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01-12-2024 | Pituitary Adenoma | Original Article

Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score

Authors: Alberto Acitores Cancela, Víctor Rodríguez Berrocal, Hector Pian Arias, Juan José Díez Gómez, Pedro Iglesias Lozano

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

Pituitary adenomas (PAs) usually have a soft consistency, facilitating gross total resection. However, 5–13% of PAs with fibrous consistency are challenging to remove entirely and are accompanied by greater morbimortality. This study aims to identify the clinical and radiological characteristics that correlate with PA fibrous consistency preoperatively. A simple scoring system has been proposed to predict incidence of fibrous PAs.

Materials and methods

Consecutive interventions (226) were analyzed, all performed through an endoscopic endonasal transsphenoidal approach. Univariable and multivariable logistic regression analysis was performed. Hosmer–Lemeshow test and receiver operating characteristic (ROC) curves were assessed to evaluate the model. A point scoring system (PiTCon) was derived based on the multivariable regression model. Our study aimed to identify the clinical and radiological characteristics that correlate with fibrous tumor consistency preoperatively.

Results

The best diagnostic accuracy for predicting PA consistency consisted of five predictive factors: age, compressive symptoms, panhypopituitarism, craniocaudal extension of the PA in mm, and prior surgery. The multivariable model achieved good discrimination with an area under the curve (AUC) of the ROC curve being 0.82 and the 95% CI 0.76 to 0.88. Internal validation yielded an optimism-adjusted C-statistic of 0.80 (95% CI 0.74 to 0.86). A point scoring system (PiTCon score) was designed using the best predictive model.

Conclusions

PA consistency can be estimated preoperatively regarding clinical and radiological characteristics. We propose a point-based scoring system (PiTCon score) that can better guide neurosurgeons in clinical decision-making and surgical risk assessment and help establish and describe patient prognosis.

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Abe T, Iwata T, Kawamura N, Izumiyama H, Ikeda H, Matsumoto K (1997) Staged transsphenoidal surgery for fibrous nonfunctioning pituitary adenomas with suprasellar extension. Neurol Med Chir (Tokyo) 37:830–837. https://doi.org/10.2176/nmc.37.830CrossRefPubMed

Acitores Cancela A, Rodríguez Berrocal V, Pian Arias H, Díez JJ, Iglesias P (2022) Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery. Endocrine. https://doi.org/10.1007/s12020-022-03161-1CrossRefPubMed

Acitores Cancela A, Rodríguez Berrocal V, Pian H, Martínez San Millán JS, Díez JJ, Iglesias P (2021) Clinical relevance of tumor consistency in pituitary adenoma. Hormones 20:463–473. https://doi.org/10.1007/s42000-021-00302-5CrossRefPubMed

Araujo-Castro M, Pascual-Corrales E, Martínez San Millan JS, Rebolleda G, Pian H, Ruz-Caracuel I, De Los Santos Granados G, Ley Urzaiz L, Escobar-Morreale HF, Rodríguez Berrocal V (2020) Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish pituitary tumor center of excellence. Endocrine 69:5–17. https://doi.org/10.1007/s12020-020-02247-yCrossRefPubMed

Azab WA, Nasim K, Abdelnabi EA, Yousef W, Najibullah M, Khan T, Zaidan SN, Bokeris AA, Mostafa KH, Geng D (2019) Endoscopic endonasal excision of large and giant pituitary adenomas: radiological and intraoperative correlates of the extent of resection. World Neurosurg 126:e793–e802. https://doi.org/10.1016/j.wneu.2019.02.151CrossRefPubMed

Bhimani AD, Schupper AJ, Arnone GD, Chada D, Chaker AN, Mohammadi N, Hadjipanayis CG, Mehta AI (2022) Size matters: rethinking of the sizing classification of pituitary adenomas based on the rates of surgery: a multi-institutional retrospective study of 29,651 patients. J Neurol Surgery, Part B Skull Base 83:66–75. https://doi.org/10.1055/s-0040-1716673CrossRef

Cappelletti M, Ruggeri AG, Spizzichino L, D’Amico A, D’avella E, Delfini R (2019) Fibrous pituitary macroadenomas: predictive role of preoperative radiologic investigations for proper surgical planning in a cohort of 66 patients. World Neurosurg 121:e449–e457. https://doi.org/10.1016/j.wneu.2018.09.137CrossRefPubMed

Černý M, Sedlák V, Lesáková V, Francůz P, Netuka D (2023) Methods of preoperative prediction of pituitary adenoma consistency: a systematic review. Neurosurg Rev 46. https://doi.org/10.1007/s10143-022-01909-x

Cohen-Cohen S, Helal A, Yin Z, Ball MK, Ehman RL, Van Gompel JJ, Huston J (2022) Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg 136:1356–1363. https://doi.org/10.3171/2021.6.JNS204425CrossRefPubMed

10.

