gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Preoperative predictors of malignancy in non-enhancing glioma in the era of molecular classification

Identifikation präoperativer Prädiktoren für Malignität in nicht-Kontrastmittel-aufnehmenden Gliomen unter Berücksichtigung der neuen WHO Klassifikation

Meeting Abstract

  • presenting/speaker Philip Dao Trong - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Jessica Jesser - Universitätsklinikum Heidelberg, Neuroradiologie, Heidelberg, Deutschland
  • Andreas von Deimling - Universitätsklinikum Heidelberg, Neuropathologie, Heidelberg, Deutschland
  • Samuel Kilian - Universität Heidelberg, Institut für medizinische Biometrie und Informatik, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Christine Jungk - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV024

doi: 10.3205/19dgnc024, urn:nbn:de:0183-19dgnc0247

Veröffentlicht: 8. Mai 2019

© 2019 Dao Trong et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: The association of contrast enhancement (CE) with malignancy in glioma is widely accepted. A higher grade of uncertainty exists for preoperative grading of non-enhancing (NE) tumors. Prior studies have pointed out, that CE alone is not able to distinguish between higher and lower grade glioma, since up to 40% of higher grade glioma do not enhance. Here, we sought to reevaluate tumor grading of non-enhancing glioma in light of the 2016 revision of the WHO classification and analyzed clinical data and radiographic features which might predict WHO grading or IDH mutation status.

Methods: Out of 626 consecutive patients, 72 with non-enhancing supratentorial glioma were identified who underwent first surgery in our department from 2012 to 2017. Tumors were graded on the basis of histopathological and molecular criteria according to the revised WHO classification of 2016. Radiographic features (T2/FLAIR mismatch sign, subventricular zone (SVZ) involvement, preoperative tumor volume, growth rate) and clinical data (age, Pignatti risk score, presenting symptoms) were used for univariate logistic regression analysis to identify preoperative predictors of malignancy.

Results: 75% (54) of patients in which preoperative MRI suggested a lower-grade glioma were indeed classified as WHO° III or IV. 57% (41) of the patients were IDH mutated (mut) and 43% (31) IDH wildtype (wt). Malignancy was stratified by two different grading systems: 1. WHO grade (WHO°II vs. WHO°III+IV) and 2. molecular criteria (IDHmut WHO°II+III (lower grade) vs. IDHwt WHO°II-IV+IDHmut WHO°IV (higher grade)). In the univariate logistic regression model clinical and radiographic features (age, Pignatti risk score, involvement of the SVZ, T2/FLAIR mismatch) were able to predict malignancy only when considering molecular grading as compared to the traditional WHO grading system (age: p<0.0001, Pignatti: p<0.0001, involvement of the SVZ: p=0.01, T2/FLAIR mismatch sign: p<0.0001).

Conclusion: In this series, 46-75% of all non-enhancing gliomas were classified as malignant depending on the grading system. But more importantly, clinical and radiographic features were able to predict malignancy only when considering molecular grading as compared to the traditional WHO grading system.