How 'Sturgeon' guides the surgeon in pediatric neuro-oncology.

BACKGROUND: Central nervous system (CNS) tumors represent the leading cause of pediatric cancer-related deaths. Primary treatment often involves neurosurgical tumor resection. Accurate diagnosis is crucial to perform the best-suited extent of resection. Recently, we published Sturgeon, an AI-based validated intraoperative nanopore sequencing tool, delivering accurate methylation-based diagnoses during surgery. Although several other nanopore sequencing strategies have been described, clear evidence of clinical impact remains critically absent. Here, we report a care evaluation analyzing the impact of Sturgeon on real-time pediatric neurosurgical decision-making. METHODS: Since May 2023, a dual diagnostic neuro-oncological workflow incorporating intraoperative frozen section analyses and ultra-fast nanopore sequencing using Sturgeon has been fully implemented as standard of care at the Princess Máxima Center for Pediatric Oncology in the Netherlands. This intraoperative diagnostic workflow has been applied to all pediatric patients (<19 years of age) with primary CNS tumors and the multidisciplinary indication for tumor resection surgery. RESULTS: Sturgeon delivered correct diagnoses in 82 out of 94 consecutive patients (87.2%, <90 minutes), no diagnosis in 11.7% and one incorrect diagnosis (1.1%). The diagnosis obtained by Sturgeon supported the intended surgical strategy (85.7%) or changed the strategy (14.3%) toward a more aggressive or limited resection. This contributed to a low complication rate and less second-look surgeries. Earlier communication of the histomolecular diagnosis to patients and their families was observed. CONCLUSIONS: Intraoperative use of Sturgeon provides essential guidance toward the most optimal neurosurgical strategy for pediatric CNS tumors and thereby has great potential to contribute to better clinical outcome.