The Diagnostic Accuracy And Reproducibility For Glioma Histological Diagnosis Are Suboptimal.

SPECIAL ARTICLE
TOPIC SPECIAL ARTICLE

´ Stephanie Puget, MD, PhD*‡ Nathalie Boddaert, MD, PhD§ Anne-Sophie Veillard, MD{ Mathew Garnett, MDk Catherine Miquel, MD, PhD#** Felipe Andreiuolo, MD‡ Christian Sainte-Rose, MD, PhD* Thomas Roujeau, MD* Federico DiRocco, MD* Marie Bourgeois, MD* Michel Zerah, MD* Francois Doz, MD, PhD‡‡ x Jacques Grill, MD, PhD‡§§ Pascale Varlet, MD, PhD#
ˆ*Department of Neurosurgery, Hopital ´ Necker Enfants Malades, Universite Paris Descartes, Paris, France; ‡UPRES EA3535, Gustave Roussy Institute, Villejuif, France; ˆ §Department of Neuroradiology, Hopital ´ Necker Enfants Malades, Universite Paris Descartes, Paris, France; {Biostatistics and Epidemiology Department, Gustave Roussy Institute, Villejuif, France; kDepartment of Neurosurgery, AddenbrookesHospital, Cambridge, United Kingdom; #Department of Pathology, Sainte-Anne Hospital, ´ Universite Paris Descartes, Paris, France; **UMR Inserm U894; Centre Paul Broca, ´ Universite Paris Descartes, Paris, France; ‡‡Department of Pediatric and Oncology, Curie Institute, Paris, France; §§Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France Correspondence:´phanie Puget, MD, PhD, Ste Department of Neurosurgery, Hopital Necker Enfants Malades, ´ Universite Paris Descartes, `vres, 149 Rue de Se 75015 Paris, France. E-mail: stephanie.puget@nck.aphp.fr Received, January 12, 2010. Accepted, January 4, 2011. Published Online, March 2, 2011. Copyright ª 2011 by the Congress of Neurological Surgeons

Neuropathological and Neuroradiological Spectrum of PediatricMalignant Gliomas: Correlation With Outcome
BACKGROUND: The diagnostic accuracy and reproducibility for glioma histological diagnosis are suboptimal. OBJECTIVE: To characterize radiological and histological features in pediatric malignant gliomas and to determine whether they had an impact on survival. METHODS: We retrospectively reviewed a series of 96 pediatric malignant gliomas. Allhistological samples were blindly and independently reviewed and classified according to World Health Organization 2007 and Sainte-Anne classifications. Radiological features were reviewed independently. Statistical analyses were performed to investigate the relationship between clinical, radiological, and histological features and survival. RESULTS: Cohort median age was 7.8 years; median follow-up was 4.8years. Tumors involved cerebral hemispheres or basal ganglia in 82% of cases and brainstem in the remaining 18%. After histopathological review, low-grade gliomas and nonglial tumors were excluded (n = 27). The World Health Organization classification was not able to demonstrate differences between groups and patients survival. The Sainte-Anne classification identified a 3-year survival ratedifference between the histological subgroups (oligodendroglioma A, oligodendroglioma B, malignant glioneuronal tumors, and glioblastomas; P = .02). The malignant glioneuronal tumor was the only glioma subtype with specific radiological features. Tumor location was significantly associated with 3-year survival rate (P = .005). Meningeal attachment was the only radiological criteria associated withlonger survival (P = .02). CONCLUSION: The Sainte-Anne classification was better able to distinguish pediatric malignant gliomas in terms of survival compared with the World Health Organization classification. In this series, neither of these 2 histological classifications provided a prognostic stratification of the patients.
KEY WORDS: Children, High-grade astrocytomas, Histological classification,MRI
Neurosurgery 69:215–224, 2011
DOI: 10.1227/NEU.0b013e3182134340

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rain tumors are the most common solid tumors in children and have the highest mortality rate of all solid pediatric tumors. The glial cell tumors account for approximately 60% of all pediatric brain tumors, with 50% of them being high-grade tumors.1 Despite neurooncological advances in...