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Clinicoradiological features of intraneural perineuriomas obviate the need for tissue diagnosis
Thomas J Wilson1, B Matthew Howe2, Shelby A Stewart2
11Department of Neurosurgery, Stanford University, Stanford, California; and.
Objective:
This study aimed to define a set of clinicoradiological parameters with a high specificity for the diagnosis of intraneural perineurioma, obviating the need for operative tissue diagnosis.
Methods:
The authors retrospectively reviewed MR images obtained in a large cohort of patients who underwent targeted fascicular biopsy and included only those patients for whom the biopsy yielded a diagnosis. Clinical and radiological findings were then tested for their ability to predict a tissue diagnosis of intraneural perineurioma. The authors propose a new set of diagnostic criteria, referred to as the Perineurioma Diagnostic Criteria. The sensitivity, specificity, positive predictive value, and negative predictive value of several clinicoradiological methods of diagnosis were compared.
Results:
A total of 195 patients who underwent targeted fascicular biopsy were included in the cohort, of whom 51 had a tissue diagnosis of intraneural perineurioma. When the clinicoradiological methods used in this study were compared, the highest sensitivity (0.86), negative predictive value (0.95), and F1 score (0.88) were observed for the decision trees generated in C5.0 and rPart, whereas the highest specificity (1.0) and positive predictive value (1.0) were observed for the Perineurioma Diagnostic Criteria.
Conclusions:
This study identified clinical and radiological features that are associated with a diagnosis of perineurioma. The Perineurioma Diagnostic Criteria were determined to be the following: 1) no cancer history, 2) unifocal disease, 3) moderate to severe hyperintensity on T2-weighted MR images, 4) moderate to severe contrast enhancement, 5) homogeneous contrast enhancement, 6) fusiform shape, 7) enlargement of the involved nerves, and 8) age ≤ 40 years. Use of the Perineurioma Diagnostic Criteria obviates the need for tissue diagnosis when all of the criteria are satisfied.
Insights
This study introduces the Perineurioma Diagnostic Criteria, a set of clinicoradiological findings that accurately diagnose intraneural perineurioma without surgery. These criteria offer high specificity and positive predictive value, reducing the need for invasive tissue diagnosis.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Intraneural perineurioma diagnosis often requires invasive tissue biopsy.
- Developing non-invasive diagnostic methods is crucial for patient management.
Purpose of the Study:
- To define clinicoradiological parameters for specific diagnosis of intraneural perineurioma.
- To establish criteria that obviate the need for operative tissue diagnosis.
Main Methods:
- Retrospective review of MR images from 195 patients who underwent fascicular biopsy.
- Analysis of clinical and radiological findings to predict tissue diagnosis.
- Comparison of diagnostic performance of various clinicoradiological methods.
Main Results:
- The Perineurioma Diagnostic Criteria demonstrated perfect specificity (1.0) and positive predictive value (1.0).
- Decision trees (C5.0, rPart) showed high sensitivity (0.86) and negative predictive value (0.95).
- The Perineurioma Diagnostic Criteria include no cancer history, unifocal disease, specific MRI characteristics, and patient age.
Conclusions:
- The Perineurioma Diagnostic Criteria provide a highly specific, non-invasive method for diagnosing intraneural perineurioma.
- These criteria can replace the need for tissue diagnosis when all features are met.
- The identified features aid in differentiating perineurioma from other nerve sheath tumors.
