Preoperative Detection of Local Tumor Extent in Patients with Advanced Retinoblastoma: Predictive Value of MRI and Clinical Findings

Abstract

Objective Before planned enucleation, local tumor extension in advanced retinoblastoma is routinely assessed preoperatively using high-resolution magnetic resonance imaging (MRI). The aim of our study was to analyse the predictive value of MRI and clinical characteristics for predicting tumor extent, as confirmed by histopathology postoperatively.

Patients and Methods All consecutive patients were included who underwent primary enucleation for advanced retinoblastoma after high-resolution MRI examination in our hospital between January 2011 and December 2021. The primary study endpoint was the evaluation of the predictability of histopathological risk factors on preoperative MRI examination. The sensitivity and specificity of the MRI examination with respect to clinically relevant optic nerve infiltration and choroidal infiltration were determined.

Results The mean age of the 209 included patients was 1.6 years (range 1 month to 4.7 years). MRI indicated optic nerve infiltration in 46 (22%) patients, extensive choroidal infiltration in 78 (40.2%) patients, and scleral infiltration in one patient (2.6%). Histopathological examination demonstrated postlaminar optic infiltration in 25 (12%) patients and extensive choroidal infiltration in 17 (8.1%) cases. Scleral infiltration was evident in 8 (3.8%) patients. In the final multivariate analysis, MRI findings of tumor infiltration and a preoperative intraocular pressure ≥ 20 mmHg were independently associated with histopathological evidence of clinically relevant optic nerve (p = 0.033/p = 0.011) and choroidal infiltration (p = 0.005/p = 0.029). The diagnostic accuracy of the prediction models based on the multivariate analysis for the identification of the clinically relevant optic nerve (AUC = 0.755) and choroidal infiltration (AUC = 0.798) was greater than that of purely MRI-based prediction (respectively 0.659 and 0.742). The sensitivity and specificity of MRI examination for determining histopathological risk factors in our cohort were 64% and 65% for clinically relevant optic infiltration and 87% and 64% for clinically relevant choroidal infiltration.

Conclusion The local tumor extent of retinoblastoma with infiltration of the optic nerve and choroid can be well estimated based on radiological and clinical characteristics before treatment initiation. The combination of clinical and radiological risk factors supports the possibility of early treatment stratification in retinoblastoma patients.

Fazitbox

Wir konnten in vorliegender Studie zeigen, dass die hochauflösende MRT unter Verwendung von Orbitaspulen klinisch wertvoll für die Erkennung von metastatischen Hochrisikofaktoren bei Kindern mit Retinoblastom sein kann. Die Vorhersagbarkeit wird durch das Hinzuziehen klinischer Parameter weiter verbessert. Goldstandard bleibt aber bislang unverändert die histopathologische Analyse enukleierter Augen.

Bereits bekannt:

Die präoperative MRT mit Orbitaspule dient zur Detektion von Hochrisikofaktoren für eine Metastasierung und ist somit unabdingbar für die Therapieplanung (Einleitung einer neoadjuvanten Chemotherapie, Abschätzung des erforderlichen Operationsumfangs bei primärer Enukleation).

Neu beschrieben:

Die vorliegende Studie befasst sich mit der MRT-morphologischen Vorhersagbarkeit histopathologischer Risikofaktoren im Vergleich zu der postoperativ gewonnenen Histopathologie. Die Vorhersagbarkeit wird durch das Hinzuziehen klinischer Parameter weiter verbessert.

Key words

ocular tumors - pediatric ophthalmology - pathology

Publication History

Received: 24 April 2023

Accepted: 19 October 2023

Article published online:
22 December 2023

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