Improved Prediction of Surgical Resectability in Patients with Glioblastoma using an Artificial Neural Network

In managing a patient with glioblastoma (GBM), a surgeon must carefully consider whether sufficient tumour can be removed so that the patient can enjoy the benefits of decompression and cytoreduction, without impacting on the patient's neurological status. In a previous study we identified the five most important anatomical features on a pre-operative MRI that are predictive of surgical resectability and used them to develop a simple, objective, and reproducible grading system. The objective of this study was to apply an artificial neural network (ANN) to improve the prediction of surgical resectability in patients with GBM. Prospectively maintained databases were searched to identify adult patients with supratentorial GBM that underwent craniotomy and resection. Performance of the ANN was evaluated against logistic regression and the standard grading system by analysing their Receiver Operator Characteristic (ROC) curves; Area Under Curve (AUC) and accuracy were calculated and compared using Wilcoxon signed rank test with a value of p < 0.05 considered statistically significant. In all, 135 patients were included, of which 33 (24.4%) were found to have complete excision of all contrast-enhancing tumour. The AUC and accuracy were significantly greater using the ANN compared to the standard grading system (0.87 vs. 0.79 and 83% vs. 80% respectively; p < 0.01 in both cases). In conclusion, an ANN allows for the improved prediction of surgical resectability in patients with GBM.