Prevalence and Imaging-Based Classification of Pituitary Adenomas with Hard Consistency: A Systematic Review and Meta-Analysis

Abstract

Abstract OBJECTIVE Transsphenoidal resection of pituitary adenomas can be challenging in patients with tumors with a hard consistency. We performed a systematic review and meta-analysis of the literature to identify the true incidence and the performance of radiological findings in identifying pituitary adenomas with a hard consistency.METHODS A literature search was conducted and included studies that compared intraoperative pituitary tumor consistency and pre-operative magnetic resonance imaging (MRI). Using random-effects meta-analysis and univariate analysis, we evaluate the prevalence of hard pituitary tumors.RESULTS Of studies the 916 studies, 888 studies were excluded. Finally, 28 studies harboring 1116 patients with pituitary tumors were included. Of them, hard-consistency tumors were intraoperatively adjudicated in 219 patients (weighted incidence of 16,82%,95% CI, 12.35–22.48%; I2 = 65,1%). Seventeen (60%) reported a relation between radiological findings and intraoperative tumor consistency in at least one MRI sequence, with a weighted proportion of 15%, 95% CI, 10,31% − 22,70%). Apparent diffusion correlation(ADC), and T2-weighted sequences were associated with tumor consistency in 31% and 53% of the studies, respectively. Nonetheless, conflicting signal intensities across the studies precluded conventional MRI sequences from accurately predicting pituitary tumor consistency.CONCLUSION The weighted incidence of pituitary tumors adjudicated as having a hard consistency was 16% in the present sample of studies.