Luryi Alexander L, Michaelides Elias M, Babu Seilesh, Bojrab Dennis I, Kveton John F, Hong Robert S, Zappia John, Sargent Eric W, Schutt Christopher A
Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States.
Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States.
Am J Otolaryngol. 2019 Mar-Apr;40(2):133-136. doi: 10.1016/j.amjoto.2019.01.009. Epub 2019 Jan 28.
To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology.
Retrospective chart review.
Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017.
Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses.
Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05).
Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.
与手术病理结果相比，评估小脑脑桥角（CPA）肿块术前诊断的准确性。
回顾性病历审查。
2007年至2017年在两家三级医疗机构接受CPA肿块手术的患者。
术前诊断与手术病理诊断的一致性百分比；预测诊断的敏感性、特异性、阳性预测值和阴性预测值。
411例抽样患者中，术前诊断与手术病理的一致性为93.2%。前庭神经鞘瘤以外的肿块一致性为57.9%。前庭神经鞘瘤和脑膜瘤的预测具有较高的阳性预测值（分别为0.95和0.97）和阴性预测值（分别为0.76和0.99）。面神经瘤的预测敏感性为0.13，阳性预测值为0.25。头痛（p = 0.001）和面部无力（p = 0.003）与不同的病理特征显著相关。听力损失与诊断预测差异有关（p = 0.02），但与手术病理差异无关（p>0.05）。
本文展示了小脑脑桥角肿块术前预测诊断与手术病理的比较。前庭神经鞘瘤和脑膜瘤能被有效识别，而包括面神经瘤在内的罕见CPA肿块很少能被正确识别。诊治CPA肿块患者的临床医生应注意诊断的不确定性，这可能导致治疗方案或预后的改变。
