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Incidence of high grade gliomas presenting as radiographically non-enhancing lesions: experience in 111 surgically treated non-enhancing gliomas with tissue diagnosis

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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.

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Acknowledgements

The authors would like to thank Linda Alberga for assistance with manuscript preparation.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA

    Daniel G. Eichberg, Long Di, Alexis A. Morell, Ashish H. Shah, Alexa M. Semonche, Christopher N. Chin, Aria M. Jamshidi, Evan M. Luther, Ricardo J. Komotar & Michael E. Ivan

  2. Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA

    Rita G. Bhatia

  3. Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Ricardo J. Komotar & Michael E. Ivan

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  1. Daniel G. Eichberg
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Eichberg, D.G., Di, L., Morell, A.A. et al. Incidence of high grade gliomas presenting as radiographically non-enhancing lesions: experience in 111 surgically treated non-enhancing gliomas with tissue diagnosis. J Neurooncol 147, 671–679 (2020). https://doi.org/10.1007/s11060-020-03474-z

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