title: Differences in the Pathological Diagnosis and Repeat Craniotomy Rates in Cerebral Tumors Undergoing Biopsy or Resection in an Urban Versus Regional Center.
abstract: Primary intracranial tumors occur with an incidence of between 2.5 and 6 per 100,000 individuals. They require specialist expertise for investigation and management including input from radiology, pathology, neurosurgery, and oncology. Therefore, most patients with intracranial neoplasia are investigated and managed in larger hospitals. The geographically dispersed population of Australia has facilitated the development of neurosurgical units in regional areas. However, major metropolitan hospitals are over-represented compared with regional centers in most research cohorts. We therefore sought to investigate the spectrum of intracranial neoplasms undergoing biopsy and surgery at a major regional center in Australia and to compare the demographic and pathological features to similar cohorts treated in major metropolitan hospitals.We searched the pathological databases of both a major regional pathology provider and a major metropolitan pathology practice, which provides surgical pathology services for both a large private and a large public neurosurgical hospital, to identify all cerebral tumors undergoing biopsy or resection over a 14-year period (calendar years 2001 and 2014).In all, 3717 cerebral tumors were identified. Among them, 51% were from an urban private hospital, 33% from an urban public hospital, and 16% from a regional public hospital. Overall, one-third of them were neuroepithelial in origin, a quarter metastatic disease, a fifth meningeal, and one-tenth were pituitary adenomas. The regional center treated a higher proportion of metastatic tumors and less meningeal tumors compared with the urban center. Additionally, patients were less likely to undergo a second operation in the regional center (P < 0.001). The differences give an important insight into the burden of neurosurgical disease in regional Australia, and how it differs from that encountered in large metropolitan centers.
authors.affiliation: From the Department of Neurosurgery, Wollongong Hospital (CRV, SK); Southern IML Pathology, Wollongong (AL); Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research (NW, JA, AJG); Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards (JB); Sydney Medical School, University of Sydney (JA, JB, AJG); and Sydney Vital Translational Research Centre, Royal North Shore Hospital, Pacific Highway, St Leonards, New South Wales, Australia (AJG).
authors.forename: Craig R
authors.initials: CR
authors.lastname: Vonhoff
authors.forename: Alistair
authors.initials: A
authors.lastname: Lochhead
authors.forename: Stavros
authors.initials: S
authors.lastname: Koustais
authors.forename: Nicole
authors.initials: N
authors.lastname: Watson
authors.forename: Juliana
authors.initials: J
authors.lastname: Andrici
authors.forename: Janice
authors.initials: J
authors.lastname: Brewer
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D003399:Craniotomy / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018302:Neoplasms, Neuroepithelial / Q000473:pathology* / Q000601:surgery*; D009517:New South Wales; D055815:Young Adult