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The Shape grading system: a classification for growth patterns of pituitary adenomas

  • Original Article - Pituitaries
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Abstract

Background

Long-term tumor control of pituitary adenomas may be achieved by gross total resection (GTR). Factors, which influence the extent of resection, are invasiveness, tumor size, and possibly tumor shape. Nevertheless, the latter factor has not been assessed so far and there is no classification for the different shapes. The aim of this study was to evaluate the impact of different tumor shapes on GTR rates and outcome according to our proposed “Shape grading system.”

Methods

In this retrospective single center study, the radiological outcome of nonfunctioning pituitary adenomas was assessed with respect to the following previously defined growth patterns: spherical (Shape I), oval (Shape II), dumbbell (Shape III), mushroom (Shape IV), and polylobulated (Shape V).

Results

A total of 191 patients were included (Shape I, n = 28 (15%); Shape II, n = 91 (48%); Shape III, n = 37 (19%); Shape IV, n = 12 (6%); Shape V, n = 23 (12%)). GTR was achieved in 101 patients (53%) with decreasing likelihood of GTR in higher shape grades (Shape I, n = 23 (82%); Shape II, n = 67 (74%); Shape III, n = 9 (24%); Shape IV, n = 2 (17%); Shape V, n = 0 (0%)). This correlated with larger tumor remnants, a higher risk of tumor recurrence/regrowth and therefore necessity of re-surgery and/or radiotherapy/radiosurgery.

Conclusion

The “Shape grading system” may be used as a predictor of the outcome in nonfunctioning pituitary adenomas. The higher the “Shape grade,” the higher the likelihood for lower GTR rates, larger tumor remnants, and need for further therapies.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Sven Berkmann, Jaqueline Lattmann & Javier Fandino

  2. Division of Endocrinology, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland

    Philipp Schuetz & Beat Mueller

  3. Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland

    Michael Diepers & Luca Remonda

  4. Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany

    Michael Buchfelder

Authors
  1. Sven Berkmann
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  2. Jaqueline Lattmann
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  3. Philipp Schuetz
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  4. Michael Diepers
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  5. Luca Remonda
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  6. Javier Fandino
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  7. Michael Buchfelder
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  8. Beat Mueller
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Contributions

Conceptualization: Sven Berkmann.

Data curation/methodology: Sven Berkmann, Jaqueline Lattmann.

Formal analysis and investigation: Sven Berkmann, Jaqueline Lattmann, Michael Diepers, Michael Buchfelder.

Writing—original draft preparation: Sven Berkmann, Jaqueline Lattmann.

Writing—review and editing: all authors.

Funding acquisition: Sven Berkmann.

Resources: Sven Berkmann.

Supervision: Sven Berkmann, Javier Fandino, Luca Remonda, Beat Mueller.

Corresponding author

Correspondence to Sven Berkmann.

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Conflict of interest

The authors declare no competing interests.

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Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Sven Berkmann and Jaqueline Lattmann contributed equally

The results of the present study have been presented at the Congress of the Swiss Society of Neurosurgery at Lugano/CH in 2018.

This article is part of the Topical Collection on Pituitaries

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Berkmann, S., Lattmann, J., Schuetz, P. et al. The Shape grading system: a classification for growth patterns of pituitary adenomas. Acta Neurochir 163, 3181–3189 (2021). https://doi.org/10.1007/s00701-021-04912-1

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  • DOI: https://doi.org/10.1007/s00701-021-04912-1

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