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Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients. International forum of allergy & rhinology Geltzeiler, M., Choby, G. W., Ji, K. S., Mace, J. C., Almeida, J. P., de Almeida, J., Champagne, P., Chan, E., Ciporen, J. N., Chaskes, M. B., Cornell, S., Drozdowski, V., Fernandez-Miranda, J., Gardner, P. A., Hwang, P. H., Kalyvas, A., Kong, K. A., McMillan, R. A., Nayak, J. V., Patel, C., Patel, Z. M., Celda, M. P., Pinheiro-Neto, C., Sanusi, O. R., Snyderman, C. H., Thorp, B. D., Van Gompel, J. J., Zadeh, G., Zenonos, G., Zwagerman, N. T., Wang, E. W. 2023

Abstract

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 over-treating 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 (OS) and disease-free survival (DFS).RESULTS: 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 (phiC = 0.26; 95% 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 (phi = 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 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. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/alr.23145

View details for PubMedID 36841933