Abstract：
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.
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).
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.
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.
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).
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.
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.
摘要：
背景：嗅神经母细胞瘤（ONB）的传统治疗包括切缘阴性切除并切除筛板，dura,和嗅觉灯泡，不管颅内疾病。这种方法可能会过度治疗某些患者。我们的调查检查了与隐匿性颅内疾病相关的危险因素，以优化治疗结果。
方法：本回顾性研究，多机构队列研究检查了与隐匿性颅内受累相关的临床协变量.患者人口统计学，分期,Hyam的分级和硬脑膜的病理受累，收集嗅球/嗅束和大脑。回顾了诊断成像。估计阳性和阴性预测值(NPV)以及效应大小估计。Cox风险回归分析了与总体生存率（OS）和无病生存率（DFS）的关系。
结果：确定了224名新诊断为ONB（2005-2021）的受试者。计算机断层扫描（CT）上颅底骨受累的病理性硬膜NPV最高（88.0％），嗅觉灯泡（88%），和大脑受累（97.3%）。Hyam的等级类别与硬脑膜受累显着相关（φC=0.26；95％CI：0.16，0.42）。没有放射学颅底受累的受试者（n=66）的病理阳性率为12.1％。在这个子组中，Hyam的分级对硬脑膜阳性具有临床意义（φ=0.34；95％CI：-0.12，0.71），其中28.6％涉及高级别肿瘤。颅内结构的临床或病理阳性均与OS或DFS显着差异无关。
结论：对于硬脑膜和嗅球受累，CT和MRI均具有相当好的NPV。较高的Hyam等级与硬脑膜受累有关。低度肿瘤未累及颅底的患者可能适合避免颅底切除，然而，需要进一步调查。本文受版权保护。保留所有权利。
方法：本回顾性研究，
结果：确定了224名新诊断为ONB（2005-2021）的受试者。
结论：对于硬脑膜和嗅球受累，CT和MRI均具有相当好的NPV。
