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Biopsy of diffuse midline glioma is safe and impacts targeted therapy: a systematic review and meta-analysis

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Abstract

Purpose

To quantify the safety and utility of biopsy of pediatric diffuse midline glioma (DMG).

Methods

This study was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were queried for relevant articles from inception until June 2023. Two reviewers identified all articles that included diagnostic yield, morbidity, and mortality rates for pediatric DMG patients. Studies that did not present original data or were not in English or peer-reviewed were excluded. Meta-analysis was conducted in R using Freeman-Tukey or logit transformation and DerSimonian-Laird random-effects models. The risk of bias was assessed using the Newcastle–Ottawa Scale. A protocol for this review was not registered.

Results

We identified 381 patients from ten studies that met all criteria. DMG biopsy is safe overall (0% mortality, 95% CI: 0–0.6%; 11.0% morbidity, 95% CI: 4.8–18.9%) and has a high diagnostic yield (99.9%, 95% CI: 98.5–100%). The use of stereotactic biopsy is a significant moderator of morbidity (p = 0.0238). Molecular targets can be identified in approximately 53.4% of tumors (95% CI: 37.0–69.0%), although targeted therapies are only delivered in about 33.5% of all cases (95% CI: 24.4–44.1%). Heterogeneity was high for morbidity and identification of targets. The risk of bias was low for all studies.

Conclusion

We conducted the first meta-analysis of DMG biopsy to show that it is safe, effective, and able to identify relevant molecular targets that impact targeted therapy.

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Data availability

The extracted data has been included with the supplementary materials.

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Author information

Authors and Affiliations

  1. Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, NJ, USA

    Allen Y. Fu & Anisha Srinivasan

  2. Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA

    Allen Y. Fu, Yug Yadava, Catherine A. Mazzola & Adam Ammar

  3. Department of Public Health, Rutgers University, New Brunswick, NJ, USA

    Jay Kavia

  4. Department of Biology, Rowan University, Glassboro, NJ, USA

    Yug Yadava

  5. Robert Wood Johnson Library of the Health Sciences, The State University of New Jersey, RutgersNew Brunswick, NJ, USA

    Pam Hargwood

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  1. Allen Y. Fu
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Contributions

A.A. conceived the study. A.Y.F. and P.H. prepared the search query. A.Y.F., Y.Y., and J.K. conducted the review process. A.Y.F. and A.S. conducted the risk of bias assessment. A.Y.F. conducted all analyses, prepared all figures and tables, and wrote the main manuscript. C.A.M. and A.A. critically revised the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Allen Y. Fu.

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Fu, A.Y., Kavia, J., Yadava, Y. et al. Biopsy of diffuse midline glioma is safe and impacts targeted therapy: a systematic review and meta-analysis. Childs Nerv Syst 40, 625–634 (2024). https://doi.org/10.1007/s00381-023-06208-4

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  • DOI: https://doi.org/10.1007/s00381-023-06208-4

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