Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas after Transsphenoidal Surgery

TRANSSPHER Study Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE: To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS: Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS: Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5%; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION: This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.

Original languageEnglish (US)
Pages (from-to)460-469
Number of pages10
JournalOperative Neurosurgery
Volume17
Issue number5
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

Fingerprint

Pituitary Neoplasms
Neoplasms
Area Under Curve
Magnetic Resonance Imaging
Frontal Lobe
Temporal Lobe
Research
ROC Curve
Multicenter Studies
Prospective Studies
Sensitivity and Specificity

Keywords

  • Adenoma
  • Extent of resection
  • Grading scale
  • Pituitary
  • Residual
  • Transsphenoidal

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{1fa3bbc6262942298c98fda788b52e51,
title = "Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas after Transsphenoidal Surgery",
abstract = "BACKGROUND: A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE: To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS: Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS: Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5{\%}; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION: This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.",
keywords = "Adenoma, Extent of resection, Grading scale, Pituitary, Residual, Transsphenoidal",
author = "{TRANSSPHER Study Group} and Mooney, {Michael A.} and Sarris, {Christina E.} and Zhou, {James J.} and Garni Barkhoudarian and Chicoine, {Michael R.} and Fernandez-Miranda, {Juan C.} and Gardner, {Paul A.} and Hardesty, {Douglas A.} and Heidi Jahnke and Kelly, {Daniel F.} and Liebelt, {Brandon D.} and Mayberg, {Marc R.} and Prevedello, {Daniel M.} and John Sfondouris and Sheehy, {John P.} and Chandler, {James P.} and Yuen, {Kevin C.J.} and White, {William L.} and Little, {Andrew S.} and Benita Valappil and Ralph Dacey and Gregory Zipfel and Albert Kim and John Evans and Lesniak, {Matt S.} and Orin Bloch and Christina Amidei and Caryl Tongco and Bridget Hoskins and Smith, {Timothy R.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1093/ons/opy401",
language = "English (US)",
volume = "17",
pages = "460--469",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas after Transsphenoidal Surgery

AU - TRANSSPHER Study Group

AU - Mooney, Michael A.

AU - Sarris, Christina E.

AU - Zhou, James J.

AU - Barkhoudarian, Garni

AU - Chicoine, Michael R.

AU - Fernandez-Miranda, Juan C.

AU - Gardner, Paul A.

AU - Hardesty, Douglas A.

AU - Jahnke, Heidi

AU - Kelly, Daniel F.

AU - Liebelt, Brandon D.

AU - Mayberg, Marc R.

AU - Prevedello, Daniel M.

AU - Sfondouris, John

AU - Sheehy, John P.

AU - Chandler, James P.

AU - Yuen, Kevin C.J.

AU - White, William L.

AU - Little, Andrew S.

AU - Valappil, Benita

AU - Dacey, Ralph

AU - Zipfel, Gregory

AU - Kim, Albert

AU - Evans, John

AU - Lesniak, Matt S.

AU - Bloch, Orin

AU - Amidei, Christina

AU - Tongco, Caryl

AU - Hoskins, Bridget

AU - Smith, Timothy R.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE: To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS: Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS: Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5%; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION: This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.

AB - BACKGROUND: A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE: To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS: Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS: Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5%; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION: This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.

KW - Adenoma

KW - Extent of resection

KW - Grading scale

KW - Pituitary

KW - Residual

KW - Transsphenoidal

UR - http://www.scopus.com/inward/record.url?scp=85073176522&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073176522&partnerID=8YFLogxK

U2 - 10.1093/ons/opy401

DO - 10.1093/ons/opy401

M3 - Article

C2 - 30649445

AN - SCOPUS:85073176522

VL - 17

SP - 460

EP - 469

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 5

ER -