Perioperative imaging predictors of tumor progression and pseudoprogression: a systematic review.

in Critical reviews in oncology/hematology by Giovanni Librizzi, Giuseppe Lombardi, Alessandra Bertoldo, Renzo Manara

TLDR

  • The study looked at images of people with a type of brain tumor called high-grade gliomas before and after radiation treatment. They wanted to see if there were any patterns in the images that could predict whether someone would have a type of progression called pseudoprogression. However, the study found that the patterns were not very clear and that more research is needed to find better predictors.

Abstract

In high-grade gliomas, pseudoprogression after radiation treatment might dramatically impact patient's management. We searched for perioperative imaging predictors of pseudoprogression in high-grade gliomas according to PRISMA guidelines, using MEDLINE/Pubmed and Embase (until January 2024). Study design, sample size, setting, diagnostic gold standard, imaging modalities and contrasts, and differences among variables or measures of diagnostic accuracy were recorded. Study quality was assessed through the QUADAS-2 tool. Twelve studies (11 with MRI, one with PET; 1058 patients) were reviewed. Most studies used a retrospective design (9/12), and structural MRI (7/12). Studies were heterogeneous in metrics and diagnostic reference standards; patient selection bias was a frequent concern. Pseudoprogression and progression showed some significant group differences in perioperative imaging metrics, although often with substantial overlap. Radiomics showed moderate accuracy but requires further validation. Current literature is scarce and limited by methodological concerns, highlighting the need of new predictors and multiparametric approaches.

Overview

  • The study aimed to identify perioperative imaging predictors of pseudoprogression in high-grade gliomas using MEDLINE/Pubmed and Embase databases until January 2024. The study design was retrospective, and the sample size was 1058 patients. The diagnostic gold standard was structural MRI, and the imaging modalities and contrasts used were MRI and PET. The study quality was assessed using the QUADAS-2 tool. The primary objective of the study was to identify imaging predictors of pseudoprogression in high-grade gliomas.

Comparative Analysis & Findings

  • The study found that pseudoprogression and progression showed some significant group differences in perioperative imaging metrics, although often with substantial overlap. Radiomics showed moderate accuracy but requires further validation. The study highlights the need for new predictors and multiparametric approaches.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice, as they provide insights into the predictors of pseudoprogression in high-grade gliomas. The study's limitations include methodological concerns, which highlight the need for new predictors and multiparametric approaches. Future research directions could focus on developing new predictors and improving the accuracy of existing ones.
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