Skip to main content

Table 2 diagnostic strategy and results

From: Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushing’s disease: surgical outcome, mortality, and complications

  Microscopic trans-sphenoidal adenomectomy Endoscopic transsphenoidal adenomectomy Tested difference (95% CI; p-value) Tested difference (95% CI; p-value) (Microadenoma only) Tested difference (95% CI; p-value) (Macroadenoma only)
N % N %    
Inferior petrosal sinus sampling 30 34.5 13 26.0 8.5 (−7.2 to 24.2; p = 0.302) 2.4 (−17.6 to 22.4; p = 0.815) ^
Radiologic imaging      p = 0.000 p = 0.000 p = 0.003
-CT or X-ray 27 31.0 1 2.0 29.0 (18.5 to 39.5) 31.9 (19.3 to 44.5) 16.7 (−0.5 to 33.9)
-MRI 1.5 Tesla 60 69.0 18 36.0 33.0 (16.5 to 49.5) 38.7 (20.1 to 57.3) 27.0 (−2.8 to 56.8)
-MRI 3 Tesla 0 0.0 31 62.0 62.0 (48.5 to 75.4) 70.6 (55.3 to 85.9) 43.8 (19.5 to 68.1)
Radiology results      p = 0.144 p = 0.359 p = 0.339
-Adenoma 56 64.4 40 80.0 15.6 (0.6 to 30.6) 14.1 (−5.2 to 33.4) 5.6 (−5.0 to 16.2)
-No adenoma 24 27.6 7 14.0 13.6 (1.6 to 27.0) 12.7 (−4.9 to 30.3) 5.6 (− 5.0 to 16.2)
-Inconclusive 7 8.0 3 6.0 2.0 (−6.7 to 10.7) 1.3 (−10.6 to 13.2) #
Histology results      p = 0.784 p = 0.940 p = 0.339
-Adenoma 67 77.9 41 82.0 4.1 (−9.7 to 17.9) 0.0 (−18.2 to 18.2) 5.6 (−5.0 to 16.2)
-No adenoma 16 18.6 7 14.0 4.6 (−8.1 to 17.3) 1.5 (−15.3 to 183) 5.6 (−5.0 to 16.2)
-Inconclusive 3 3.5 2 4.0 0.5 (−6.2 to 7.2) 1.5 (−7.8 to 10.8) #
Immunohistochemistry results: ACTH-positive 57 66.3 45 90.0 23.7 (10.7 to 36.7; p = 0.002) 23.5 (6.9 to 40.1; p = 0.015) 16.7 (−0.5 to 33.9; p = 0.087)
Surgeon’s intraoperative findings      p = 0.123 p = 0.231 p = 0.447
-Complete adenomectomy 48$ 58.5 25 50.0 8.5 (−9.0 to 26.0) 9.8 (−10.9 to 30.5) 8.4 (−24.9 to 41.7)
-(At least) partial adenomectomy 15$ 18.3 18 36.0 17.7 (2.0 to 33.4) 18.2 (−0.8 to 37.2) 19.5 (−7.9 to 46.9)
-Residual tumor 4$ 4.9 2 4.0 0.9 (−6.3 to 8.1) 1.5 (−1.5 to 4.5) 5.1 (− 19.2 to 29.4)
-No tumor identified 15$ 18.3 5 10.0 8.3 (−3.5 to 20.1) 6.8 (−8.7 to 22.3) 5.9 (−5.3 to 17.1)
  1. ACTH = adrenocorticotropic hormone, CI = confidence interval, CT = computed tomography, MRI = magnetic resonance imaging
  2. ^Inferior petrosal sinus sampling was considered only for patients with uncertain pituitary tumor, and therefore never in macroadenomas, $Data were missing for ≥5% of patients, #No patients with a macroadenoma with this result, therefore, no analysis could be performed