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, Zoher Ghogawala, Guy McKhann

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 ofthe use ofthe collectivewisdom 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- A nd 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 signifcantly (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.

Original languageEnglish (US)
Pages (from-to)590-601
Number of pages12
JournalNeurosurgery
Volume80
Issue number4
DOIs
StatePublished - Jan 1 2017

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Glioblastoma
Crowdsourcing
Clinical Trials
Residual Neoplasm
Brain Neoplasms
Decision Making
Magnetic Resonance Spectroscopy
Communication
Medicine
Biopsy
Surgeons
Neoplasms
Neurosurgeons

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Sonabend, A. M., Zacharia, B. E., Cloney, M. B., Sonabend, A., Showers, C., Ebiana, V., ... McKhann, G. (2017). 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
Sonabend, Adam M. ; Zacharia, Brad E. ; Cloney, Michael B. ; Sonabend, Aarón ; Showers, Christopher ; Ebiana, Victoria ; Nazarian, Matthew ; Swanson, Kristin R. ; Baldock, Anne ; Brem, Henry ; Bruce, Jeffrey N. ; Butler, William ; Cahill, Daniel P. ; Carter, Bob ; Orringer, Daniel A. ; Roberts, David W. ; Sagher, Oren ; Sanai, Nader ; Schwartz, Theodore H. ; Silbergeld, Daniel L. ; Sisti, Michael B. ; Thompson, Reid C. ; Waziri, Allen E. ; Ghogawala, Zoher ; McKhann, Guy. / Defining glioblastoma resectability through the wisdom of the crowd : A proof-of-principle study. In: Neurosurgery. 2017 ; Vol. 80, No. 4. pp. 590-601.
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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 ofthe use ofthe collectivewisdom 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- A nd 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 signifcantly (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.",
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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, Ghogawala, Z & McKhann, G 2017, '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

Defining glioblastoma resectability through the wisdom of the crowd : A proof-of-principle study. / Sonabend, Adam M.; Zacharia, Brad E.; Cloney, Michael B.; Sonabend, Aarón; Showers, Christopher; Ebiana, Victoria; Nazarian, Matthew; Swanson, Kristin R.; Baldock, Anne; Brem, Henry; Bruce, Jeffrey N.; Butler, William; Cahill, Daniel P.; Carter, Bob; Orringer, Daniel A.; Roberts, David W.; Sagher, Oren; Sanai, Nader; Schwartz, Theodore H.; Silbergeld, Daniel L.; Sisti, Michael B.; Thompson, Reid C.; Waziri, Allen E.; Ghogawala, Zoher; McKhann, Guy.

In: Neurosurgery, Vol. 80, No. 4, 01.01.2017, p. 590-601.

Research output: Contribution to journalArticle

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 - Ghogawala, Zoher

AU - McKhann, Guy

PY - 2017/1/1

Y1 - 2017/1/1

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 ofthe use ofthe collectivewisdom 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- A nd 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 signifcantly (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.

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 ofthe use ofthe collectivewisdom 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- A nd 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 signifcantly (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.

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