Article
CNS invasion in meningioma – detection by the surgeon and pathologist and its prognostic value
ZNS Invasion in Meningeomen – die intraoperative und histopathologische Detektion und ihre prognostische Wertigkeit
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Published: | June 4, 2021 |
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Objective: CNS invasion in meningiomas has been included in the current WHO classification as a sign of atypia. However, its prognostic value has been challenged and discussed. The histopathological detection is highly dependent from the surgical sampling, which is not always feasible from all areas of interest. Therefore the intraoperative assessment of invasive growth may be of additive prognostic value.
Methods: A comparative analysis of the prognostic impact of the intraoperative and histopathological detection of CNS invasion was done. Clinical data of 1517 cases with follow up data regarding radiographic recurrence was reviewed.
Results: Invasive growth was seen during resection in 23.7%(n=345) while histopathology detected it in 4.8%(n=73). The histopathological and intraoperative assessments were compatible in 63%. The prognostic impact of histopathological and intraoperative assessment was significant in the univariate but not in the multivariate analysis. Both methods of assessment combined reached statistical significance in the multivariate analysis (p=0.0409). A score including all independent prognostic factors divided the cohort into three prognostic subgroups with a risk of recurrence of 33.8%, 64.7% and 88.5% respectively.
Conclusion: The intraoperative detection of infiltrative growth of primary meningiomas into central nervous system tissue can complement the histopathological assessment of CNS invasion. The combined assessment is an independent prognostic factor regarding tumor recurrence and allows a risk-adapted tumor stratification.