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Published on: February 24, 2021
Brain invasion as a diagnostic histological feature of atypical meningiomas: Not a standalone diagnostic criterion
Li Zhang1,2, Lei Lou3, Weiwei Fu4
1Department of Pathology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Background:
WHO classifies brain invasion as an independent criterion for atypical meningiomas, though its prognostic value remains debated.
Methods:
This study retrospectively analyzed 1,476 primary meningiomas diagnosed at the First Affiliated Hospital of Fujian Medical University (1997-2021) using Cox regression and Kaplan-Meier (K-M) analysis for recurrence and recurrence-free survival (RFS).
Results:
Brain-invasive otherwise benign (BIOB) meningiomas had lower recurrence rates than classical WHO grade 2 (cWHO2) (P = .001) and comparable rates to WHO grade 1 (P = .986). K-M analysis showed longer RFS for BIOB than cWHO2 (P = .001) but shorter than WHO grade 1 (P = .031). BIOB meningiomas were subclassified into BIOB with two atypical histological features (BIOB + 2) and BIOB with zero or one (BIOB + 0/1); cWHO2 meningiomas were subclassified into those meeting only atypical histologic criteria (cWHO2 (h)), only mitotic criteria (cWHO2 (m)), or both (cWHO2 (h + m)). No significant differences in RFS among BIOB + 2, cWHO2 (h), and cWHO2 (m) (all P > .05). RFS for BIOB + 2, cWHO2(h), and cWHO2(m) were superior to that of WHO1 and BIOB + 0/1 (all P < .05), but inferior to that of cWHO2 (h + m) (all P < .05). RFS of BIOB + 0/1 was not significantly different from WHO grade 1 (P = .449), and both were inferior to BIOB + 2, cWHO2 (h), cWHO2 (m), and cWHO2 (h + m) (all P < .05).
Conclusion:
These findings suggest that brain invasion alone is insufficient for diagnosing atypical meningiomas and should be considered alongside additional histological features for risk stratification.
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