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Predicting tumor consistency and extent of resection in non-functioning pituitary tumors

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Abstract

Purpose

To (1) identify a radiological parameter to predict non-functioning pituitary tumor (NFPT) consistency, (2) examine the relationship between NFPT consistency and extent of resection (EOR), (3) investigate if tumor consistency predictors can anticipate EOR.

Methods

The ratio (T2SIR) between the T2 min signal intensity (SI) of the tumor and the T2 mean SI of the CSF was the main radiological parameter, being determined through a radiomic-voxel analysis and calculated using the following formula: T2SIR = [(T2 tumor mean SI – SD)/T2 CSF SI]. The tumor consistency was pathologically estimated as collagen percentage (CP). EOR of NFPTs was evaluated by exploiting a volumetric technique and its relationship with the following explanatory variables was explored: CP, Knosp-grade, tumor volume, inter-carotid distance, sphenoidal sinus morphology, Hardy-grade, suprasellar tumor extension.

Results

A statistically significant inverse correlation between T2SIR and CP was demonstrated (p = 0.0001), with high diagnostic power of T2SIR in predicting NFPT consistency (ROC curve analysis’ AUC = 0.88; p = 0.0001). The following predictors of EOR were identified in the univariate analysis: CP (p = 0.007), preoperative volume (p = 0.045), Knosp grade (p = 0.0001), tumor suprasellar extension (p = 0.044). The multivariate analysis demonstrated two variables as unique predictors of EOR: CP (p = 0.002) and Knosp grade (p = 0.001). The T2SIR was a significant predictor of EOR both in the univariate (p = 0.01) and multivariate model (p = 0.003).

Conclusion

This study offers the potential to improve NFPT preoperative surgical planning and patient counseling by employing the T2SIR as a preoperative predictor of tumor consistency and EOR. Meanwhile, tumor consistency and Knosp grade were found to play an important role in predicting EOR.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request. The raw data are not publicly available because of ethical restrictions.

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Authors and Affiliations

  1. Unit of Neurosurgery, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

    Giorgio Fiore, Giulio Andrea Bertani, Mauro Pluderi, Stefano Borsa, Manuela Caroli & Marco Locatelli

  2. Unit of Oncology and Onco-Hematology, University of Milan, Milan, Italy

    Giorgio Fiore & Leonardo Tariciotti

  3. Unit of Endocrinology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Emanuele Ferrante, Elisa Sala & Giovanna Mantovani

  4. Unit of Neuroradiology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Giorgio Conte, Giulia Platania, Karin Kremenova & Fabio Maria Triulzi

  5. Unit of Pathology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Elisabetta Kuhn, Letterio Runza & Stefano Ferrero

  6. Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy

    Elisabetta Kuhn & Stefano Ferrero

  7. Unit of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Giorgio Conte, Fabio Maria Triulzi & Marco Locatelli

  8. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Giovanna Mantovani

  9. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Giorgio Fiore

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  1. Giorgio Fiore
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Contributions

Conceptualization: GF, ML, GAB, GC; Methodology: GF, ML, GAB, GM, EF, GC, EK; Formal analysis, data collection and investigation: GF, GC, GP, KK, EK, LR, MP, SB, MC; Writing—original draft preparation: GF, GAB; Writing—review and editing: All authors; Supervision: ML, GAB, GM, EF, FMT, SF; All authors approved the final version of the manuscript.

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Correspondence to Giorgio Fiore.

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Fiore, G., Bertani, G.A., Conte, G. et al. Predicting tumor consistency and extent of resection in non-functioning pituitary tumors. Pituitary 26, 209–220 (2023). https://doi.org/10.1007/s11102-023-01302-x

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