Multidisciplinary protocol of preoperative and surgical management of patients with pituitary tumors candidates to pituitary surgery

Araujo‐Castro, Marta; Pascual‐Corrales, Eider; Millán, Juan Martínez San; Rebolleda, Gema; Pián, Héctor; Ruz-Caracuel, Ignacio; Santos, Gonzalo de los; Urzaiz, Luis Ley; Escobar-Morreale, Héctor F.; Berrocal, Víctor Rodríguez

doi:10.1016/j.ando.2020.11.001

Cited by 16 publications

(14 citation statements)

References 81 publications

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“…Age (range 31 to 81 years, mean 55.4 years) and gender (6 female and 6 male patients) of the 12 DPA patients roughly conformed to epidemiological data reported for monomorphous PA [15]. However, children and adolescents were not part of our cohort, which may suggest that DPA develop successively, presenting clinically at a slightly higher age than monomorphous PA.…”

Section: Discussionsupporting

confidence: 80%

Double adenomas of the pituitary reveal distinct lineage markers, copy number alterations, and epigenetic profiles

et al. 2021

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Purpose Pituitary adenoma (PA) constitutes the third most common intracranial neoplasm. The mostly benign endocrine lesions express no hormone (null cell PA) or the pituitary hormone(s) of the cell lineage of origin. In 0.5–1.5% of surgical specimens and in up to 10% of autopsy cases, two or three seemingly separate PA may coincide. These multiple adenomas may express different hormones, but whether or not expression of lineage-restricted transcription factors and molecular features are distinct within multiple lesions remains unknown. Methods Searching the data bank of the German Pituitary Tumor Registry 12 double pituitary adenomas with diverse lineage were identified among 3654 adenomas and 6 hypophyseal carcinomas diagnosed between 2012 and 2020. The double adenomas were investigated immunohistochemically for expression of hormones and lineage markers. In addition, chromosomal gains and losses as well as global DNA methylation profiles were assessed, whenever sufficient material was available (n = 8 PA). Results In accordance with the literature, combinations of GH/prolactin/TSH–FSH/LH adenoma (4/12), GH/prolactin/TSH–ACTH adenoma (3/12), and ACTH–FSH/LH adenoma (3/12) were observed. Further, two out of 12 cases showed a combination of a GH/prolactin/TSH adenoma with a null-cell adenoma. Different expression pattern of hormones were confirmed by different expression of transcription factors in 11/12 patients. Finally, multiple lesions that were molecularly analysed in 4 patients displayed distinct copy number changes and global methylation pattern. Conclusion Our data confirm and extend the knowledge on multiple PA and suggest that such lesions may origin from distinct cell types.

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Section: Discussionsupporting

confidence: 80%

Double adenomas of the pituitary reveal distinct lineage markers, copy number alterations, and epigenetic profiles

et al. 2021

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“…6 Araujo-Castro et al have delineated a very detailed, multidisciplinary protocol for enhancing the preoperative management of these medically complex patients as well based on recent international guidelines. 7 That being said, the data pertaining to postoperative managements of patients with specific attention to laboratory usage and diagnosis of endocrinopathies is sparse.…”

Section: Discussionmentioning

confidence: 99%

The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas

Benjamin

Dastagirzada

Bevilacqua

et al. 2022

J Neurol Surg B Skull Base

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Purpose After developing a protocol for evaluating, diagnosing, and treating postoperative endocrinopathy both during the hospitalization and during the immediate discharge period following resection of pituitary adenomas, we sought to assess the impact of this protocol on quality outcomes. Methods An IRB-exempt, quality improvement initiated, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective comparison of a pre-and-post-protocol cohort of all patients undergoing endoscopic endonasal resection of pituitary adenomas at NYU Langone Medical Center from January 2013 to December 2018. Demographic characteristics of the patients and their tumors with their postoperative outcomes were recorded. Quality outcomes regarding number of laboratory studies sent, rate of diabetes insipidus, length of stay, and readmission rate were also recorded. Statistical analysis was performed between the pre- and post-protocol groups. Results There was a significant reduction in laboratory studies sent per patient (55.66 vs. 18.82, p <0.001). This corresponded with an overall cost reduction in laboratory studies of $255.95 per patient. There was a decrease in the overall number of patients treated with DDAVP (21.4% in the pre-protocol group vs. 8.9% in the post-protocol group, p = 0.04). All post-protocol patients requiring DDAVP at discharge were identified by 48 hours. There was no significant change in length of stay or need for hydrocortisone supplementation postoperatively between the two groups. Length of stay was driven mostly by need for reoperation during initial hospitalization. There was no significant change in the rate of 30-day readmission. Conclusion Implementation of a postoperative management protocol results in a more efficient diagnosis and management of endocrinopathy after pituitary adenoma surgery which translates to decreased cost.

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“…Clinicians must be able to determine good surgical candidates prior to recommending surgery. This is often difficult, as the management of sellar masses may require the expertise of neurosurgeons, otolaryngologists, endocrinologists, along with the assistance of ophthalmologists, oncologists and neurologists [5]. The ability to quantify individual risk factors has been elusive and few studies have demonstrated links between preoperative factors and postoperative complications due to the relative complexity of these diseases.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The State of Machine Learning in Outcomes Prediction of Transsphenoidal Surgery: A Systematic Review

Yang

Smith

et al. 2022

J Neurol Surg B Skull Base

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The purpose of this analysis is to assess the use of machine learning (ML) algorithms in the prediction of post-operative outcomes, including complications, recurrence, and death in transsphenoidal surgery. Following PRISMA guidelines, we systematically reviewed all papers that used at least one ML algorithm to predict outcomes after transsphenoidal surgery. We searched Scopus, PubMed, and Web of Science databases for studies published prior to May 12th, 2021. We identified 13 studies enrolling 5048 patients. We extracted the general characteristics of each study; the sensitivity, specificity, AUC of the ML models developed as well as the features identified as important by the ML models. We identified 12 studies with 5048 patients that included ML algorithms for adenomas, three with 1807 patients specifically for acromegaly, and five with 2105 patients specifically for Cushing’s disease. Nearly all were single institution studies. The studies used a heterogeneous mix of ML algorithms and features to build predictive models. All papers reported an AUC greater than .7, which indicates clinical utility. ML algorithms have the potential to predict post-operative outcomes of transsphenoidal surgery and can improve patient care. Ensemble algorithms and neural networks were often top performers when compared to other ML algorithms. Biochemical and pre-operative features were most likely to be selected as important by ML models. Inexplicability remains a challenge, but algorithms such as local interpretable model-agnostic explanation or Shapley value can increase explainability of ML algorithms. Our analysis shows that ML algorithms have the potential to greatly assist surgeons in clinical decision making.

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Multidisciplinary protocol of preoperative and surgical management of patients with pituitary tumors candidates to pituitary surgery

Cited by 16 publications

References 81 publications

Double adenomas of the pituitary reveal distinct lineage markers, copy number alterations, and epigenetic profiles

Double adenomas of the pituitary reveal distinct lineage markers, copy number alterations, and epigenetic profiles

The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas

The State of Machine Learning in Outcomes Prediction of Transsphenoidal Surgery: A Systematic Review

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