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Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification.
Pituitary 2019; 22(5):467-475P

Abstract

PURPOSE

Cavernous sinus invasion by pituitary adenomas is an important prognostic factor for evaluating the possibilities of complete remission and to guide patient management. A widely used Magnetic Resonance Imaging grading system, suggested by Knosp in 1993, has recently been revised by the same group. The aims of our study were to apply this revised grading system to our surgical series, to determine its association with surgical outcomes, gross-total resection (GTR) and endocrinological remission (ER), paying particular attention to grades 3A and 3B, which represent the novelty of this revised classification.

METHODS

We included consecutive patients who underwent endoscopic endonasal surgery for a macroadenoma from September 2012 to December 2016. MRI images were reviewed and classified according to the revised Knosp classification. Surgical reports indicated the intra-operative CS invasion. GTR and ER were evaluated on 3-months post-operative MRI and endocrine evaluation.

RESULTS

254 patients were included in this study. We found a total rate of cavernous sinus invasion of 18.4%. Different outcomes were observed for each grade, with an increased rate of cavernous sinus invasion with each grade. Per-operative rates of invasion were 61.5 and 78.6% in grades 3A and 3B respectively. GTR was negatively correlated with the grade, while rates were 55.8% and 30.0% for grades 3A and 3B respectively.

CONCLUSION

The revised Knosp radiological classification contributes to the prediction of surgical outcomes and early ER in pituitary adenomas. To manage, as precisely as possible, the risk of early recurrence in pituitary adenomas, clinicians should also consider other recognized prognostic factors, such as the proliferative status of the tumor.

Authors+Show Affiliations

Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France. Service d'Endocrinologie, Diabète, Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre-Bénite, France. Université Lyon 1, 69100, Villeurbanne, France.Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.Université Lyon 1, 69100, Villeurbanne, France. Hospices Civils de Lyon, Service de Biostatistiques et Bio-informatique, 69003, Lyon, France. CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe de Biostatistiques-Santé, 69100, Villeurbanne, France.Université Lyon 1, 69100, Villeurbanne, France. INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France. Centre de Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France.Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France. Université Lyon 1, 69100, Villeurbanne, France.Université Lyon 1, 69100, Villeurbanne, France. INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France. Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France.Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France. gerald.raverot@chu-lyon.fr. Université Lyon 1, 69100, Villeurbanne, France. gerald.raverot@chu-lyon.fr. INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France. gerald.raverot@chu-lyon.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31286328

Citation

Buchy, Marie, et al. "Predicting Early Post-operative Remission in Pituitary Adenomas: Evaluation of the Modified Knosp Classification." Pituitary, vol. 22, no. 5, 2019, pp. 467-475.
Buchy M, Lapras V, Rabilloud M, et al. Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification. Pituitary. 2019;22(5):467-475.
Buchy, M., Lapras, V., Rabilloud, M., Vasiljevic, A., Borson-Chazot, F., Jouanneau, E., & Raverot, G. (2019). Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification. Pituitary, 22(5), pp. 467-475. doi:10.1007/s11102-019-00976-6.
Buchy M, et al. Predicting Early Post-operative Remission in Pituitary Adenomas: Evaluation of the Modified Knosp Classification. Pituitary. 2019;22(5):467-475. PubMed PMID: 31286328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification. AU - Buchy,Marie, AU - Lapras,Véronique, AU - Rabilloud,Muriel, AU - Vasiljevic,Alexandre, AU - Borson-Chazot,Françoise, AU - Jouanneau,Emmanuel, AU - Raverot,Gérald, PY - 2019/7/10/pubmed PY - 2019/7/10/medline PY - 2019/7/10/entrez KW - Cavernous sinus KW - Classification KW - Pituitary adenoma KW - Prognosis KW - Remission SP - 467 EP - 475 JF - Pituitary JO - Pituitary VL - 22 IS - 5 N2 - PURPOSE: Cavernous sinus invasion by pituitary adenomas is an important prognostic factor for evaluating the possibilities of complete remission and to guide patient management. A widely used Magnetic Resonance Imaging grading system, suggested by Knosp in 1993, has recently been revised by the same group. The aims of our study were to apply this revised grading system to our surgical series, to determine its association with surgical outcomes, gross-total resection (GTR) and endocrinological remission (ER), paying particular attention to grades 3A and 3B, which represent the novelty of this revised classification. METHODS: We included consecutive patients who underwent endoscopic endonasal surgery for a macroadenoma from September 2012 to December 2016. MRI images were reviewed and classified according to the revised Knosp classification. Surgical reports indicated the intra-operative CS invasion. GTR and ER were evaluated on 3-months post-operative MRI and endocrine evaluation. RESULTS: 254 patients were included in this study. We found a total rate of cavernous sinus invasion of 18.4%. Different outcomes were observed for each grade, with an increased rate of cavernous sinus invasion with each grade. Per-operative rates of invasion were 61.5 and 78.6% in grades 3A and 3B respectively. GTR was negatively correlated with the grade, while rates were 55.8% and 30.0% for grades 3A and 3B respectively. CONCLUSION: The revised Knosp radiological classification contributes to the prediction of surgical outcomes and early ER in pituitary adenomas. To manage, as precisely as possible, the risk of early recurrence in pituitary adenomas, clinicians should also consider other recognized prognostic factors, such as the proliferative status of the tumor. SN - 1573-7403 UR - https://www.unboundmedicine.com/medline/citation/31286328/Predicting_early_post-operative_remission_in_pituitary_adenomas:_evaluation_of_the_modified_knosp_classification L2 - https://doi.org/10.1007/s11102-019-00976-6 DB - PRIME DP - Unbound Medicine ER -