Felix Behling, Hannes Becker, Hanna Gött, Jonas Tellermann, Christina Fodi, Darius Kalasauskas, Florian Ringel, Clemens Sommer, Johannes Wach, Erdem Güresir, Alonso Barrantes-Freer, Karl-Michael Schebesch, Julius Höhne, Miriam Weiss, Christian Musahl, Lukas Andereggen, Ingeborg Fischer, Mahmoud Messerer, Guilia Cossu, Alberto Vandenbulke, Benjamin Brokinkel, Uta Schick, Michael Glatza, Henry W. S. Schroeder, Gleb Dashevskii, Josefine Radke, Samir Jabari, Dimitrios Paraskevopoulos, Thomas Millner, Guido Caffaratti, Georgios Georgountzos, Jiri Fiedler, Barbora Musilova, Luigi Maria Cavallo, Teresa Somma, Roberto Colasanti, Luigino Tosatto, Daniela Bartolini, Alina Itter, Paulina Günzerodt, Quratul Ain, Peter Baumgarten, Dorothee Mielke, Jens Schittenhelm, Marcos Tatagiba
- In the WHO classification of meningiomas brain invasion (BI) remains a stand-alone criterion for atypia. Several retrospective analyses have demonstrated that BI alone does not seem to have any independent prognostic relevance. However, non-standardized intraoperative sampling of meningioma tissue and loose adherence to the histopathological criteria of BI may influence the quality of retrospective data among different institutions. To further address this topic, the INVADER Study was initiated. The first part focuses on gaining a deeper insight into the sampling methodology and factors influencing the diagnostic yield of BI among different neurosurgical centers.
Methods: In this multicenter observational trial 13 neurosurgical centers included patients surgically treated for meningioma in the course of 12 months. Two assessment sheets were used to document the intraoperative assessment of the surgeon (intraoperative signs of invasive growth, extent of resection, completeness ofIn the WHO classification of meningiomas brain invasion (BI) remains a stand-alone criterion for atypia. Several retrospective analyses have demonstrated that BI alone does not seem to have any independent prognostic relevance. However, non-standardized intraoperative sampling of meningioma tissue and loose adherence to the histopathological criteria of BI may influence the quality of retrospective data among different institutions. To further address this topic, the INVADER Study was initiated. The first part focuses on gaining a deeper insight into the sampling methodology and factors influencing the diagnostic yield of BI among different neurosurgical centers.
Methods: In this multicenter observational trial 13 neurosurgical centers included patients surgically treated for meningioma in the course of 12 months. Two assessment sheets were used to document the intraoperative assessment of the surgeon (intraoperative signs of invasive growth, extent of resection, completeness of sampling, sampling of suspicious areas) and the histopathological work-up by the pathologist (sufficient tissue, BI, criteria used for BI assessment). Overall, 572 cases were included after exclusion of incomplete datasets.
Results: BI was detected in 5.1% of all assessed cases. Between different centers, the detection rate varied from 0.0 to 11.8%. Meningiomas that received prior surgery and radiation treatment had a significantly higher rate of BI (44.4%) compared to virgin meningiomas (3.5%) or prior surgery alone (5.3%, p<0.0001). Intraoperatively, adhesion and invasion of CNS tissue was observed in 6.4 and 25.3%, respectively. Both observations were associated with a higher detection rate of BI (p=0.0135 and p<0.0001, respectively). A separate sample suspicious of BI was taken in 10.8% of cases and was also associated with a higher rate of BI detection (p=0.0177). The diagnostic sensitivity and specificity of intraoperative suspicion of CNS invasion were 58.9 and 76.5%, respectively. The positive and negative predictive value were 11.9 and 97.2%. There was no difference in the detection rate of BI when the complete brain-meningioma interface was sampled.
Conclusions: BI was present in 5.1% of meningiomas. While intraoperative features suggestive of invasion were significantly associated with BI, the diagnostic performance of intraoperative assessment was limited, primarily due to the prevalence of BI. Complete sampling of the brain-meningioma interface did not improve diagnostic yield.…
