Abstract

Purpose

Although non-enhancing lesions suspicious for glioma are usually assumed to be low grade glioma (LGG), some high grade glioma (HGG) do not enhance, which may lead to a delay in biopsy and/or resection, diagnosis, and treatment initiation. Thus, there is a clear need for a large-sample study that quantifies the rate of malignant, non-enhancing gliomas.

Methods

We retrospectively reviewed our series of 561 consecutive surgically treated gliomas with tissue diagnosis, 111 of which were non-enhancing, to determine the prevalence of high-grade histology in radiographically presumed LGG. Relative expression of tumor markers were also reported for non-enhancing lesions to investigate genetic correlates.

Results

We identified 561 surgically treated gliomas with tissue diagnosis from August 2012 to July 2018 and found that 111 patients (19.8%) demonstrated non-enhancing lesions suspicious for glioma on preoperative MRI. Thirty-one (27.9%) of the non-enhancing lesions were classified as HGGs (WHO Grade III or IV). Non-enhancing lesions were four times more likely to be HGG in patients older than 60 years than patients younger than 35 years (41.2% vs. 11.4%, Pearson Chi² p < 0.001). Binomial logistic regression showed a significant inverse effect of age on the presence of IDH mutation in non-enhancing HGGs (p = 0.007).

Conclusion

A clinically significant proportion (27.9%) of non-enhancing lesions were found to be HGG on final pathologic diagnosis. Thus, in patients with good functional and health status, especially those older than 60 years, we recommend obtaining tissue diagnosis of all lesions suspected to be glioma, even those that are non-enhancing, to guide diagnosis as well as early initiation of chemotherapy and radiation therapy.

中文翻译：

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表现为放射学上未增强的病变的高级别神经胶质瘤的发病率：接受111例经手术治疗的非增强型神经胶质瘤的诊断。

摘要

目的

尽管通常认为可疑为神经胶质瘤的非增生性病变为低度神经胶质瘤（LGG），但某些高度神经胶质瘤（HGG）不能增强，可能会导致活检和/或切除，诊断和治疗开始延迟。因此，显然需要进行大样本研究以量化恶性，非增强型神经胶质瘤的发生率。

方法

我们回顾性分析了我们连续进行的561例经手术治疗且具有组织学诊断的神经胶质瘤，其中111例未增强，以判断影像学上推测为LGG的高级组织学患病率。还报道了非增强性病变的肿瘤标志物的相对表达，以研究遗传相关性。

结果

我们从2012年8月至2018年7月，对561例经手术治疗的神经胶质瘤进行了组织诊断，发现111例患者（19.8％）在术前MRI上表现出可疑的胶质瘤增生性病变。31例（27.9％）未增强的病变被分类为HGG（WHO III或IV级）。60岁以上患者的非增强性病变发生HGG的可能性是35岁以下患者的4倍（41.2％比11.4％，Pearson Chi ² p <0.001）。二项式逻辑回归显示年龄对非增强型HGG中IDH突变的存在具有显着的逆作用（p = 0.007）。

结论

在最终病理诊断中，临床上显着比例（27.9％）的非增强性病变为HGG。因此，对于功能和健康状况良好的患者，尤其是60岁以上的患者，我们建议对所有怀疑为神经胶质瘤的病变进行组织诊断，包括那些非增强性病变，以指导诊断以及及早开始化疗和放射治疗。