Ding W, Huang Z, Zhou G, Li L, Zhang M, Li Z (2021) Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma. Neurosurg Rev. https://doi.org/10.1007/s10143-020-01469-yCrossRefPubMed

11.

De Alcubierre D, Puliani G, Cozzolino A, Hasenmajer V, Minnetti M, Sada V, Martines V, Zaccagnino A, Ruggeri AG, Pofi R, Sbardella E, Venneri MA (2023) Pituitary adenoma consistency affects postoperative hormone function: a retrospective study. BMC Endocr Disord 23:1–12. https://doi.org/10.1186/s12902-023-01334-1CrossRef

12.

Farrell CJ, Garzon-Muvdi T, Fastenberg JH, Nyquist GG, Rabinowitz MR, Rosen MR, Evans JJ (2019) Management of nonfunctioning recurrent pituitary adenomas. Neurosurg Clin N Am 30:473–482. https://doi.org/10.1016/j.nec.2019.05.006CrossRefPubMed

13.

Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman CH, Gardner PA (2018) Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg 129:430–441. https://doi.org/10.3171/2017.2.JNS162214CrossRefPubMed

14.

Fiore G, Bertani GA, Conte G, Ferrante E, Tariciotti L, Kuhn E, Runza L, Pluderi M, Borsa S, Caroli M, Sala E, Platania G, Kremenova K, Ferrero S, Triulzi FM, Mantovani G, Locatelli M (2023) Predicting tumor consistency and extent of resection in non-functioning pituitary tumors. Pituitary. https://doi.org/10.1007/s11102-023-01302-xCrossRefPubMed

15.

Jang JH, Kim KH, Lee YM, Kim JS, Kim YZ (2016) Surgical results of pure endoscopic endonasal transsphenoidal surgery for 331 pituitary adenomas: a 15-year experience from a single institution. World Neurosurg 96:545–555. https://doi.org/10.1016/j.wneu.2016.09.051CrossRefPubMed

16.

Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space. Neurosurgery 33:610–618. https://doi.org/10.1227/00006123-199310000-00008CrossRefPubMed

17.

Lagerstrand K, Gaedes N, Eriksson S, Farahmand D, De Coursey E, Johansson G, Jönsson L, Skoglund T (2021) Virtual magnetic resonance elastography has the feasibility to evaluate preoperative pituitary adenoma consistency. Pituitary 24:530–541. https://doi.org/10.1007/s11102-021-01129-4CrossRefPubMedPubMedCentral

18.

Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL (2010) A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery 66:702–713. https://doi.org/10.1227/01.NEU.0000367555.16733.E1CrossRefPubMed

19.

Mastorakos P, Mehta GU, Chatrath A, Moosa S, Lopes MB, Payne SC, Jane JA (2019) Tumor to cerebellar peduncle T2-weighted imaging intensity ratio fails to predict pituitary adenoma consistency. J Neurol Surgery, Part B Skull Base 80:252–257. https://doi.org/10.1055/s-0038-1668516CrossRef

20.

Mendi BAR, Batur H, Çay N, Çakır BT (2023) Radiomic analysis of preoperative magnetic resonance imaging for the prediction of pituitary adenoma consistency. Acta Radiol 64:2470–2478. https://doi.org/10.1177/02841851231174462CrossRefPubMed

21.

Micko A, Oberndorfer J, Weninger WJ, Vila G, Höftberger R, Wolfsberger S, Knosp E (2020) Challenging Knosp high-grade pituitary adenomas. J Neurosurg 132:1739–1746. https://doi.org/10.3171/2019.3.JNS19367CrossRef

22.

Mooney MA, Sarris CE, Zhou JJ, Barkhoudarian G, Chicoine MR, Fernandez-Miranda JC, Gardner PA, Hardesty DA, Jahnke H, Kelly DF, Liebelt BD, Mayberg MR, Prevedello DM, Sfondouris J, Sheehy JP, Chandler JP, Yuen KCJ, White WL, Little AS, Valappil B, Dacey R, Zipfel G, Kim A, Evans J, Lesniak MS, Bloch O, Amidei C, Tongco C, Hoskins B, Smith TR (2019) Proposal and validation of a simple grading scale (TRANSSPHER grade) for predicting gross total resection of nonfunctioning pituitary macroadenomas after transsphenoidal surgery. Oper Neurosurg 17:460–469. https://doi.org/10.1093/ons/opy401CrossRef

23.

Ostrom QT, Patil N, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS (2020) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013–2017. Neuro Oncol 22:iv1–iv96. https://doi.org/10.1093/neuonc/noaa200CrossRefPubMedPubMedCentral

24.

