurrent GBM ScoreRI, resectability indexSTR, subtotal resection",

author = "Sonabend, {Adam M.} and Zacharia, {Brad E.} and Cloney, {Michael B.} and Aar{\'o}n Sonabend and Christopher Showers and Victoria Ebiana and Matthew Nazarian and Swanson, {Kristin R.} and Anne Baldock and Henry Brem and Bruce, {Jeffrey N.} and William Butler and Cahill, {Daniel P.} and Bob Carter and Orringer, {Daniel A.} and Roberts, {David W.} and Oren Sagher and Nader Sanai and Schwartz, {Theodore H.} and Silbergeld, {Daniel L.} and Sisti, {Michael B.} and Thompson, {Reid C.} and Waziri, {Allen E.} and Guy McKhann",

note = "Publisher Copyright: {\textcopyright} 2017 by the Congress of Neurological Surgeons.",

year = "2016",

month = aug,

day = "4",

doi = "10.1227/NEU.0000000000001374",

language = "English (US)",

volume = "80",

pages = "590--601",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Sonabend, AM, Zacharia, BE, Cloney, MB, Sonabend, A, Showers, C, Ebiana, V, Nazarian, M, Swanson, KR, Baldock, A, Brem, H, Bruce, JN, Butler, W, Cahill, DP, Carter, B, Orringer, DA, Roberts, DW, Sagher, O, Sanai, N, Schwartz, TH, Silbergeld, DL, Sisti, MB, Thompson, RC, Waziri, AE & McKhann, G 2016, 'Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study', Neurosurgery, vol. 80, no. 4, pp. 590-601. https://doi.org/10.1227/NEU.0000000000001374

TY - JOUR

T1 - Defining Glioblastoma Resectability Through the Wisdom of the Crowd

T2 - A Proof-of-Principle Study

AU - Sonabend, Adam M.

AU - Zacharia, Brad E.

AU - Cloney, Michael B.

AU - Sonabend, Aarón

AU - Showers, Christopher

AU - Ebiana, Victoria

AU - Nazarian, Matthew

AU - Swanson, Kristin R.

AU - Baldock, Anne

AU - Brem, Henry

AU - Bruce, Jeffrey N.

AU - Butler, William

AU - Cahill, Daniel P.

AU - Carter, Bob

AU - Orringer, Daniel A.

AU - Roberts, David W.

AU - Sagher, Oren

AU - Sanai, Nader

AU - Schwartz, Theodore H.

AU - Silbergeld, Daniel L.

AU - Sisti, Michael B.

AU - Thompson, Reid C.

AU - Waziri, Allen E.

AU - McKhann, Guy

PY - 2016/8/4

Y1 - 2016/8/4

N2 - BACKGROUND:: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE:: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS:: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a “resectability index” for each lesion by pooling responses from all 13 surgeons. RESULTS:: Neurosurgeons’ individual surgical goals varied significantly (P = .015), but the resectability index calculated from the surgeons’ pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor (R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes (P < .01) and nonresectable residual (P < .01), but not resectable residual. CONCLUSION:: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials. ABBREVIATIONS:: AI, aggressiveness indexANOVA, analysis of varianceBx, biopsyDICOM, digital imaging and communications in medicineEOR, extent of resectionGBM, glioblastomaGTR, gross total resectionKPS, Karnofsky Performance ScaleMSM, motor-speech-middle cerebral arteryNIH score, National Institutes of Health Recurrent GBM ScoreRI, resectability indexSTR, subtotal resection

AB - BACKGROUND:: Extent of resection (EOR) correlates with glioblastoma outcomes. Resectability and EOR depend on anatomical, clinical, and surgeon factors. Resectability likely influences outcome in and of itself, but an accurate measurement of resectability remains elusive. An understanding of resectability and the factors that influence it may provide a means to control a confounder in clinical trials and provide reference for decision making. OBJECTIVE:: To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability. METHODS:: We surveyed 13 academic tumor neurosurgeons nationwide to assess the resectability of newly diagnosed glioblastoma. Participants reviewed 20 cases, including digital imaging and communications in medicine-formatted pre- and postoperative magnetic resonance images and clinical vignettes. The selected cases involved a variety of anatomical locations and a range of EOR. Participants were asked about surgical goal, eg, gross total resection, subtotal resection (STR), or biopsy, and rationale for their decision. We calculated a “resectability index” for each lesion by pooling responses from all 13 surgeons. RESULTS:: Neurosurgeons’ individual surgical goals varied significantly (P = .015), but the resectability index calculated from the surgeons’ pooled responses was strongly correlated with the percentage of contrast-enhancing residual tumor (R = 0.817, P < .001). The collective STR goal predicted intraoperative decision of intentional STR documented on operative notes (P < .01) and nonresectable residual (P < .01), but not resectable residual. CONCLUSION:: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials. ABBREVIATIONS:: AI, aggressiveness indexANOVA, analysis of varianceBx, biopsyDICOM, digital imaging and communications in medicineEOR, extent of resectionGBM, glioblastomaGTR, gross total resectionKPS, Karnofsky Performance ScaleMSM, motor-speech-middle cerebral arteryNIH score, National Institutes of Health Recurrent GBM ScoreRI, resectability indexSTR, subtotal resection

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DO - 10.1227/NEU.0000000000001374

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JO - Neurosurgery

JF - Neurosurgery

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ER -

Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study

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