Dogar T, Imran A A, Hasan M, Jaffar R, Bajwa R, Qureshi I D.
Space occupying lesions of central nervous system: a radiological and histopathological correlation.
Biomedica Jan ;31(1):15-20.

Introduction: Space occupying lesions (SOLs) of the Central nervous system (CNS) can pursue a serious clinical course even when they are inflammatory lesions or benign neoplasms. Radiology is the only means of assessment prior to a surgical diagnosis. Increasingly sophisticated radiological techniques are available for diagnosis and precise localization for a stereotactic biopsy. The radiological impression of an SOL, however, requires confirmation by histological examination of a tissue biopsy. Hence histopathology remains the gold standard for diagnosis. Materials and Methods: This cross sectional, comparative study included one hundred and two consecutive cases of SOLs. Their clinical history and radiological findings were noted. The histopathological diagnosis was correlated with radiological diagnosis using Cohen’s kappa with the former as the gold standard. Results: Using Cohen’s kappa a value of 0.05 was obtained when the collective data was compared, implying a ‘poor’ agreement between the two modalities of diagnosis. Similar results were obtained when only glial neoplasms were compared (kappa = 0.03). However meningiomas showed a kappa value of 0.40 indicating 'moderate' agreement. Cohen’s kappa showed the superiority of the histopathological diagnoses in accurately categorizing lesions. Conclusion: Our study showed that histopathological diagnosis remains more definitive as compared to radiological diagnosis in the context of SOLs of brain. Hence it is concluded that a multidisciplinary approach is ideal for space occupying lesions of the central nervous system. The neurosurgeon, neuroradiologist and neuropathologist form a triad that is essential for diagnosis, management and follow up of these cases. However, histopathology remains the yardstick against which all emerging techniques must be measu-red.

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