Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic re

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Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis Gianluca Trevisi 1

&

Paolo Barbone 1 & Giorgio Treglia 2,3,4 & Maria Vittoria Mattoli 5 & Annunziato Mangiola 1,5

Received: 3 June 2019 / Revised: 28 July 2019 / Accepted: 5 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract Intraoperative ultrasonography (iUS) is considered an accurate, safe, and cost-effective tool to estimate the extent of resection of both high-grade (HGG) and low-grade (DLGG) diffuse gliomas (DGs). However, it is currently missing an evidence-based assessment of iUS diagnostic accuracy in DGs surgery. The objective of review is to perform a systematic review and meta-analysis of the diagnostic performance of iUS in detecting tumor residue after DGs resection. A comprehensive literature search for studies published through October 2018 was performed according to PRISMADTA and STARD 2015 guidelines, using the following algorithm: (“ultrasound” OR “ultrasonography” OR “ultra-so*” OR “echo*” OR “eco*”) AND (“brain” OR “nervous”) AND (“tumor” OR “tumour” OR “lesion” OR “mass” OR “glio*” OR “GBM”) AND (“surgery” OR “surgical” OR “microsurg*” OR “neurosurg*”). Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), and diagnostic odds ratio (DOR) of iUS in DGs were calculated. A subgroup analysis for HGGs and DLGGs was also conducted. Thirteen studies were included in the systematic review (665 DGs). Ten articles (409 DGs) were selected for the meta-analysis with the following results: sensitivity 72.2%, specificity 93.5%, LR− 0.29, LR+ 3, and DOR 9.67. Heterogeneity among studies was non-significant. Subgroup analysis demonstrates a better diagnostic performance of iUS for DLGGs compared with HGGs. iUS is an effective technique in assessing DGs resection. No significant differences are seen regarding iUS modality and transducer characteristics. Its diagnostic performance is higher in DLGGs than HGGs and could be worsened by previous treatments, surgical artifacts, and small tumor residue volumes. Keywords Diffuse glioma . Extent of resection . High-grade glioma . Intraoperative ultrasound . Low-grade glioma . Residual tumor

Introduction * Gianluca Trevisi [email protected] 1

Neurosurgical Unit, Presidio Ospedaliero Santo Spirito, Via Fonte Romana, 8, 65124 Pescara, Italy

2

Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

3

Imaging Institute of Southern Switzerland, Bellinzona and Lugano, Lugano, Switzerland

4

Nuclear Medicine and Molecular Imaging, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland

5

Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy

Diffuse gliomas (DGs), namely astrocytomas, oligodendrogliomas, and oligoastrocytomas (the latter diagnosis currently strongly discouraged) WHO grade II (diffuse lowgrade gliomas—D