P.021 Surgical management of incidentally discovered diffusely infiltrating glioma

Opoku-Darko, Michael; Lang, Sonja; Kelly, J. C.; Cadieux, Magalie

doi:10.1017/cjn.2017.106

Cited by 3 publications

(4 citation statements)

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“…Incidental gliomas pose a challenge to treating physicians because of their rarity and lack of clear guidelines. This study identi ed 14% of all cases to be incidental, which is consistent with previous ndings [25][26][27][28][29][30]. Enabling easy access to imaging, especially MRI, the number of incidental tumors is expected to further increase, which underpins the importance of studies on incidental gliomas to gain a better understanding for the best possible treatment option.…”

Section: Discussionsupporting

confidence: 89%

“…[31,32] Furthermore, a lower preoperative tumor volume enhances the probability of a gross total resection (GTR) of iLGG. Further, better postoperative performance scores and low risk of permanent neurological de cits in iLGG have been shown in previous studies [6,27,29]. A "wait and see" ("wait and scan") strategy allows the tumor to enlarge longitudinally, as this has been described by Pallud et al [31,32].…”

Section: Discussionmentioning

confidence: 69%

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Differences in molecular characteristics and overall survival between incidental and symptomatic lower grade gliomas

Demetz

Krigers

Moser

et al. 2023

Preprint

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Purpose: Data on differences in overall survival and molecular characteristics between incidental (iLGG) and symptomatic lower grade Glioma (sLGG) are limited. The aim of this study was to investigate differences between patients with iLGG and sLGG. Methods: All adult patients with a histologically proven diffuse (WHO°II) or anaplastic (WHO°III) glioma who underwent their first surgery at the authors’ institution between 2010 and 2019 were retrospectively included. Tumor volume on pre- and postoperative MRI scans was determined. Clinical and routine neuropathological data were gained from patients’ charts. Results: Out of 161 patients included, 23 (14%) were diagnosed as incidental findings. Main reasons for obtaining MRI were: headache(n=12), trauma(n=2), MRI indicated by other departments(n=7), staging examination for cancer(n=1), volunteering for MRI sequence testing(n=1). The asymptomatic patients were significantly younger with a median age of 38 years (IqR28-48) vs. 50 years (IqR38-61), p=0.011. Incidental LGG showed significantly lower preoperative tumor volumes in T1 CE (p=0.008), FLAIR (p=0.038) and DWI (p=0.028). Incidental LGG demonstrated significantly lower anaplasia levels (p=0.004) and lower expression of MIB-1 (p=0.008) compared to sLGG. IDH1-mutation was significantly more common in iLGG (p=0.024). Incidental LGG showed a significantly longer OS (mean 212 vs 70 months, p=0.005) and PFS (mean 201 vs 61 months, p=0.001) compared to sLGG. Conclusion: Our study is the first to depict a significant difference in molecular characteristics between iLGG and sLGG. The findings of this study confirmed and extended the results of previous studies showing a better outcome and more favorable radiological, volumetric and neuropathological features of iLGG.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 69%

Differences in molecular characteristics and overall survival between incidental and symptomatic lower grade gliomas

Demetz

Krigers

Moser

et al. 2023

Preprint

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“…Previous studies of IDG included tumors that came to attention during workup for headache 18,[25][26][27] . We elected to exclude such cases as there was no instance in our series of a tumor detected in persons with a long-standing headache disorder during a purely 'routine' imaging study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of asymptomatic glioma and implications for survival

