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

Michael A. Mooney(Barrow Neurological Institute), Christina E. Sarris(Barrow Neurological Institute), James J. Zhou(Barrow Neurological Institute), Garni Barkhoudarian(Saint John's Health Center), Michael R. Chicoine(Washington University in St. Louis), Juan C. Fernandez‐Miranda(University of Pittsburgh), Paul A. Gardner(University of Pittsburgh), Douglas A. Hardesty(Barrow Neurological Institute), Heidi Jahnke(Barrow Neurological Institute), Daniel F. Kelly(Saint John's Health Center), Brandon Liebelt(Barrow Neurological Institute), Marc R Mayberg(University of Washington), Daniel M. Prevedello(The Ohio State University Wexner Medical Center), John Sfondouris(Barrow Neurological Institute), John P. Sheehy(Barrow Neurological Institute), James P. Chandler(Northwestern University), Kevin C.J. Yuen(Barrow Neurological Institute), William L White(Barrow Neurological Institute), Andrew S Little(Barrow Neurological Institute), The TRANSSPHER Study Group(Barrow Neurological Institute), William L White(Barrow Neurological Institute), Andrew S Little(Barrow Neurological Institute), John Sfondouris(Barrow Neurological Institute), Brandon Liebelt(Barrow Neurological Institute), Heidi Jahnke(Barrow Neurological Institute), Paul A. Gardner(University of Pittsburgh), Juan C Fernandez-Miranda(University of Pittsburgh), Benita Valappil(University of Pittsburgh), Michael R Chicoine(Washington University in St. Louis), Ralph G. Dacey(Washington University in St. Louis), Gregory J. Zipfel(Washington University in St. Louis), Albert Kim(Washington University in St. Louis), John A. Evans(Washington University in St. Louis), Daniel F. Kelly(Saint John's Health Center), Garni Barkhoudarian(Saint John's Health Center), Annie Heng(Northwestern University), James P. Chandler(Northwestern University), Matt S Lesniak(Northwestern University), Orin Bloch(Northwestern University), Christina Amidei(Northwestern University), Kevin C J Yuen(Barrow Neurological Institute), Caryl Tongco(University of Washington), Marc R. Mayberg(University of Washington), Daniel M Prevedello(The Ohio State University Wexner Medical Center), B. Hoskins(Harvard University), Timothy R. Smith(Harvard University)
Operative Neurosurgery
January 11, 2019
10.1093/ons/opy401
Cited by 45

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.

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