title: Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study.
abstract: 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.
  
  
  
  To provide proof of concept of the use of the collective wisdom of experienced brain tumor surgeons in assessing glioblastoma resectability.
  
  
  
  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- and 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.
  
  
  
  Neurosurgeons' individual surgical goals varied significantly ( 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.
  
  
  
  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.
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Adam M
authors: AM
authors: Sonabend
authors: Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Brad E
authors: BE
authors: Zacharia
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Michael B
authors: MB
authors: Cloney
authors: Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors: Aarón
authors: A
authors: Sonabend
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Christopher
authors: C
authors: Showers
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Victoria
authors: V
authors: Ebiana
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Matthew
authors: M
authors: Nazarian
authors: Department of Neurological Surgery, Mayo Clinic, Scottsdale, Arizona.
authors: Kristin R
authors: KR
authors: Swanson
authors: University California at San Diego School of Medicine, San Diego, California.
authors: Anne
authors: A
authors: Baldock
authors: Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Henry
authors: H
authors: Brem
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Jeffrey N
authors: JN
authors: Bruce
authors: Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: William
authors: W
authors: Butler
authors: Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Daniel P
authors: DP
authors: Cahill
authors: Division of Neurosurgery, Department of Surgery, University California at San Diego School of Medicine, San Diego, California.
authors: Bob
authors: B
authors: Carter
authors: Department of Neurological Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors: Daniel A
authors: DA
authors: Orringer
authors: Division of Neurosurgery, Dartmouth University, Lebanon, New Hampshire.
authors: David W
authors: DW
authors: Roberts
authors: Department of Neurological Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors: Oren
authors: O
authors: Sagher
authors: Division of Neurosurgical Oncology, Barrow Neurological Institute, Phoenix, Arizona.
authors: Nader
authors: N
authors: Sanai
authors: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Theodore H
authors: TH
authors: Schwartz
authors: Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.
authors: Daniel L
authors: DL
authors: Silbergeld
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Michael B
authors: MB
authors: Sisti
authors: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Reid C
authors: RC
authors: Thompson
authors: Inova Neuroscience Institute, Falls Church, Virginia.
authors: Allen E
authors: AE
authors: Waziri
authors: Alan and Jacqueline Stuart Spine Research Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors: Zoher
authors: Z
authors: Ghogawala
authors: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York.
authors: Guy
authors: G
authors: McKhann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D010865:Pilot Projects
keywords: Crowdsourcing; EOR; Extent of resection; Glioblastoma; Glioma; Resectability