Risk estimation in non-enhancing glioma: introducing a clinical sore
The preoperative grading of non-enhancing glioma (NEG) remains challenging. Herein, we analyzed clinical and magnetic resonance imaging (MRI) features to predict malignancy in NEG according to the 2021 WHO classification and developed a clinical score, facilitating risk estimation. A discovery cohor...
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| Hauptverfasser: | , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
27 April 2023
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| In: |
Cancers
Year: 2023, Jahrgang: 15, Heft: 9, Pages: 1-14 |
| ISSN: | 2072-6694 |
| DOI: | 10.3390/cancers15092503 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/cancers15092503 Verlag, kostenfrei, Volltext: https://www.mdpi.com/2072-6694/15/9/2503 
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| Verfasserangaben: | Philip Dao Trong, Samuel Kilian, Jessica Jesser, David Reuss, Fuat Kaan Aras, Andreas Von Deimling, Christel Herold-Mende, Andreas Unterberg and Christine Jungk |
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| 520 | |a The preoperative grading of non-enhancing glioma (NEG) remains challenging. Herein, we analyzed clinical and magnetic resonance imaging (MRI) features to predict malignancy in NEG according to the 2021 WHO classification and developed a clinical score, facilitating risk estimation. A discovery cohort (2012-2017, n = 72) was analyzed for MRI and clinical features (T2/FLAIR mismatch sign, subventricular zone (SVZ) involvement, tumor volume, growth rate, age, Pignatti score, and symptoms). Despite a “low-grade” appearance on MRI, 81% of patients were classified as WHO grade 3 or 4. Malignancy was then stratified by: (1) WHO grade (WHO grade 2 vs. WHO grade 3 + 4) and (2) molecular criteria (IDHmut WHO grade 2 + 3 vs. IDHwt glioblastoma + IDHmut astrocytoma WHO grade 4). Age, Pignatti score, SVZ involvement, and T2/FLAIR mismatch sign predicted malignancy only when considering molecular criteria, including IDH mutation and CDKN2A/B deletion status. A multivariate regression confirmed age and T2/FLAIR mismatch sign as independent predictors (p = 0.0009; p = 0.011). A “risk estimation in non-enhancing glioma” (RENEG) score was derived and tested in a validation cohort (2018-2019, n = 40), yielding a higher predictive value than the Pignatti score or the T2/FLAIR mismatch sign (AUC of receiver operating characteristics = 0.89). The prevalence of malignant glioma was high in this series of NEGs, supporting an upfront diagnosis and treatment approach. A clinical score with robust test performance was developed that identifies patients at risk for malignancy. | ||
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