Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers

Abstract

Purpose The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria for Pituitary Tumor Centers of Excellence (PTCOEs) based on expert consensus. Aim of the study was to validate those previously proposed criteria through collection and evaluation of self-reported activity of several internationally-recognized tertiary pituitary centers, thereby transforming the qualitative 2017 definition into a validated quantitative one, which could serve as the basis for future objective PTCOE accreditation. Methods An ad hoc prepared database was distributed to nine Pituitary Centers chosen by the Project Scientific Committee and comprising Centers of worldwide repute, which agreed to provide activity information derived from registries related to the years 2018–2020 and completing the database within 60 days. The database, provided by each center and composed of Excel® spreadsheets with requested specific information on leading and supporting teams, was reviewed by two blinded referees and all 9 candidate centers satisfied the overall PTCOE definition, according to referees’ evaluations. To obtain objective numerical criteria, median values for each activity/parameter were considered as the preferred PTCOE definition target, whereas the low limit of the range was selected as the acceptable target for each respective parameter. Results Three dedicated pituitary neurosurgeons are preferred, whereas one dedicated surgeon is acceptable. Moreover, 100 surgical procedures per center per year are preferred, while the results indicated that 50 surgeries per year are acceptable. Acute post-surgery complications, including mortality and readmission rates, should preferably be negligible or nonexistent, but acceptable criterion is a rate lower than 10% of patients with complications requiring readmission within 30 days after surgery. Four endocrinologists devoted to pituitary diseases are requested in a PTCOE and the total population of patients followed in a PTCOE should not be less than 850. It appears acceptable that at least one dedicated/expert in pituitary diseases is present in neuroradiology, pathology, and ophthalmology groups, whereas at least two expert radiation oncologists are needed. Conclusion This is, to our knowledge, the first study to survey and evaluate the activity of a relevant number of high-volume centers in the pituitary field. This effort, internally validated by ad hoc reviewers, allowed for transformation of previously formulated theoretical criteria for the definition of a PTCOE to precise numerical definitions based on real-life evidence. The application of a derived synopsis of criteria could be used by independent bodies for accreditation of pituitary centers as PTCOEs.

Multidisciplinary Team Care in Pituitary Tumours

“…The pursuit of excellence in delivering the best care to patients with pituitary tumours and other sellar lesions, including craniopharyngiomas or Rathke’s cleft cysts, has led to the implementation of Pituitary MDT/PTCOE. Pituitary MDT/PTCOE are now widely recommended by different guidelines and medical societies relevant in the field [ 2 , 10 , 11 , 22 , 23 ]. The definition criteria of PTCOE have been proposed [ 10 ], and further validated in a survey of several internationally recognised tertiary centres [ 11 ].…”

“…Pituitary MDT/PTCOE are now widely recommended by different guidelines and medical societies relevant in the field [ 2 , 10 , 11 , 22 , 23 ]. The definition criteria of PTCOE have been proposed [ 10 ], and further validated in a survey of several internationally recognised tertiary centres [ 11 ]. Organising and delivering multidisciplinary management by experienced pituitary neurosurgeons and endocrinologists, with the support of other key specialists, is critical to the definition of Pituitary MDT/PTCOE [ 10 , 11 , 12 ].…”

“…The mission and main clinical goals of the Pituitary MDT/PTCOE are summarised in Table 1 . Ultimately, the key goal is to eliminate, or at least reduce, the excess morbidity and mortality due to pituitary tumours, pituitary hypersecretion syndromes, and other disorders affecting the pituitary, as well as manage the anterior or posterior pituitary hormone deficiencies [ 8 , 10 , 11 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. For most patients, this requires the establishment of a complex program of care and the need for long-term follow-up [ 10 , 11 ].…”

“…Pituitary MDT/PTCOE have only been implemented in recent years; thus, formal definitions are still controversial. However, defining the scope and structure of Pituitary MDT/PTCOE has been addressed by relevant societies in the field, including the Pituitary Society [ 10 , 11 ], and the European Reference Network on Rare Endocrine Conditions (Endo-ERN) [ 26 , 27 ].…”

“…The above-mentioned aspects, together with the challenging anatomical location of the pituitary and its relationship with key structures such as the optic chiasm, impose several difficulties on the management of patients with pituitary tumours. Hence, the best care for pituitary tumour patients is provided by an experienced MDT working in an interdisciplinary and collaborative manner within the frame of a Pituitary MDT or Pituitary Tumour Centre of Excellence (PTCOE) [ 10 , 11 , 12 ].…”