Arita Kazunori, Miwa Makiko, Bohara Manoj, Moinuddin F M, Kamimura Kiyohisa, Yoshimoto Koji
Department of Neurosurgery, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.
Surg Neurol Int. 2020 Mar 28;11:55. doi: 10.25259/SNI_5_2020. eCollection 2020.
Accurate diagnosis of brain tumor is crucial for adequate surgical strategy. Our institution follows a comprehensive preoperative evaluation based on clinical and imaging information.
To assess the precision of preoperative diagnosis, we compared the "top three list" of differential diagnosis (the first, second, and third diagnoses according to the WHO 2007 classification including grading) of 1061 brain tumors, prospectively and consecutively registered in preoperative case conferences from 2010 to the end of 2017, with postoperative pathology reports.
The correct diagnosis rate (sensitivity) of the first diagnosis was 75.8% in total. The sensitivity of the first diagnosis was high (84-94%) in hypothalamic-pituitary and extra-axial tumors, 67-75% in intra-axial tumors, and relatively low (29-42%) in intraventricular and pineal region tumors. Among major three intra-axial tumors, the sensitivity was highest in brain metastasis: 83.8% followed by malignant lymphoma: 81.4% and glioblastoma multiforme: 73.1%. Sensitivity was generally low (≦60%) in other gliomas. These sensitivities generally improved when the second and third diagnoses were included; 86.3% in total. Positive predictive value (PPV) was 76.9% in total. All the three preoperative diagnoses were incorrect in 3.4% (36/1061) of cases even when broader brain tumor classification was applied.
Our institutional experience on precision of preoperative diagnosis appeared around 75% of sensitivity and PPV for brain tumor. Sensitivity improved by 10% when the second and third diagnoses were included. Neurosurgeons should be aware of these features of precision in preoperative differential diagnosis of a brain tumor for better surgical strategy and to adequately inform the patients.
准确诊断脑肿瘤对于制定合适的手术策略至关重要。我们机构采用基于临床和影像学信息的全面术前评估。
为评估术前诊断的准确性，我们将2010年至2017年底前瞻性连续登记于术前病例讨论中的1061例脑肿瘤的鉴别诊断“前三诊断清单”（根据WHO 2007分类包括分级的第一、第二和第三诊断）与术后病理报告进行了比较。
第一诊断的正确诊断率（敏感性）总体为75.8%。下丘脑 - 垂体和轴外肿瘤中第一诊断的敏感性较高（84 - 94%），轴内肿瘤中为67 - 75%，脑室和松果体区肿瘤中相对较低（29 - 42%）。在主要的三种轴内肿瘤中，脑转移瘤的敏感性最高：83.8%，其次是恶性淋巴瘤：81.4%和成胶质细胞瘤：73.1%。其他胶质瘤的敏感性一般较低（≤60%）。当纳入第二和第三诊断时，这些敏感性总体有所提高；总计86.3%。阳性预测值（PPV）总体为76.9%。即使应用更广泛的脑肿瘤分类，在3.4%（36/1061）的病例中所有三个术前诊断均不正确。
我们机构关于脑肿瘤术前诊断准确性的经验显示敏感性和PPV约为75%。纳入第二和第三诊断时敏感性提高了10%。神经外科医生应了解脑肿瘤术前鉴别诊断准确性的这些特点，以制定更好的手术策略并充分告知患者。
