Delayed diagnosis of childhood low-grade glioma: causes, consequences, and potential solutions.
OBJECTIVE
Diagnosis of childhood brain tumors is delayed more than diagnosis of other pediatric cancers. However, the contribution of the most common pediatric brain tumors, lowgrade gliomas (LGG), to this delay has never been investigated.


METHODS
We retrospectively reviewed cases of childhood LGG diagnosed from January 1995 through December 2005 at our institution. The pre-diagnosis symptom interval (PSI) was conservatively calculated, and its association with race, sex, age, tumor site, tumor grade, and outcome measures (survival, disease progression, shunt use, seizures, extent of resection) was analyzed. Cases of neurofibromatosis type 1 were reported separately.


RESULTS
The 258 children had a median follow-up of 11.1 years, and 226 (88 %) remained alive. Greater pre-diagnosis symptom interval (PSI) was significantly associated with grade I (vs. grade II) tumors (p = 0.03) and age >10 years at diagnosis (p = 0.03). Half of the 16 spinal tumors had a PSI > 6 months. PSI was significantly associated with progression (p = 0.02) in grade I tumors (n = 195) and in grade I tumors outside the posterior fossa (n = 134, p = 0.03). Among children with grade I tumors, median PSI was longer in those who had seizures (10.3 months) than in those who did not (2.5 months) (p = 0.09).


CONCLUSIONS
Delayed diagnosis of childhood LGG allows tumor progression. To reduce time to diagnosis, medical curricula should emphasize inclusion of LGG in the differential diagnosis of CNS neoplasm.
Pediatric Oncology Education Program, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
Aska
A
Arnautovic
Catherine
C
Billups
Alberto
A
Broniscer
Amar
A
Gajjar
Frederick
F
Boop
Ibrahim
I
Qaddoumi
D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult