Neuropathology Training Worldwide—Evolution and Comparisons

Bigio, Marc R. Del; Hainfellner, Johannes A.; McLean, Catriona; Powell, Suzanne Zein-Eldin; Sikorska, Beata; Takahashi, Hitoshi; Weis, Joachim; Xuereb, John H.

doi:10.1111/bpa.12104

Cited by 9 publications

(3 citation statements)

References 104 publications

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“…Here, a control group of patients receiving targeted therapies without previous surgery for tissue sampling may help address this confounding factor. We also acknowledge that this is a highly advanced and individualized approach that is not readily available in other regions or healthcare systems, and therefore has wide implications for the generalizability of this approach in an international setting and the standard of care that could be provided to these patients [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk–benefit analysis

Alhalabi,

Dao Trong,

Kaes

et al. 2024

J Neurooncol

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Purpose Surgery for recurrent glioma provides cytoreduction and tissue for molecularly informed treatment. With mostly heavily pretreated patients involved, it is unclear whether the benefits of repeat surgery outweigh its potential risks. Methods Patients receiving surgery for recurrent glioma WHO grade 2–4 with the goal of tissue sampling for targeted therapies were analyzed retrospectively. Complication rates (surgical, neurological) were compared to our institutional glioma surgery cohort. Tissue molecular diagnostic yield, targeted therapies and post-surgical survival rates were analyzed. Results Between 2017 and 2022, tumor board recommendation for targeted therapy through molecular diagnostics was made for 180 patients. Of these, 70 patients (38%) underwent repeat surgery. IDH-wildtype glioblastoma was diagnosed in 48 patients (69%), followed by IDH-mutant astrocytoma (n = 13; 19%) and oligodendroglioma (n = 9; 13%). Gross total resection (GTR) was achieved in 50 patients (71%). Tissue was processed for next-generation sequencing in 64 cases (91%), and for DNA methylation analysis in 58 cases (83%), while immunohistochemistry for mTOR phosphorylation was performed in 24 cases (34%). Targeted therapy was recommended in 35 (50%) and commenced in 21 (30%) cases. Postoperatively, 7 patients (11%) required revision surgery, compared to 7% (p = 0.519) and 6% (p = 0.359) of our reference cohorts of patients undergoing first and second craniotomy, respectively. Non-resolving neurological deterioration was documented in 6 cases (10% vs. 8%, p = 0.612, after first and 4%, p = 0.519, after second craniotomy). Median survival after repeat surgery was 399 days in all patients and 348 days in GBM patients after repeat GTR. Conclusion Surgery for recurrent glioma provides relevant molecular diagnostic information with a direct consequence for targeted therapy under a reasonable risk of postoperative complications. With satisfactory postoperative survival it can therefore complement a multi-modal glioma therapy approach.

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Section: Discussionmentioning

confidence: 99%

Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk–benefit analysis

Alhalabi,

Dao Trong,

Kaes

et al. 2024

J Neurooncol

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“…Although neuropathology is not recognized in France as a primary specialty, unlike in other countries in Europe and America, Pitié‐Salpêtrière laboratory remains a pivot between neurology, neurosurgery, pathology and neuroscience. This privileged situation gives it national and international visibility.…”

Section: Present and Prospect: Neuropathology And Neurosciencesmentioning

confidence: 99%

Neuropathology in Pitié‐Salpêtrière hospital: Past, present and prospect

Seilhean

2019

Neuropathology

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Pitié and La Salpêtrière, both founded in the17th century, were for long two distinct hospitals until they merged in 1964. The name La Salpêtrière is inherited from the initial purpose of the buildings designed to produce saltpeter for gun powder. But the place was soon transformed into an asylum to shelter the poor and the insane. From the care of this underprivileged population, alienists such as Pinel have paved the way for modern medicine for the mentally ill at the time of the French Revolution. In the second half of the 19th century, Jean-Martin Charcot and his students laid the foundations of modern neurology from the observation of the large population hosted in La Salpêtrière, mostly women with severe chronic diseases. Charcot led clinicopathological studies in almost all the fields of nervous system disorders. His successors (including Raymond, Dejerine, Pierre Marie) maintained the same close relationship between clinical neurology and neuropathology. In parallel with the development of neurosurgery at Pitié hospital, neuropathology first spread through small laboratories attached to clinical departments. The merger of the two hospitals in the early '60s coincided with the creation of a large university hospital in which the care and study of diseases of the nervous system were preponderant. An independent laboratory of neuropathology was created, led by Raymond Escourolle. This period was on the eve of important developments in neuroscience around the world. Today, the Pitié-Salpêtrière neuropathology laboratory still plays a central role between neurology and neurosurgery clinics and major research institutes such as the Brain Institute, callled Institut du Cerveau et de la Moelle (ICM), and the Institute of Myology.

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“…Expert intraoperative diagnostic interpretation for pituitary surgery is limited for several reasons. Most importantly, expert neuropathologists are unevenly distributed both within the United States and globally 19 . An estimated 40% of neuropathology fellowships in the US are vacant, leaving many neurosurgical centers without subspecialty expertise 20 .…”

Section: Introductionmentioning

confidence: 99%

Development and prospective validation of an artificial intelligence-based smartphone app for rapid intraoperative pituitary adenoma identification

Bou-Nassif,

Reiner,

Pease

et al. 2024

Commun Med

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Background Intraoperative pathology consultation plays a crucial role in tumor surgery. The ability to accurately and rapidly distinguish tumor from normal tissue can greatly impact intraoperative surgical oncology management. However, this is dependent on the availability of a specialized pathologist for a reliable diagnosis. We developed and prospectively validated an artificial intelligence-based smartphone app capable of differentiating between pituitary adenoma and normal pituitary gland using stimulated Raman histology, almost instantly. Methods The study consisted of three parts. After data collection (part 1) and development of a deep learning-based smartphone app (part 2), we conducted a prospective study that included 40 consecutive patients with 194 samples to evaluate the app in real-time in a surgical setting (part 3). The smartphone app’s sensitivity, specificity, positive predictive value, and negative predictive value were evaluated by comparing the diagnosis rendered by the app to the ground-truth diagnosis set by a neuropathologist. Results The app exhibits a sensitivity of 96.1% (95% CI: 89.9–99.0%), specificity of 92.7% (95% CI: 74–99.3%), positive predictive value of 98% (95% CI: 92.2–99.8%), and negative predictive value of 86.4% (95% CI: 66.2–96.8%). An external validation of the smartphone app on 40 different adenoma tumors and a total of 191 scanned SRH specimens from a public database shows a sensitivity of 93.7% (95% CI: 89.3–96.7%). Conclusions The app can be readily expanded and repurposed to work on different types of tumors and optical images. Rapid recognition of normal versus tumor tissue during surgery may contribute to improved intraoperative surgical management and oncologic outcomes. In addition to the accelerated pathological assessments during surgery, this platform can be of great benefit in community hospitals and developing countries, where immediate access to a specialized pathologist during surgery is limited.

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Neuropathology Training Worldwide—Evolution and Comparisons

Cited by 9 publications

References 104 publications

Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk–benefit analysis

Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk–benefit analysis

Neuropathology in Pitié‐Salpêtrière hospital: Past, present and prospect

Development and prospective validation of an artificial intelligence-based smartphone app for rapid intraoperative pituitary adenoma identification

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