Magnetic resonance imaging for tumor restaging after chemotherapy in retinoblastoma with optic nerve invasion

Chawla, Bhavna; Chaurasia, Shweta; Sharma, Sanjay; Pattebahadur, Rajesh; Hasan, Muhamad Fahmi; Seth, Rachna; Kashyap, Seema; Sen, Seema

doi:10.1080/13816810.2018.1502790

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Many studies have been published correlating the clinical and MRI features in relation to RB high risk features [ 7 , 14 , 15 ]. In the era of targeted therapy like intra-arterial chemotherapy, identification of these features was important because many eyes with advanced disease were salvaged with non-surgical treatment [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consensus on choroidal invasion has been also reached, where this can be focal or massive (massive choroidal invasion is defined as having diameter of 3 mm or more in any tumor dimension) [ 14 ]. Magnetic resonance imaging (MRI) is now becoming the most widely used modality in the workup for RB staging and assessment prior to primary enucleation [ 15 ]. To detect risk factors for metastasis, MRI is a helpful tool but not as reliable as histopathology, where microscopic infiltration is best detected [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Many studies have been published correlating the clinical and MRI features in relation to RB high risk features. [7,14,15] In the era of targeted therapy like intra-arterial chemotherapy, identification of these features was important because many eyes with advanced disease were salvaged with nonsurgical treatment. [6] The combined clinical and MRI features could predict high-risk RB, while ICRB and/or Reese-Ellworth classifications alone provided limited correlation with high-risk RB.…”

Section: Discussionmentioning

confidence: 99%

“…[14] Magnetic resonance imaging (MRI) is now becoming the most widely used modality in the workup for RB staging and assessment prior to primary enucleation. [15] To detect risk factors for metastasis, MRI is a helpful tool but not as reliable as histopathology, where microscopic infiltration is best detected. [11] Generally, the role of MRI in RB assessment includes: determination of the growth pattern, extension of the ON involvement, detection of orbital and/or meningeal extension, and the presence of second tumors.…”

Section: Introductionmentioning

confidence: 99%

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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“…[12] Magnetic resonance imaging (MRI) is now becoming the most widely used modality in the workup for RB staging and assessment prior to primary enucleation. [13] To detect risk factors for metastasis, MRI is a helpful tool but not as reliable as histopathology, where microscopic infiltration is best detected. [11] Generally, the role of MRI in RB assessment includes: determination of the growth pattern, extension of the ON involvement, detection of orbital and/or meningeal extension, and the presence of second tumors.…”

Section: Introductionmentioning

confidence: 99%

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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Magnetic resonance imaging for tumor restaging after chemotherapy in retinoblastoma with optic nerve invasion

Abstract: MRI is a valuable tool for restaging of retinoblastoma and predicting residual optic nerve disease after neoadjuvant chemotherapy. Combined thickening and enhancement on MRI appeared to be a more reliable indicator of post-laminar invasion as compared to thickening or enhancement alone.

Cited by 7 publications

References 21 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.

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

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