Smith S J, Boddu S, Macarthur D C
Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.
Br J Neurosurg. 2007 Dec;21(6):588-92. doi: 10.1080/02688690701684246.
The histological grading of meningiomas underwent substantial revision and standardization in a WHO review of 2000. Prior to this the histological definition of atypical and malignant meningiomas was less tightly defined. We conducted a retrospective analysis of all meningiomas operated on between 1993 and 2003 in our unit (n=565), to assess whether the WHO changes had altered the proportion of tumours diagnosed as atypical. The percentage of tumours graded WHO II (atypical meningiomas) has increased significantly since these changes were adopted (18.3-23.1%, p=0.0408). We also examined the epidemiology of meningioma, finding that previous irradiation is associated with atypical meningiomas (p=0.038) and surgeons find that complete excision is also more difficult with atypical tumours (p=0.010), reporting poorer Simpson grades intraoperatively before the tumour grade is known. The increase in atypical lesions caused by the grading changes may lead to a corresponding increase in the numbers of patients referred for radiotherapy/radiosurgery, and we examine the evidence base for this strategy and whether our experience is replicated in other units.
在2000年世界卫生组织（WHO）的一次审查中，脑膜瘤的组织学分级经历了重大修订和标准化。在此之前，非典型和恶性脑膜瘤的组织学定义界定得不够严格。我们对1993年至2003年间在我们科室接受手术的所有脑膜瘤（n = 565）进行了回顾性分析，以评估WHO的这些变化是否改变了被诊断为非典型肿瘤的比例。自从采用这些变化以来，WHO II级（非典型脑膜瘤）肿瘤的百分比显著增加（从18.3%增至23.1%，p = 0.0408）。我们还研究了脑膜瘤的流行病学，发现既往接受过放疗与非典型脑膜瘤相关（p = 0.038），并且外科医生发现非典型肿瘤更难实现完整切除（p = 0.010），在知晓肿瘤分级之前术中报告的辛普森分级较差。分级变化导致的非典型病变增加可能会相应增加转诊接受放疗/放射外科治疗的患者数量，我们研究了这一策略的证据基础以及我们的经验是否在其他科室得到重复验证。
