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@ARTICLE{DaoTrong:276073,
      author       = {P. Dao Trong and S. Kilian and J. Jesser and D. Reuss and
                      F. K. Aras and A. von Deimling$^*$ and C. Herold-Mende and
                      A. Unterberg and C. Jungk},
      title        = {{R}isk {E}stimation in {N}on-{E}nhancing {G}lioma:
                      {I}ntroducing a {C}linical {S}core.},
      journal      = {Cancers},
      volume       = {15},
      number       = {9},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2023-00979},
      pages        = {2503},
      year         = {2023},
      abstract     = {The preoperative grading of non-enhancing glioma (NEG)
                      remains challenging. Herein, we analyzed clinical and
                      magnetic resonance imaging (MRI) features to predict
                      malignancy in NEG according to the 2021 WHO classification
                      and developed a clinical score, facilitating risk
                      estimation. A discovery cohort (2012-2017, n = 72) was
                      analyzed for MRI and clinical features (T2/FLAIR mismatch
                      sign, subventricular zone (SVZ) involvement, tumor volume,
                      growth rate, age, Pignatti score, and symptoms). Despite a
                      'low-grade' appearance on MRI, $81\%$ of patients were
                      classified as WHO grade 3 or 4. Malignancy was then
                      stratified by: (1) WHO grade (WHO grade 2 vs. WHO grade 3 +
                      4) and (2) molecular criteria (IDHmut WHO grade 2 + 3 vs.
                      IDHwt glioblastoma + IDHmut astrocytoma WHO grade 4). Age,
                      Pignatti score, SVZ involvement, and T2/FLAIR mismatch sign
                      predicted malignancy only when considering molecular
                      criteria, including IDH mutation and CDKN2A/B deletion
                      status. A multivariate regression confirmed age and T2/FLAIR
                      mismatch sign as independent predictors (p = 0.0009; p =
                      0.011). A 'risk estimation in non-enhancing glioma' (RENEG)
                      score was derived and tested in a validation cohort
                      (2018-2019, n = 40), yielding a higher predictive value than
                      the Pignatti score or the T2/FLAIR mismatch sign (AUC of
                      receiver operating characteristics = 0.89). The prevalence
                      of malignant glioma was high in this series of NEGs,
                      supporting an upfront diagnosis and treatment approach. A
                      clinical score with robust test performance was developed
                      that identifies patients at risk for malignancy.},
      keywords     = {CDKN2A/B (Other) / IDH mutation (Other) / lower-grade
                      glioma (Other) / malignant glioma (Other) / molecular
                      classification (Other) / non-enhancing glioma (Other) /
                      prognostic score (Other) / risk estimation (Other)},
      cin          = {B300 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)B300-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {312 - Funktionelle und strukturelle Genomforschung
                      (POF4-312)},
      pid          = {G:(DE-HGF)POF4-312},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37173969},
      pmc          = {pmc:PMC10177456},
      doi          = {10.3390/cancers15092503},
      url          = {https://inrepo02.dkfz.de/record/276073},
}