Dominique Simons

34 statements · 1 topic

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Neuroblastoma is a surgically challenging tumor to resect, and this is mainly due to the adhesion and encasement to important structures, the heterogeneity, and the therapy-induced changes.
quote · Neuroblastoma
So the goal for surgeons is to resect more than 95% of the tumor tissue while sparing those anatomical structures.
quote · Neuroblastoma

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Dominique's statements about Neuroblastoma 34 statements

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Dominique Simons, MSc - Best of the Best in Pediatric Surgery 2024

Quotation Neuroblastoma is a surgically challenging tumor to resect, and this is mainly due to the adhesion and encasement to important structures, the heterogeneity, and the therapy-induced changes. Open
Statement Neuroblastoma is surgically challenging to resect mainly due to adhesion and encasement to important structures, heterogeneity, and therapy-induced changes. Open
Quotation So the goal for surgeons is to resect more than 95% of the tumor tissue while sparing those anatomical structures. Open
Statement The surgical goal for neuroblastoma is to resect more than 95% of the tumor tissue while sparing anatomical structures. Open
Statement 3D models of patient-specific anatomy are routinely made to prepare surgeons for neuroblastoma resection. Open
Statement Complete resection of neuroblastoma is often very difficult or even impossible due to tumor location. Open
Statement Surgeons face a dilemma of whether to resect more tumor tissue with possible complications such as bleeding or to leave residual tumor tissue. Open
Quotation And this led to the question, can we actually distinguish vital from non-vital tumor tissue since the nerveoblastoma is so heterogeneous? Open
Statement Biology can be used as a biomarker for tumor vitality in neuroblastoma. Open
Statement In ADC imaging, diffusion restriction is associated with viable tumor tissue and appears as a low signal. Open
Statement In MIBG SPECT-CT imaging, high uptake is associated with viable tumor tissue. Open
Statement MIBG uptake and diffusion restriction in neuroblastoma change over time, suggesting the biology and vitality of the tumor may also change. Open
Statement ADC and MIBG scans have different 3D positions from T1-weighted MRI, requiring image registration. Open
Statement Registration accuracy is evaluated using the Dice coefficient (which measures overlap between two structures) and target registration error (which measures distance between two points). Open
Statement Risk group delineation uses ADC and MIBG values within the tumor volume with thresholds based on literature. Open
Statement High-risk areas in the 3D model are associated with diffusion restriction and MIBG uptake. Open
Statement Seven patients with abdominal neuroblastoma eligible for surgery were included prospectively. Open
Statement Multimodal 3D models were successfully created for every patient in the study. Open
Statement Median target registration error was 5.3 mm for ADC and 4.3 mm for MIBG. Open
Statement Accurate initial registration was achieved for all patients with a median Dice of 0.81 for ADC and 0.77 for MIBG. Open
Quotation We achieved an accurate initial registration for all patients with a median dies of 0.81 for the ADC and the median dies of 0.77 for the MIBG and the median target registration error was 5.3 for the ADC and 4.3 for MIBG and this allowed the creation of multi-modal 3D models for every patient. Open
Statement In some cases, ADC and MIBG risk models showed similar patterns, with the lateral side of the tumor marked as high risk and the medial side as low risk. Open
Statement In other cases, ADC and MIBG identified completely different regions as high risk (e.g., cranial part high-risk on ADC versus a different region on MIBG). Open
Quotation And this led to the question of whether these areas really predict what the literature suggests and this brings me to, uh, my future perspectives. Open
Statement The thresholds used for risk stratification are based on limited literature, which questions the reliability of the ADC and MIBG values used. Open
Quotation Uh, however, there are still some limitations as the thresholds are based on limited literature which questions the reliability of our ABC and MIBG values that we use and we should evaluate the accuracy of the models. Open
Statement The image registration is performed using Elastix software in programming environments such as Python or MATLAB. Open
Quotation Well, I've created it myself. So we do this with, um, basic image registration. There are some software tools available for this, but we use the main tool, uh, Elastics it's called, and you do this in program, uh, programming software such as Python or, um, MATLAB, uh, something like that, but there are multiple options. Open
Statement Segmentation of the neuroblastoma is the most time-consuming step; the actual registration takes only a few minutes. Open
Quotation Well, the main stubborn thing to do is to make the segmentation of the neuroblastoma. That's most of the time, uh, but actually the registration is about a few minutes. It's really quick. Open
Statement Simmons performs the 3D model creation herself with verification from radiologists, especially in early phases. Open
Quotation I mainly do it myself with the help of, of course, radiologists because I always check them with them. Um, you get better over time, of course, but especially in the first phases, I always check my models with the radiologist uh to make sure that I was correct. Open
Statement Current practice believes that MIBG-positive areas should be resected, but discordant ADC/MIBG findings suggest this may need re-evaluation. Open
Quotation And it's really interesting what you say about how this can possibly change because now we really believe that we should, uh, resect the MRBG positive area, but this shows that we may, maybe don't know. Open