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Biopsy in diffuse pontine gliomas: expert neurosurgeon opinion—a survey from the SIOPE brain tumor group

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Abstract

Introduction

The prognosis of diffuse intrinsic pontine glioma (DIPG) is poor. The role of biopsy in DIPG remains controversial since the diagnosis may be established with imaging alone. Recent advances in understanding molecular biology and targeting of brain tumors have created a renewed interest in biopsy for DIPG. The Neurosurgery Working Group (NWG) of the SIOP-Europe Brain Tumor Group (BTG) undertook a survey among international pediatric neurosurgeons to define their current perceptions and practice regarding DIPG biopsy.

Methods

The NWG developed a 20-question survey which was emailed to neurosurgeons in the International Society for Pediatric Neurosurgery (ISPN). The questionnaire included questions on diagnosis, indications, and techniques for biopsy, clinical trials, and healthcare infrastructure.

Results

The survey was sent to 202 neurosurgeons and 73 (36%) responded. Consensus of > 75% agreement was reached for 12/20 questions, which included (1) radiological diagnosis of DIPG is sufficient outside a trial, (2) clinical trial–based DIPG biopsy is justified if molecular targets are investigated and may be used for treatment, and (3) morbidity/mortality data must be collected to define the risk:benefit ratio. The remaining 8/20 questions proved controversial and failed to reach consensus.

Conclusions

Routine DIPG biopsy continues to be debated. Most neurosurgeons agreed that DIPG biopsy within a clinical trial should be supported, with the aims of defining the procedure risks, improving understanding of tumor biology, and evaluating new treatment targets. Careful family counseling and consent remain important.

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Authors and Affiliations

  1. Department of Neurosurgery, IIS-Fundación Jimenez Diaz-UAM, Hospital Fundación Jiménez Díaz, Grupo Quirón, Madrid, Spain

    Sonia Tejada

  2. Neurosurgery Department, Great Ormond Street Hospital, London, UK

    Kristian Aquilina

  3. Neurosurgery Department, Leeds General Infirmary, Leeds, UK

    John Goodden

  4. Neurosurgery Department, Alder Hey Children’s NHS Foundation, Liverpool, UK

    Benedetta Pettorini & Conor Mallucci

  5. Neurosurgery Department, Erasmus University Medical Center, Rotterdam, Netherlands

    Marie Lise van Veelen

  6. Department of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany

    Ulrich-W. Thomale

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  1. Sonia Tejada
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  2. Kristian Aquilina
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  3. John Goodden
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  4. Benedetta Pettorini
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  6. Marie Lise van Veelen
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  7. Ulrich-W. Thomale
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Correspondence to Sonia Tejada.

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Tejada, S., Aquilina, K., Goodden, J. et al. Biopsy in diffuse pontine gliomas: expert neurosurgeon opinion—a survey from the SIOPE brain tumor group. Childs Nerv Syst 36, 705–711 (2020). https://doi.org/10.1007/s00381-020-04523-8

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  • DOI: https://doi.org/10.1007/s00381-020-04523-8

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