Diagnostic value of Knosp grade and modified Knosp grade for cavernous sinus invasion in pituitary adenomas: a systematic review and meta‐analysis
- 25 January 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Pituitary
- Vol. 24 (3), 457-464
- https://doi.org/10.1007/s11102-020-01122-3
Abstract
Objective This study aimed to examine the reliability of existing Knosp grade (KG) and modified KG for cavernous sinus invasion (CSI). Methods A thorough search of literature from 1993 to 2020 in six databases was performed. Studies that reported the intraoperative confirmation of CSI using KG and/or modified KG were included. The pooled estimates were calculated by meta-analysis with a bivariate mixed-effect model and the assessment of heterogeneity with I2 statistic. Results The final search yielded 12 eligible studies, which enrolled 3006 patients assessed with KG and 1315 patients assessed with modified KG. The results of the area under the receiver operating characteristic curve showed the good discriminative abilities of grades 2–4 (0.90), 3–4 (0.86) and 3B–4 (0.91) in predicting CSI. Grade 3A showed a remarkably lower CSI rate (44% versus 81%) and incomplete resection rate (26% versus 52%) than grade 3B. Grades 0 and 1 showed a low CSI rate. CSI and incomplete resection rates in grade 2 (30% and 21%, respectively) were close to those in grade 3A. Conclusions Modifying the KG improved its prognostic role in CSI and gross total resection. However, these grading systems cannot be used as the group standard for invasive and non-invasive pituitary adenomas (PAs) because of the weak reliability of the scale’s middle grades (grades 2 and 3A). Authors of future PA studies should consider reporting KG as high (grades 3B and 4), medium (grades 2 and 3A) and low (grades 0 and 1) to optimise the application of the scale.Keywords
Funding Information
- the Fujian Provincial Key Project of Science and Technology Plan (2018Y0067)
- the Fujian Medical University Sailing Fund Projec (2019QH2043)
This publication has 21 references indexed in Scilit:
- Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classificationJournal of Neurosurgery, 2015
- Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 casesJournal of Neurosurgery, 2014
- Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomesJournal of Neurosurgery, 2014
- Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0–2 nonfunctioning pituitary macroadenomas at a single institutionJournal of Neurosurgery, 2014
- Wnt4 is overexpressed in human pituitary adenomas and is associated with tumor invasionJournal of Clinical Neuroscience, 2014
- Endoscopic endonasal approach for pituitary adenomas: a series of 555 patientsPituitary, 2013
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Evaluation of magnetic resonance imaging criteria for cavernous sinus invasion in patients with pituitary adenomas: logistic regression analysis and correlation with surgical findingsSurgical Neurology, 2006
- Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviewsJournal of Clinical Epidemiology, 2005
- Pituitary Adenomas with Invasion of the Cavernous Sinus SpaceNeurosurgery, 1993