Rutkowski MJ, Chang K, Cardinal T, Du R, Tafreshi AR, Donoho DA, Brunswick A, Micko A, Liu CJ, Shiroishi MS, Carmichael JD, Zada G (2021) Development and clinical validation of a grading system for pituitary adenoma consistency. J Neurosurg 134:1800–1807. https://doi.org/10.3171/2020.4.JNS193288CrossRef

25.

Rutland JW, Loewenstern J, Ranti D, Tsankova NM, Bellaire CP, Bederson JB, Delman BN, Shrivastava RK, Balchandani P (2021) Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J Neurosurg 134:771–779. https://doi.org/10.3171/2019.12.JNS192940CrossRef

26.

Schur S, Lasry O, Tewfik MA, Di Maio S (2020) Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery. Interdiscip Neurosurg Adv Tech Case Manag 20. https://doi.org/10.1016/j.inat.2019.100628

27.

Su CQ, Zhang X, Pan T, Chen XT, Chen W, Duan SF, Ji J, Hu WX, Lu SS, Hong XN (2019) Texture analysis of high b-value diffusion-weighted imaging for evaluating consistency of pituitary macroadenomas. J Magn Reson Imaging 1–7. https://doi.org/10.1002/jmri.26941

28.

Thotakura AK, Patibandla MR, Panigrahi MK, Mahadevan A (2017) Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie 63:453–457. https://doi.org/10.1016/j.neuchi.2017.06.003CrossRefPubMed

29.

Wacholder S, Silverman DT, McLaughlin JK, Mandel JS (1992) Selection of controls in case-control studies: II. Types of controls. Am J Epidemiol 135:1029–1041. https://doi.org/10.1093/oxfordjournals.aje.a116397CrossRefPubMed

30.

Wang H, Zhang W, Li S, Fan Y, Feng M, Wang R (2021) Development and evaluation of deep learning-based automated segmentation of pituitary adenoma in clinical task. J Clin Endocrinol Metab 106:2535–2546. https://doi.org/10.1210/clinem/dgab371CrossRefPubMed

31.

Yamamoto J, Kakeda S, Shimajiri S, Takahashi M, Watanabe K, Kai Y, Moriya J, Korogi Y, Nishizawa S (2014) Tumor consistency of pituitary macroadenomas: predictive analysis on the basis of imaging features with contrast-enhanced 3D FIESTA at 3T. Am J Neuroradiol 35:297–303. https://doi.org/10.3174/ajnr.A3667CrossRefPubMedPubMedCentral

32.

Yao A, Rutland JW, Verma G, Banihashemi A, Padormo F, Tsankova NM, Delman BN, Shrivastava RK, Balchandani P (2020) Pituitary adenoma consistency: direct correlation of ultrahigh field 7T MRI with histopathological analysis. Eur J Radiol 126. https://doi.org/10.1016/j.ejrad.2020.108931

33.

Yiping L, Ji X, Daoying G, Bo Y (2016) Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J Neuroradiol 43:186–194. https://doi.org/10.1016/j.neurad.2015.09.003CrossRefPubMed

34.

Yun JJ, Johans SJ, Shepherd DJ, Martin B, Joyce C, Borys E, Reddy AS, Patel CR, Germanwala AV (2020) The utility of using preoperative MRI as a predictor for intraoperative pituitary adenoma consistency and surgical resection technique. J Neurol Surgery, Part B Skull Base 81:651–658. https://doi.org/10.1055/s-0039-1694049CrossRef

35.

Zeynalova A, Kocak B, Durmaz ES, Comunoglu N, Ozcan K, Ozcan G, Turk O, Tanriover N, Kocer N, Kizilkilic O, Islak C (2019) Preoperative evaluation of tumour consistency in pituitary macroadenomas: a machine learning-based histogram analysis on conventional T2-weighted MRI. Neuroradiology 61:767–774. https://doi.org/10.1007/s00234-019-02211-2CrossRefPubMed

36.

Zhang X, Fei Z, Zhang W, Zhang J-n, Liu W-p, Fu L-a, Cao W-d, Jiang X-f, Song S-J (2008) Endoscopic endonasal transsphenoidal surgery for invasive pituitary adenoma. J Clin Neurosci 15:241–245. https://doi.org/10.1016/j.jocn.2007.03.008CrossRefPubMed

Title: Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score
Authors: Alberto Acitores Cancela
Víctor Rodríguez Berrocal
Hector Pian Arias
Juan José Díez Gómez
Pedro Iglesias Lozano
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Pituitary Adenoma
Panhypopituitarism
Hypopituitarism
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05976-5

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Springer Medicine

Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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