Consensus in Pituitary Pathology: Impact after New Classification for Korea

Jae Sung ParkSouth Korea Speaker Consensus in Pituitary Pathology: Impact after New Classification for KoreaThe management of pituitary neuroendocrine tumors (PitNETs) in South Korea is undergoing a significant transition following the 2022 WHO classification. While the shift from "adenoma" to "PitNET" implies a malignant potential, from a neurosurgical perspective, these tumors remain generally far more indolent than primary brain cancers such as high-grade gliomas. Identifying the specific subset of patients who require aggressive intervention is therefore paramount. Our recent institutional study indicates that high-risk non-functioning pituitary adenomas (NFPAs) are more prevalent in younger female patients and exhibit a higher incidence of cavernous sinus invasion. Consequently, a more proactive surgical approach is often warranted for these high-risk phenotypes. Beyond clinical considerations, the Korean healthcare system—characterized by government-led cost controls and supplemental private insurance—faces unique challenges. There is a growing trend of patients requesting malignancy-level ICD coding to secure broader insurance coverage, a phenomenon increasingly driven by external socio-economic factors. Although the Korean Brain Tumor Society (KBTS) previously debated this classification, a definitive consensus remains elusive. Rather than proposing a singular solution, this session aims to raise these multi-faceted issues from a neurosurgical viewpoint, inviting diverse expert perspectives to foster a collective dialogue on the nature of PitNETs within our evolving medical and socio-economic landscape.