Distinguishing grade I meningioma from higher grade meningiomas without biopsy

John M. Varlotto, John Flickinger, Martin T. Pavelic, Charles S. Specht, Jonas M. Sheehan, Dana T. Timek, Michael J. Glantz, Steven Sogge, Christopher Dimaio, Richard Moser, Shakeeb Yunus, Thomas J. Fitzgerald, Urvashi Upadhyay, Paul Rava, Matthew Tangel, Aaron Yao, Sangam Kanekar

Research output: Contribution to journalArticle

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Abstract

Background: Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas. Methods: Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades. Results: Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10% of being Grade II-III meningiomas. Conclusions: Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.

Original languageEnglish (US)
Pages (from-to)38421-38428
Number of pages8
JournalOncotarget
Volume6
Issue number35
DOIs
StatePublished - Jan 1 2015

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Meningioma
Biopsy
Blood Vessels
Neoplasms
Pathology
Paresis
Radiology
Neuroimaging

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Varlotto, J. M., Flickinger, J., Pavelic, M. T., Specht, C. S., Sheehan, J. M., Timek, D. T., ... Kanekar, S. (2015). Distinguishing grade I meningioma from higher grade meningiomas without biopsy. Oncotarget, 6(35), 38421-38428. https://doi.org/10.18632/oncotarget.5376
Varlotto, John M. ; Flickinger, John ; Pavelic, Martin T. ; Specht, Charles S. ; Sheehan, Jonas M. ; Timek, Dana T. ; Glantz, Michael J. ; Sogge, Steven ; Dimaio, Christopher ; Moser, Richard ; Yunus, Shakeeb ; Fitzgerald, Thomas J. ; Upadhyay, Urvashi ; Rava, Paul ; Tangel, Matthew ; Yao, Aaron ; Kanekar, Sangam. / Distinguishing grade I meningioma from higher grade meningiomas without biopsy. In: Oncotarget. 2015 ; Vol. 6, No. 35. pp. 38421-38428.
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abstract = "Background: Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas. Methods: Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades. Results: Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10{\%} of being Grade II-III meningiomas. Conclusions: Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.",
author = "Varlotto, {John M.} and John Flickinger and Pavelic, {Martin T.} and Specht, {Charles S.} and Sheehan, {Jonas M.} and Timek, {Dana T.} and Glantz, {Michael J.} and Steven Sogge and Christopher Dimaio and Richard Moser and Shakeeb Yunus and Fitzgerald, {Thomas J.} and Urvashi Upadhyay and Paul Rava and Matthew Tangel and Aaron Yao and Sangam Kanekar",
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Varlotto, JM, Flickinger, J, Pavelic, MT, Specht, CS, Sheehan, JM, Timek, DT, Glantz, MJ, Sogge, S, Dimaio, C, Moser, R, Yunus, S, Fitzgerald, TJ, Upadhyay, U, Rava, P, Tangel, M, Yao, A & Kanekar, S 2015, 'Distinguishing grade I meningioma from higher grade meningiomas without biopsy', Oncotarget, vol. 6, no. 35, pp. 38421-38428. https://doi.org/10.18632/oncotarget.5376

Distinguishing grade I meningioma from higher grade meningiomas without biopsy. / Varlotto, John M.; Flickinger, John; Pavelic, Martin T.; Specht, Charles S.; Sheehan, Jonas M.; Timek, Dana T.; Glantz, Michael J.; Sogge, Steven; Dimaio, Christopher; Moser, Richard; Yunus, Shakeeb; Fitzgerald, Thomas J.; Upadhyay, Urvashi; Rava, Paul; Tangel, Matthew; Yao, Aaron; Kanekar, Sangam.

In: Oncotarget, Vol. 6, No. 35, 01.01.2015, p. 38421-38428.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Distinguishing grade I meningioma from higher grade meningiomas without biopsy

AU - Varlotto, John M.

AU - Flickinger, John

AU - Pavelic, Martin T.

AU - Specht, Charles S.

AU - Sheehan, Jonas M.

AU - Timek, Dana T.

AU - Glantz, Michael J.

AU - Sogge, Steven

AU - Dimaio, Christopher

AU - Moser, Richard

AU - Yunus, Shakeeb

AU - Fitzgerald, Thomas J.

AU - Upadhyay, Urvashi

AU - Rava, Paul

AU - Tangel, Matthew

AU - Yao, Aaron

AU - Kanekar, Sangam

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas. Methods: Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades. Results: Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10% of being Grade II-III meningiomas. Conclusions: Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.

AB - Background: Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas. Methods: Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades. Results: Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10% of being Grade II-III meningiomas. Conclusions: Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.

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Varlotto JM, Flickinger J, Pavelic MT, Specht CS, Sheehan JM, Timek DT et al. Distinguishing grade I meningioma from higher grade meningiomas without biopsy. Oncotarget. 2015 Jan 1;6(35):38421-38428. https://doi.org/10.18632/oncotarget.5376