Soleman Jehuda, Kozyrev Danil A, Ben-Sira Liat, Constantini Shlomi, Roth Jonathan
Department of Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children's Hospital Tel Aviv, Weizman Street 12, Tel Aviv, Israel.
Departments of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's University Hospital of Basel, Basel, Switzerland.
Childs Nerv Syst. 2020 Aug;36(8):1607-1619. doi: 10.1007/s00381-020-04658-8. Epub 2020 May 6.
Due to technical advancements and availability of neuroimaging, detection of incidental pediatric brain tumors (IPBT) is growing rapidly. The management of these asymptomatic lesions remains unclear; radiological, pathological, and clinical risk factors for further growth and malignant transformation (MT) are not well defined.
We systematically reviewed the literature on the dilemmas and management of IPBT suggestive of a low-grade brain tumor (LGBT). Keyword searches of the PubMed and Medline (NCBI) databases identified studies on IPBT describing the prevalence, neuroimaging, management, or risk of MT through July 2019. References of the identified articles were also reviewed.
A total of 2021 records were screened. Fifty-nine full-text articles were reviewed, and 34 published studies were included. IPBT are diagnosed in 0.2-5.7% of children undergoing brain imaging for various reasons. The accepted approach for management of lesions showing radiological characteristics suggestive of LGBT is radiological follow-up. The rate at which additional intervention is required during follow-up for these apparently low-grade lesions is 9.5%. Nevertheless, the dilemma of early surgical resection or biopsy vs. clinical and radiological follow-up of IPBT is still unresolved. The risk in these cases is missing a transformation to a higher grade tumor. However, MT of pediatric LGBT is very rare, occurring in less than 3% of the cases of proven low-grade gliomas in children. The risk of future MT in pediatric low-grade gliomas seems to be greater in the presence of specific molecular markers such as BRAF V-600E, CDKN2A, and H3F3A K27M.
The natural history, management, and prognosis of IPBT remain ambiguous. It seems that lesions suggestive of LGBT can initially be followed, since many of these lesions remain stable over time and MT is rare. However, controversy among centers concerning the ideal approach still exists. Further observational and prospective cohort studies, focusing on potential clinical and radiological characteristics or risk factors suggestive of high-grade tumors, tumor progress, or MT of IPBT, are needed.
由于技术进步和神经影像学的应用，儿童偶发性脑肿瘤（IPBT）的检出率正在迅速上升。这些无症状病变的管理仍不明确；关于进一步生长和恶性转化（MT）的放射学、病理学和临床危险因素尚未得到很好的界定。
我们系统回顾了关于提示低级别脑肿瘤（LGBT）的IPBT的困境和管理的文献。通过对PubMed和Medline（NCBI）数据库进行关键词搜索，确定了截至2019年7月关于IPBT的研究，这些研究描述了其患病率、神经影像学、管理或MT风险。还对已识别文章的参考文献进行了回顾。
共筛选了2021条记录。对59篇全文进行了回顾，纳入了34项已发表的研究。在因各种原因接受脑部成像的儿童中，IPBT的诊断率为0.2%至5.7%。对于显示出提示LGBT放射学特征的病变，公认的管理方法是放射学随访。在对这些看似低级别病变的随访期间，需要额外干预的比例为9.5%。然而，IPBT早期手术切除或活检与临床和放射学随访之间的困境仍未解决。这些病例的风险在于遗漏向高级别肿瘤的转化。然而，儿童LGBT的MT非常罕见，在已证实的儿童低级别胶质瘤病例中发生率不到3%。在存在特定分子标志物如BRAF V-600E、CDKN2A和H3F3A K27M的情况下，儿童低级别胶质瘤未来发生MT的风险似乎更大。
IPBT的自然史、管理和预后仍不明确。似乎提示LGBT的病变最初可以进行随访，因为这些病变中的许多随着时间推移保持稳定，且MT罕见。然而，各中心对于理想方法仍存在争议。需要进一步的观察性和前瞻性队列研究，重点关注提示高级别肿瘤、肿瘤进展或IPBT的MT的潜在临床和放射学特征或危险因素。
