Diagnosis of Postlaminar Optic Nerve Invasion in Retinoblastoma With MRI Features

Li, Zhenzhen; Guo, Jun; Xu, Xiaolin; Wang, Yongzhe; Mukherji, Suresh K.; Xian, Junfang

doi:10.1002/jmri.26961

Cited by 19 publications

(22 citation statements)

References 37 publications

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“…[23] Li evaluated the value of MRI as a useful diagnostic tool for post-laminar optic nerve invasion with a calculated sensitivity of 82%, specificity of 73% and accuracy of 77%. [24] Similarly, in our series, ON invasion was found in 28 cases (74%) by histopathological examination, out of which 12 eyes had prelaminar invasion (31.6%), 7 eyes had laminar invasion (18.4%), and 9 (23.7%) had post-laminar invasion (including 1 patient with surgical margin involvement). ON invasion was evident by MRI in 30 (78%) patients distributed as follows: 6 (15.8%) eyes pre-laminar, 8 (21.1%) laminar, and 16 (42.1%) post-laminar (including 1 patient with surgical margin involvement).…”

Section: Discussionsupporting

confidence: 78%

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Abusayf

Alkatan

Elkhamary

et al. 2020

Preprint

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Background: Optic nerve (ON) invasion is an important high-risk feature, and an indicator for neoadjuvant chemotherapy and prognosis. We aim through this study to correlate the detected-ON invasion by Magnetic resonance imaging (MRI) with the corresponding confirmed histopathological level of invasion.Methods: A retrospective study of enucleated globes with the diagnosis of retinoblastoma received in the histopathology department(s) from January 2015 to December 2016 (2 years). Slides were reviewed for ON invasion assessment, charts were reviewed for basic demographic data. All patients underwent MRI under sedation upon diagnosis and MRI findings were collected for the above correlation.Results: A total of 38 patients were included: 21 males and 17 females. 29 (77.3%) had unilateral involvement, 7 (18.4%) had bilateral involvement and 2 cases had trilateral disease. The overall mean age at diagnosis was 22.63 ±15.15 months. Histopathological examination revealed ON invasion in 28 cases (74%) distributed as follows: prelaminar (31.6%), laminar (18.4%), and post-laminar (23.7%). MRI confirmed post-laminar ON invasion in 8 cases (true positive) but failed to detect this in 1 case. Additionally, MRI detected another 8 cases of ON invasion that were false positive on histopathology (accuracy: 63.3%; sensitivity: 88.9%; specificity: 72.4%; Positive predictive value (PPV): 50%; Negative predictive value (NPV): 95.5%).Conclusions: MRI is found to be less sensitive in evaluating prelaminar and laminar ON invasion (0.0 and 42.9%) compared to post-laminar invasion (88.9%). MRI has generally better specificity in detecting ON invasion irrespective of the invasion level. In our study, obtaining deeper and/or additional histologic sections from the other surface of the tissue block in cases where a post-laminar ON invasion by MRI is found but not confirmed histopathologically in routine sections is essential to avoid missing such an important high-risk feature.

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Section: Discussionsupporting

confidence: 78%

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Abusayf

Alkatan

Elkhamary

et al. 2020

Preprint

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“…[21] Li evaluated the value of MRI as a useful diagnostic tool for post-laminar optic nerve invasion with a measured sensitivity of 82%, specificity of 73% and accuracy of 77%. [22] Similarly, in our series, pathologically proven ON invasion was found in 28 cases (74%). 12 eyes had prelaminar invasion (31.6%), 7 eyes had laminar invasion (18.4%), and 9 (23.7%) had post-laminar invasion (including 1 patient with surgical margin involvement).…”

Section: Discussionsupporting

confidence: 71%

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Abusayf

Alkatan

Maktabi

et al. 2019

Preprint

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Purpose: High-risk histopathological features in primary enucleated retinoblastoma globes affect the indication for neoadjuvant chemotherapy to avoid the increased risk of metastasis and to improve survival in such children. Optic nerve (ON) invasion is an important indicator of prognosis and we aim through this study to correlate the detected-ON invasion by imaging with the corresponding confirmed histopathological level of invasion. Methods: This is an approved retrospective study with collaborative agreement between the 2 centres. All enucleated globes with the diagnosis of retinoblastoma received in the histopathology department(s) from January 2015 to December 2016 (2 years) were collected for review by 2 pathologists and the charts were reviewed for basic demographic data. All patients underwent Magnetic resonance imaging (MRI) under sedation upon diagnosis and MRI reading was done by an experienced single neuroradiologist. Results: A total of 38 patients were included: 21 males and 17 females. 29 (77.3%) had unilateral involvement, 7 (18.4%) had bilateral involvement and 2 cases had trilateral disease. The overall mean age at diagnosis was 22.63 ±15.15 months. 28 cases (74%) had pathologically-proven ON invasion: prelaminar (31.6%), laminar (18.4%), and post-laminar (23.7%). Post-laminar ON invasion was identified in 8 cases (true positive), while another 8 were false positive. Only 1 case was missed on MRI (accuracy: 63.3%; sensitivity: 88.9%; specificity: 72.4%; Positive predictive value (PPV): 50%; Negative predictive value (NPV): 95.5%). Conclusions: MRI was found to be less sensitive in evaluating pre-laminar and laminar ON invasion (0.0 and 42.9%) compared to post-laminar invasion (88.9%) but had better specificity in detecting various levels of invasion (72.4 to 83.9%). Obtaining deeper histologic sections in some cases where there are mismatching ON level of invasion between MRI and histopathological examination is recommended to avoid misleading assessment of the high-risk histopathological features. There are no solid international protocols of how many sections should be obtained to evaluate the optic nerve invasion in these globes and this should be established for universal use especially in less developed countries where experienced pathologists might be lacking. Key words: Retinoblastoma; High-risk, Histopathology; Optic nerve invasion; Lamina cribrosa; Radiology; Magnetic resonance imaging; Chemotherapy.

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“…In the case of opaque media, ultrasonography (B-scan) provides useful information to assess any tumor growth or optic nerve threat, while high-resolution contrast-enhanced magnetic resonance imaging (MRI) enables the evaluation of tumor activity and potential exteriorization. While its sensitivity and specificity in detecting scleral and peribulbar invasion is considered to be near 100%, MRI is, however, less sensitive to detecting early choroidal [ 93 ] or postlaminar optic nerve invasion [ 93 , 94 ]. Finally ultrasonic biomicroscopy proved to be instrumental, not only for the determination of a tumor-free entry meridian prior to intravitreal injection for vitreous disease in case of compromised pupil dilation or presence of opaque media [ 57 , 71 ], but also for the assessment and monitoring of tumor invasion of the ciliary body and/or posterior chamber [ 57 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

Stathopoulos

Rouic

Moll

et al. 2021

Cancers

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Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.

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Diagnosis of Postlaminar Optic Nerve Invasion in Retinoblastoma With MRI Features

Cited by 19 publications

References 37 publications

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma.

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

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