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J Neurol Surg B Skull Base
DOI: 10.1055/a-2531-2230
Original Article

Multi-Institutional Modified Delphi For Genomics in Expert Consensus Survey of Genomic Testing for Anterior Skull Base Malignancies

Authors

  • Anirudh Saraswathula

    1   Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

  • Shreya Sriram 

    1   Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

  • Corinna Levine

    2   Department of Otolaryngology–Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida, United States

  • Nyall R. London Jr.

    1   Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

  • Shirley Y. Su

    3   Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

  • Mathew Geltzeiler

    4   Department of Otolaryngology–Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, United States

  • Sanjeet V. Rangarajan

    5   Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Nashville, Tennessee, United States

  • Ian Witterick 

    6   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada

  • Brian Thorp

    7   Department of Otolaryngology–Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States

  • Kathleen Kelly Gallagher

    8   Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States

  • Kenneth Byrd

    9   Department of Otolaryngology–Head and Neck Surgery, Augusta University, Augusta, Georgia, United States

  • Ricardo Carrau

    10   Department of Otolaryngology–Head and Neck Surgery, Ohio State University School of Medicine, Columbus, Ohio, United States

  • Waleed Abuzeid

    11   Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States

  • Eric Wang

    12   Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

  • Carl Snyderman 

    12   Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

  • Erin L. McKean

    13   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States

Funding A.S. was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health (T32DC000027).
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Abstract

Objectives

The use of genomic testing for patients with anterior skull base malignancies has grown dramatically. There are no clear guidelines on indications for testing. As the literature on the subject is still in early stages, there is a need for expert consensus. We conducted a modified Delphi expert consensus process with high-volume North American cranial base surgical programs.

Design, Setting, Participants

A modified Delphi consensus approach was used, following the method laid out by the American Academy of Otolaryngology-Head and Neck Surgery, and included 13 high-volume care centers. An otolaryngologist was appointed at each location to serve as the institutional representative.

Main Outcome Measures

Participant responses to Delphi surveys were tabulated to determine consensus.

Results

Thirteen teams responded comprising 23 otolaryngologists and 10 neurosurgeons. Overall, 11 of 12 institutions reported genomic testing to be fairly or easily available at their location, and 22 of 38 initial statements achieved consensus. Statements achieving consensus focused on primary and recurrent rare tumors without possibility of margin-negative resection, those with family history of anterior skull base malignancies, or rare tumors with distant metastasis. Statements regarding routine genomic sequencing or for primary tumors and cost of care did not achieve consensus.

Conclusions

Expert multidisciplinary teams agreed on several appropriate settings for genomic sequencing in patients with anterior skull base malignancies, including recurrence, distant metastasis, and the inability to achieve a margin-negative resection. Further research is needed to explicitly clarify the role of genomic sequencing in this rare disease group.

Keywords

anterior skull base - genomic testing - Delphi - consensus

Supplementary Material



Publication History

Received: 16 May 2024

Accepted: 02 February 2025

Article published online:
04 March 2025

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