脑侵犯标准对 WHO 分级 1、2 和 3 级脑膜瘤发病率和分布的影响。
The impact of brain invasion criteria on the incidence and distribution of WHO grade 1, 2, and 3 meningiomas.
机构信息
Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Neuropathology, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Neuro Oncol. 2022 Sep 1;24(9):1524-1532. doi: 10.1093/neuonc/noac032.
BACKGROUND
In 2016 brain invasion was added as a standalone diagnostic criterion for Grade 2 meningiomas in the WHO Classification of Brain Tumors. The aim of this study was to compare the incidence and distribution of meningiomas, and agreement, between the 2007 and 2016 WHO criteria.
METHODS
All cases of intracranial meningiomas diagnosed between 2007 and 2020 at a tertiary care academic hospital were identified. The incidence of each meningioma grade in the WHO 2007 and WHO 2016 cohorts were compared. Additionally, each case in the 2007 cohort was re-graded according to the WHO 2016 criteria to determine the intra-class correlation (ICC) between criteria.
RESULTS
Of 814 cases, 532 (65.4%) were in the 2007 WHO cohort and 282 (34.6%) were in the 2016 WHO cohort. There were no differences in the distribution of meningioma grades between cohorts (P = .11). Incidence rates were: 75.0% vs. 75.2% for Grade 1, 22.7% vs. 24.5% for Grade 2, and 2.3% vs. 0.4% for Grade 3, for the 2007 and 2016 cohorts, respectively. Upon re-grading, 21 cases (3.9%) were changed. ICC between original and revised grade was 0.92 (95% CI: 0.91-0.93). Amongst Grade 2 meningiomas with brain invasion, 75.8% had three or more atypical histologic features or an elevated mitotic index.
CONCLUSIONS
Including brain invasion as a standalone diagnostic criterion for Grade 2 meningiomas had minimal impact on the incidence of specific meningioma grade tumors. There is strong agreement between the 2007 and 2016 WHO criteria, likely due to cosegregation of grade elevating features.
背景
2016 年，脑侵犯被添加为世界卫生组织（WHO）脑肿瘤分类中 2 级脑膜瘤的独立诊断标准。本研究旨在比较 2007 年和 2016 年 WHO 标准下脑膜瘤的发病率和分布以及一致性。
方法
在一家三级保健学术医院，确定了 2007 年至 2020 年间诊断的所有颅内脑膜瘤病例。比较了 2007 年和 2016 年 WHO 队列中每个脑膜瘤等级的发病率。此外，根据 2016 年 WHO 标准重新对 2007 年队列中的每个病例进行分级，以确定标准之间的组内相关系数（ICC）。
结果
在 814 例病例中，532 例（65.4%）为 2007 年 WHO 队列，282 例（34.6%）为 2016 年 WHO 队列。两组脑膜瘤分级分布无差异（P =.11）。发病率分别为：2007 年和 2016 年队列中，1 级为 75.0% vs. 75.2%，2 级为 22.7% vs. 24.5%，3 级为 2.3% vs. 0.4%。重新分级后，有 21 例（3.9%）发生变化。原始和修订等级之间的 ICC 为 0.92（95%CI：0.91-0.93）。在有脑侵犯的 2 级脑膜瘤中，75.8%有 3 个或更多非典型组织学特征或有丝分裂指数升高。
结论
将脑侵犯作为 2 级脑膜瘤的独立诊断标准对特定脑膜瘤等级肿瘤的发病率影响不大。2007 年和 2016 年 WHO 标准之间具有很强的一致性，这可能是由于分级升高特征的共分离。
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