Subclassification of the Koos grade 2 vestibular schwannoma into 2a and 2b for individualized patient care: A validity and reliability study.

Eur J Radiol

Radboud Institute for Health Sciences, Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands; Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands; Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands.

Published: May 2023

AI Article Synopsis

  • The study investigates the validity of subclassifying Koos 2 vestibular schwannoma (VS) tumors based on their size and proximity to the brainstem, challenging the standard practice of immediate treatment following growth detection.
  • Six experts evaluated 43 MRI scans to assess the reliability of the classification, finding a near-perfect agreement on Koos 2a tumors and high agreement on Koos 2b tumors.
  • Results showed excellent reliability among raters, suggesting that this refined classification can help inform treatment decisions that prioritize patient-centered care rather than just tumor size growth.

Article Abstract

Objective: Vestibular schwannoma (VS) growth of ≥2 mm during serial MRI observation, irrespective of size, is the benchmark for treatment initiation in almost all centers. Although the probability of less optimal outcomes significantly increases in VS closer to the brainstem, early intervention does not improve long-term quality of life. Moving beyond the recommendation of definitive treatment for all VS after detected growth, we subclassified Koos 2 tumors based on extrameatal extension and relation to the brainstem. The aim of the current study was to evaluate the Koos 2 subclassification's validity and the inter-and intra-rater reliability of the entire Koos classification.

Methods: Six experts, including neurosurgeons, otorhinolaryngologists and radiologists from two tertiary referral centers, classified 43 VS MRI scans. Validity of the Koos 2 subclassification was evaluated by the percentage agreement against the multidisciplinary skull base tumor board management advice. Inter- and intra-rater reliability were calculated using the intraclass correlation coefficient (ICC).

Results: Validity was almost perfect in Koos 2a VSs with a 100% agreement and 87.5% agreement for Koos 2b. Inter-rater reliability for all Koos grades was significantly excellent (ICC 0.91; 95%CI 0.866 to 0.944, p= <0.001). Five raters had an excellent intra-rater reliability (ICC > 0.90; p= <0.01) and one rater had a good intra-rater reliability (ICC 0.88; 95% CI 0.742 to 0.949).

Conclusions: Although multiple factors influence decision-making, the classification of Koos 2a and 2b with excellent inter- and intra-rater reliability, can aid in recommending treatment initiation, moving beyond detected tumor growth, aiming to optimize patient centered care.

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Source
http://dx.doi.org/10.1016/j.ejrad.2023.110799DOI Listing

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