The value of experience is not in seeing much but in seeing wisely

摘要

Non-maleficence (do no harm) and beneficence (do good) are two of the most widely recognized principles guiding cancer care and health care in general. I postulate that in the care of those with CNS tumors, defining the approach to meet these standards is still being discovered. Four papers in this issue address this in relation to understanding prognostic variables and the impact of care. Manias and colleagues report on the added benefit in terms of diagnostic accuracy and inter-rater reliability between 3 radiologists in a sample of 52 children presenting to a tertiary care center in which single-voxel MRI was added to standard imaging. A delay in diagnosis of 9.5 days was associated with this approach. Morell and colleagues review the diagnostic yield of cerebrospinal fluid sampling, a diagnostic test often performed prior to submitting the patient to biopsy for suspected CNS lymphoma. They report that diagnostic yield of cerebrospinal fluid sampling is exceedingly low, with less than 10% obviating the need for biopsy, and biopsy leading to diagnosis in 92% with low morbidity. They suggest that proceeding to biopsy may have low risk and reduce the time to diagnosis for the majority of patients. Behbahani and colleagues review through a prospective study at their institution the natural history of those with incidentally identified meningioma. Surprisingly, in 60% of the 64 patients in their study, the tumor demonstrated a self-limiting growth pattern, and none developed tumor-related symptoms. This study provides level 2 evidence for the use of serial surveillance for these patients. Finally, there are increasing reports of differences in survival based on sex in glioblastoma (GBM). Gittleman and colleagues evaluated this both in GBM (grade IV) and non-GBM (grade II-III) patients in the Central Brain Tumor Registry of the United States database, including more than 5000 patients, and found this advantage occurs only in those with GBM. Importantly, isocitrate dehydrogenase (IDH) status of these tumors are not available to further understand these findings but lend support to the differences among patients with GBM.