TY - JOUR
T1 - Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients
AU - Geltzeiler, Mathew
AU - Choby, Garret W.
AU - Ji, Keven Seung Yong
AU - JessMace, C.
AU - Almeida, Joao Paulo
AU - de Almeida, John
AU - Champagne, Pierre Olivier
AU - Chan, Erik
AU - Ciporen, Jeremy N.
AU - Chaskes, Mark B.
AU - Cornell, Sarah
AU - Drozdowski, Veronica
AU - Fernandez-Miranda, Juan
AU - Gardner, Paul A.
AU - Hwang, Peter H.
AU - Kalyvas, Aristotelis
AU - Kong, Keonho A.
AU - McMillan, Ryan A.
AU - Nayak, Jayakar V.
AU - Patel, Chirag
AU - Patel, Zara M.
AU - Celda, Maria Peris
AU - Pinheiro-Neto, Carlos
AU - Sanusi, Olabisi R.
AU - Snyderman, Carl H.
AU - Thorp, Brian D.
AU - Van Gompel, Jamie J.
AU - Zadeh, Gelareh
AU - Zenonos, Georgios
AU - Zwagerman, Nathan T.
AU - Wang, Eric W.
N1 - Publisher Copyright:
© 2023 ARS-AAOA, LLC.
PY - 2023/10
Y1 - 2023/10
N2 - Background: Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. Methods: This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). Results: A total of 224 subjects with new diagnoses of ONB (2005–2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: −0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. Conclusions: Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.
AB - Background: Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. Methods: This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). Results: A total of 224 subjects with new diagnoses of ONB (2005–2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: −0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. Conclusions: Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.
KW - esthesioneuroblastoma
KW - neoplasms
KW - olfactory neuroblastoma
KW - outcome assessment (health care)
KW - paranasal sinus cancer
KW - paranasal sinus neoplasm
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85150633320&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150633320&partnerID=8YFLogxK
U2 - 10.1002/alr.23145
DO - 10.1002/alr.23145
M3 - Article
C2 - 36841933
AN - SCOPUS:85150633320
SN - 2042-6976
VL - 13
SP - 1876
EP - 1888
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
IS - 10
ER -