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Correlation of volumetric growth and histological grade in 50 meningiomas

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Abstract

Introduction

Advances in radiological imaging techniques have enabled volumetric measurements of meningiomas to be easily monitored using serial imaging scans. There is limited literature on the relationship between tumour growth rates and the WHO classification of meningiomas despite tumour growth being a major determinant of type and timing of intervention. Volumetric growth has been successfully used to assess growth of low-grade glioma; however, there is limited information on the volumetric growth rate (VGR) of meningiomas. This study aimed to determine the reliability of VGR measurement in patients with meningioma, assess the relationship between VGR and 2016 WHO grading as well as clinical applicability of VGR in monitoring meningioma growth.

Methods

All histologically proven intracranial meningiomas that underwent resection in a single centre between April 2009 and April 2014 were reviewed and classified according to the 2016 edition of the Classification of the Tumours of the CNS. Only patients who had two pre-operative scans that were at least 3 months apart were included in the study. Two authors performed the volumetric measurements using the Slicer 3D software independently and the inter-rater reliability was assessed. Multiple regression analyses of factors affecting the VGR and VDE of meningiomas were performed using the R statistical software with p < 0.05 considered to be statistically significant.

Results

Of 548 patients who underwent resection of their meningiomas, 66 met the inclusion criteria. Sixteen cases met the exclusion criteria (NF2, spinal location, previous surgical or radiation treatment, significant intra-osseous component and poor quality imaging). Forty-two grade I and 8 grade II meningiomas were included in the analysis. The VGR was significantly higher for grade II meningiomas. Using receiver-operator characteristic (ROC) curve analysis, the optimal threshold that distinguishes between grade I and II meningiomas is 3 cm3/year. Higher histological grade, high initial tumour volume, MRI T2-signal hyperintensity and presence of oedema were found to be significant predictors of higher VGR.

Conclusion

Reliable tools now exist to evaluate and monitor volumetric growth of meningiomas. Grade II meningiomas have significantly higher VGR compared with grade I meningiomas and growth of more than 3 cm3/year is strongly suggestive of a higher grade meningioma. A larger, multi-centre prospective study to investigate the applicability of velocity of growth to predict the outcome of patients with meningioma is warranted.

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Authors and Affiliations

  1. Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK

    Wai Cheong Soon, Daniel M. Fountain, Kacper Koczyk, Mutwakil Abdulla, Sachin Giri, Mathew R. Guilfoyle, Ramez W. Kirollos & Thomas Santarius

  2. Edinburgh Surgical Sciences Qualification, University of Edinburgh, Edinburgh, UK

    Wai Cheong Soon

  3. Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, UK

    Wai Cheong Soon

  4. Medical University of Warsaw, Warsaw, Poland

    Kacper Koczyk

  5. Department of Neurosurgery, Grant Government Medical College Hospital, Mumbai, India

    Sachin Giri

  6. Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Kieren Allinson

  7. Department of Radiology, University of Cambridge, Cambridge, UK

    Tomasz Matys

Authors
  1. Wai Cheong Soon
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  2. Daniel M. Fountain
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  8. Mathew R. Guilfoyle
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  9. Ramez W. Kirollos
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  10. Thomas Santarius
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Correspondence to Wai Cheong Soon.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional ethical approval was obtained and, as we are dealing with an anonymised retrospective cohort, no individual patient consent is required.

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Presentation at a conference

Yes. Oral presentation at the Society of British Neurological Surgeons (SBNS) meeting in Oxford

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Soon, W.C., Fountain, D.M., Koczyk, K. et al. Correlation of volumetric growth and histological grade in 50 meningiomas. Acta Neurochir 159, 2169–2177 (2017). https://doi.org/10.1007/s00701-017-3277-y

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  • DOI: https://doi.org/10.1007/s00701-017-3277-y

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