Inferior Petrosal Sinus Sampling Tumor Lateralization and the Surgical Treatment of Cushing Disease: A Meta-Analysis and Systematic Review.

Kevin L Webb, Mickayla L Hinkle, Michael T Walsh, Irina Bancos, Yuki Shinya, Jamie J Van Gompel

Journal: World neurosurgery 2024;182():e712-e720

PMID: 38081579

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

To determine whether accurate inferior petrosal sinus sampling (IPSS) tumor lateralization is associated with improved clinical outcomes following the surgical treatment of Cushing disease.

METHODS

The presented study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data regarding patient demographics, IPSS tumor lateralization, and postoperative endocrinologic outcomes were abstracted and pooled with random effects meta-analysis models. Additional meta-regression models were used to examine the association between the accuracy of IPSS tumor lateralization and postoperative outcomes (recurrence/persistence or remission/cure). Statistical analyses were performed using the Comprehensive Meta-Analysis software (significance of P < 0.05).

RESULTS

Seventeen eligible articles were identified, yielding data on 461 patients. Within average follow-up duration (∼59 months), the rate of correct IPSS tumor lateralization was 69% [95% confidence interval: 61%, 76%], and the rate of postoperative remission/cure was 78% [67%, 86%]. Preoperative IPSS tumor lateralization was concordant with magnetic resonance imaging lateralization for 53% of patients [40%, 66%]. There was no significant association between the rate of correct IPSS tumor lateralization and postoperative remission/cure among study-level data (P = 0.735). Additionally, there was no association among subgroup analyses for studies using stimulatory agents during IPSS (corticotropin-releasing hormone or desmopressin, P = 0.635), nor among subgroup analyses for adult (P = 0.363) and pediatric (P = 0.931) patients.

CONCLUSIONS

Limited data suggest that the rate of correct IPSS tumor lateralization may not be positively associated with postoperative remission or cure in patients with Cushing disease. These findings bring into question the utility of IPSS tumor lateralization in the context of preoperative planning and surgical approach rather than confirming a pituitary source.

Address: Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: [email protected].

DOI: 10.1016/j.wneu.2023.12.024

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MeSH Terms: Humans, Petrosal Sinus Sampling, Pituitary ACTH Hypersecretion, Treatment Outcome, Pituitary Neoplasms, Neurosurgical Procedures