Pobereskin L H, Chadduck J B
Department of Neurosurgery, Derriford Hospital, Plymouth PL6 8DH, UK.
J Neurol Neurosurg Psychiatry. 2000 Oct;69(4):464-71. doi: 10.1136/jnnp.69.4.464.
To define the incidence of brain tumours in Devon and Cornwall and to discover which case finding methods are the most fruitful. To examine what happens to patients after the diagnosis of a brain tumour.
The primary method of case ascertainment was a review of all CT with contrast and MRI of the head performed on the population of Devon and Cornwall between 1 April 1992 and 31 March 1997. Secondary sources included registrations with the South and West Cancer Intelligence Unit and a search for all patients either admitted to hospital with a brain tumour or operated on for a brain tumour during the same period.
16,923 scans were reviewed of which 8774 (52%) were normal. The scan review found 2483 incident intracranial tumours, of which 861 were metastases. Secondary sources of case ascertainment disclosed 46 further cases. Cases were missed by the scan review mainly for technical reasons and only three patients were found who were diagnosed by non-imaging methods. The incidence of primary intracranial tumours standardised to the population of England and Wales was higher than any previously reported (21.04 (17.18-25.62)/100,000 person-years). Overall, 21% of cases were not admitted to hospital. The categories least likely to be admitted were those with sellar and cranial nerve tumours. Those not admitted to hospital were significantly older than those who were.
One fifth of patients are not admitted to hospital after the diagnosis of a brain tumour and incidence studies must use case finding methods which will capture these cases. An audit of imaging results provides almost complete case ascertainment. This study shows that the incidence of primary brain tumours is considerably higher than previously thought. Official figures from the cancer intelligence units significantly underestimate brain tumour incidence, especially for benign tumours.
确定德文郡和康沃尔郡脑肿瘤的发病率，并找出哪种病例发现方法最有成效。研究脑肿瘤诊断后患者的情况。
病例确定的主要方法是回顾1992年4月1日至1997年3月31日期间德文郡和康沃尔郡人群进行的所有头部增强CT和MRI检查。二级来源包括向南部和西部癌症情报部门登记的信息，以及查找同期因脑肿瘤入院或接受脑肿瘤手术的所有患者。
共审查了16923份扫描，其中8774份（52%）正常。扫描审查发现2483例颅内新发肿瘤，其中861例为转移瘤。二级病例确定来源又发现了46例。扫描审查漏诊病例主要是技术原因，仅发现3例通过非成像方法诊断的患者。根据英格兰和威尔士人口标准化后的原发性颅内肿瘤发病率高于以往任何报告（21.04（17.18 - 25.62）/10万人口年）。总体而言，21%的病例未入院。最不可能入院的类别是鞍区和颅神经肿瘤患者。未入院患者的年龄明显大于入院患者。
五分之一的患者在脑肿瘤诊断后未入院，发病率研究必须采用能发现这些病例的病例发现方法。对影像结果进行审核几乎可以完全确定病例。本研究表明原发性脑肿瘤的发病率比以前认为的要高得多。癌症情报部门的官方数据严重低估了脑肿瘤发病率，尤其是良性肿瘤。