Lobbous

et al. 2020

Preprint

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Background: Brain tumors can present as focal neurologic deficits (reflecting the tumor location) or generalized symptoms due to increased intracranial pressure. Occasionally, brain tumors can be found incidentally in asymptomatic patients or in patients with unrelated symptoms who undergo brain imaging. The term incidentaloma is used to refer to these imaging abnormalities. Objective: The object of this study was to examine the prevalence and correlates of asymptomatic glioma in a large epidemiological study of brain tumors. Methods: The analysis was based on a large series of patients with glioma (N = 1989) enrolled in a multicenter clinic-based epidemiologic study between 2005 and 2017. Patients were considered asymptomatic from the tumor, and thus as having an incidentally detected glioma (IDG), if the tumor was diagnosed during workup of injury or unrelated medical condition. Results: A total of 32 of 1989 (1.6%) patients were asymptomatic at diagnosis. The leading indication for brain imaging in IDG was non-workplace injuries followed by medical workup for unrelated conditions. IDG was more prevalent in patients younger than 50 years of age (2.6% vs 1.0%). IDG was also more common in patients with low grade gliomas (4.7% for WHO grade II and 1.5% for WHO grade III) vs glioblastomas (0.6% in WHO grade IV). Conclusion: The present data suggest that gliomas may be found incidentally, especially among low grade gliomas. Studies of IDG may be useful as a proxy for early detection of tumor as a means to improve patient survival.

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“…[5][6][7] Further, the approach of watchful waiting for LGG has been associated with a worse overall survival and a higher risk of malignant transformation. 8 We and others have shown that early surgical intervention for iLGG is associated with a better extent of resection (EOR) and improved survival 6,[9][10][11][12] perhaps because incidental lesions are usually smaller and located in noneloquent areas. 9 Further, improvements in mapping and monitoring techniques have meant that even incidental lesions within eloquent regions can often be safely resected.…”

mentioning

confidence: 99%

Surgical management of incidentally discovered low-grade gliomas

Gogos

Young

Pereira

et al. 2021

Journal of Neurosurgery

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OBJECTIVEAlthough most patients with low-grade glioma (LGG) present after a seizure, a small proportion is diagnosed after neuroimaging is performed for a sign or symptom unrelated to the tumor. While these tumors invariably grow, some surgeons argue for a watchful waiting approach. Here, the authors report on their experience in the surgical treatment of patients with incidental LGG (iLGG) and describe the neurological outcomes, survival, and complications.METHODSRelevant cases were identified from a prospective registry of patients undergoing glioma resection at the University of California, San Francisco, between 1997 and 2019. Cases were considered iLGG when the lesion was noted on imaging performed for a reason unrelated to the tumor. Demographic, clinical, pathological, and imaging data were extracted from the electronic medical record. Tumor volumes, growth, and extent of resection were calculated from pre- and postoperative volumetric FLAIR sequences.RESULTSOne hundred thirteen of 657 (17.2%) first-time resections for LGG were for incidental lesions. The most common reasons for the discovery of an iLGG were headaches (without mass effect, 34.5%) or trauma (16.8%). Incidental tumors were no different from symptomatic lesions in terms of laterality or location, but they were significantly smaller (22.5 vs 57.5 cm3, p < 0.0001). There was no difference in diagnosis between patients with iLGG and those with symptomatic LGG (sLGG), incorporating both molecular and pathological data. The median preoperative observation time for iLGG was 3.1 months (range 1 month–12 years), and there was a median growth rate of 3.9 cm3/year. Complete resection of the FLAIR abnormality was achieved in 57% of patients with incidental lesions but only 23.8% of symptomatic lesions (p < 0.001), and the residual volumes were smaller for iLGGs (2.9 vs 13.5 cm3, p < 0.0001). Overall survival was significantly longer for patients with incidental tumors (median survival not reached for patients with iLGG vs 14.6 years for those with sLGG, p < 0.0001). There was a 4.4% rate of neurological deficits at 6 months.CONCLUSIONSThe authors present the largest cohort of iLGGs. Patient age, tumor location, and molecular genetics were not different between iLGGs and sLGGs. Incidental tumors were smaller, a greater extent of resection could be achieved, and overall survival was improved compared to those for patients with sLGG. Operative morbidity and rates of neurological deficit were acceptably low; thus, the authors advocate upfront surgical intervention aimed at maximal safe resection for these incidentally discovered lesions.

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P.021 Surgical management of incidentally discovered diffusely infiltrating glioma

Cited by 3 publications

References 0 publications

Differences in molecular characteristics and overall survival between incidental and symptomatic lower grade gliomas

Differences in molecular characteristics and overall survival between incidental and symptomatic lower grade gliomas

Prevalence of asymptomatic glioma and implications for survival

Surgical management of incidentally discovered low-grade gliomas

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