TY - JOUR
T1 - Progressive Low-Grade Glioma
T2 - Assessment of Prognostic Importance of Histologic Reassessment and MRI Findings
AU - Narang, Amol K.
AU - Chaichana, Kaisorn L.
AU - Weingart, Jon D.
AU - Redmond, Kristin J.
AU - Lim, Michael
AU - Olivi, Alessandro
AU - Quinones-Hinojosa, Alfredo
AU - Kleinberg, Lawrence R.
PY - 2015/12/18
Y1 - 2015/12/18
N2 - Background: In patients with progressive low-grade glioma (LGG), the presence of new magnetic resonance imaging (MRI) enhancement is commonly used as an indicator of malignant degeneration, but its accuracy in this setting is uncertain. Objective: We characterize the ability of new MRI enhancement to serve as a surrogate for histologic grade in patients with progressive LGG, and to explore the prognostic value of new MRI enhancement, pathologic grade, and extent of resection. Methods: Patients at our institution with World Health Organization grade II glioma diagnosed between 1994 and 2010 and who underwent repeat biopsy or resection at progression were retrospectively reviewed (n = 108). The positive predictive value, negative predictive value, sensitivity, and specificity of new MRI enhancement were characterized. A multivariable proportional hazards model was used to test associations with overall survival (OS), and Kaplan-Meier curves were constructed to compare OS between patient subsets. Results: The positive predictive value, negative predictive value, sensitivity, and specificity of new MRI enhancement were 82%, 77%, 92%, and 57%, respectively. In patients without malignant degeneration, new MRI enhancement was associated with inferior median OS (92.5 months vs. not reached; P = 0.03). In patients with malignant degeneration, gross or near total resection was associated with improved median OS (58.8 vs. 28.8 months; P = 0.02). Conclusion: In patients with progressive LGG, new MRI enhancement and pathologic grade were discordant in greater than 20% of cases. Pathologic confirmation of grade should therefore be attempted, when safe, to dictate management. Beyond functioning as a surrogate for pathologic grade, new MRI enhancement may predict for worse outcomes, a concept that merits prospective investigation.
AB - Background: In patients with progressive low-grade glioma (LGG), the presence of new magnetic resonance imaging (MRI) enhancement is commonly used as an indicator of malignant degeneration, but its accuracy in this setting is uncertain. Objective: We characterize the ability of new MRI enhancement to serve as a surrogate for histologic grade in patients with progressive LGG, and to explore the prognostic value of new MRI enhancement, pathologic grade, and extent of resection. Methods: Patients at our institution with World Health Organization grade II glioma diagnosed between 1994 and 2010 and who underwent repeat biopsy or resection at progression were retrospectively reviewed (n = 108). The positive predictive value, negative predictive value, sensitivity, and specificity of new MRI enhancement were characterized. A multivariable proportional hazards model was used to test associations with overall survival (OS), and Kaplan-Meier curves were constructed to compare OS between patient subsets. Results: The positive predictive value, negative predictive value, sensitivity, and specificity of new MRI enhancement were 82%, 77%, 92%, and 57%, respectively. In patients without malignant degeneration, new MRI enhancement was associated with inferior median OS (92.5 months vs. not reached; P = 0.03). In patients with malignant degeneration, gross or near total resection was associated with improved median OS (58.8 vs. 28.8 months; P = 0.02). Conclusion: In patients with progressive LGG, new MRI enhancement and pathologic grade were discordant in greater than 20% of cases. Pathologic confirmation of grade should therefore be attempted, when safe, to dictate management. Beyond functioning as a surrogate for pathologic grade, new MRI enhancement may predict for worse outcomes, a concept that merits prospective investigation.
KW - Low-grade glioma
KW - Malignant degeneration
KW - MRI contrast enhancement
KW - Progression
UR - http://www.scopus.com/inward/record.url?scp=85009731498&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85009731498&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2016.04.030
DO - 10.1016/j.wneu.2016.04.030
M3 - Article
C2 - 27108796
AN - SCOPUS:85009731498
SN - 1878-8750
JO - World Neurosurgery
JF - World Neurosurgery
ER -