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Delayed diagnosis of childhood low-grade glioma: causes, consequences, and potential solutions
Aska Arnautovic1, Catherine Billups, Alberto Broniscer
1Pediatric Oncology Education Program, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
Insights
Delayed diagnosis of childhood low-grade gliomas (LGG) contributes to tumor progression. Improving medical education on LGG symptoms is crucial to reduce diagnostic delays and improve outcomes for pediatric brain tumors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Research
Background:
- Diagnosis of childhood brain tumors often faces delays compared to other pediatric cancers.
- The specific impact of low-grade gliomas (LGG), the most common pediatric brain tumors, on diagnostic delays remains under-investigated.
Purpose of the Study:
- To investigate the pre-diagnosis symptom interval (PSI) for childhood low-grade gliomas (LGG).
- To analyze the association of PSI with various clinical factors and outcomes in pediatric LGG cases.
Main Methods:
- Retrospective review of 258 childhood LGG cases diagnosed between 1995-2005.
- Calculation of pre-diagnosis symptom interval (PSI) and analysis of its correlation with age, tumor grade, site, and outcomes.
- Separate reporting for neurofibromatosis type 1 cases.
Main Results:
- Longer PSI was significantly associated with grade I vs. grade II tumors and age >10 years.
- Half of spinal LGG cases had a PSI >6 months.
- PSI correlated with tumor progression in grade I tumors and those outside the posterior fossa; seizures were linked to longer PSI in grade I LGG.
Conclusions:
- Delayed diagnosis of childhood LGG is linked to tumor progression.
- Medical curricula should incorporate LGG into the differential diagnosis of CNS neoplasms to shorten diagnostic times.
- Reducing diagnostic delays is essential for improving outcomes in pediatric brain tumor patients.
Purpose:
Diagnosis of childhood brain tumors is delayed more than diagnosis of other pediatric cancers. However, the contribution of the most common pediatric brain tumors, lowgrade gliomas (LGG), to this delay has never been investigated.
Methods:
We retrospectively reviewed cases of childhood LGG diagnosed from January 1995 through December 2005 at our institution. The pre-diagnosis symptom interval (PSI) was conservatively calculated, and its association with race, sex, age, tumor site, tumor grade, and outcome measures (survival, disease progression, shunt use, seizures, extent of resection) was analyzed. Cases of neurofibromatosis type 1 were reported separately.
Results:
The 258 children had a median follow-up of 11.1 years, and 226 (88 %) remained alive. Greater pre-diagnosis symptom interval (PSI) was significantly associated with grade I (vs. grade II) tumors (p = 0.03) and age >10 years at diagnosis (p = 0.03). Half of the 16 spinal tumors had a PSI > 6 months. PSI was significantly associated with progression (p = 0.02) in grade I tumors (n = 195) and in grade I tumors outside the posterior fossa (n = 134, p = 0.03). Among children with grade I tumors, median PSI was longer in those who had seizures (10.3 months) than in those who did not (2.5 months) (p = 0.09).
Conclusions:
Delayed diagnosis of childhood LGG allows tumor progression. To reduce time to diagnosis, medical curricula should emphasize inclusion of LGG in the differential diagnosis of CNS neoplasm.
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