intracranial tumours

Current clinico‐radiological diagnostic accuracy for intracranial tumours

A study revealed that current accuracy of a preoperative clinico‐radiological diagnosis of intracranial tumours is high.

A histopathological diagnosis is still favoured in most patients with brain tumours. The need for a tissue diagnosis might be reduced in the future due to continuous improvements in pre‐treatment diagnostics. An additional diagnostic value of special imaging protocols or techniques, including positron emission tomography (PET) or radiomics based on artificial intelligence in the preoperative workup of patients with intracranial tumours is promising. However, it is not clear to what extent they outperform the current diagnostic standards.

The aim of this study was to determine the accuracy of a routine clinico‐radiological diagnosis for a population‐based selection of intracranial tumours.

In this prospective cohort study, they included consecutive adult patients who underwent a primary surgical intervention for a suspected intracranial tumour between 2015 and 2019 at a single‐neurosurgical centre. The treating team estimated the expected diagnosis prior to surgery using predefined groups. The expected diagnosis was compared to final histopathology and the accuracy of preoperative clinico‐radiological diagnosis (sensitivity, specificity, positive and negative predictive values) was calculated.

392 patients were included in the data analysis, of whom 319 underwent a primary surgical resection and 73 were operated with a diagnostic biopsy only. The diagnostic accuracy varied between different tumour types. The overall sensitivity, specificity and diagnostic mismatch rate of clinico‐radiological diagnosis was 85.8%, 97.7% and 4.0%, respectively. For gliomas (including differentiation between low‐grade and high‐grade gliomas), the same diagnostic accuracy measures were found to be 82.2%, 97.2% and 5.6%, respectively. The most common diagnostic mismatch was between low‐grade gliomas, high‐grade gliomas and metastases. Accuracy of 90.2% was achieved for differentiation between diffuse low‐grade gliomas and high‐grade gliomas.

In conclusion, the current accuracy of a preoperative clinico‐radiological diagnosis of brain tumours is high. Although special sequences, analysis algorithms or imaging methods may add diagnostic certainty in difficult cases, future non‐invasive diagnostic methods need to outperform our results in order to add much value in a routine clinical setting in unselected patients. This findings are also relevant when estimating the risks and benefits of diagnostic biopsies in management of patients with intracranial tumours not considered eligible for tumour resection.

Contact: Fardin Nabizadeh

Source and image: Majewska, P., Sagberg, L.M., Reinertsen, I., Gulati, S., Jakola, A.S. and Solheim, O. (2021), What is the current clinico‐radiological diagnostic accuracy for intracranial tumours?. Acta Neurol Scand. https://doi.org/10.1111/ane.13430