Improving final diagnosis in paediatric posterior fossa tumours: Correlation and discrepancy between radiologic diagnosis, intraoperative surgeon's diagnosis, and histopathology.

Objectives: This study investigates discrepancies between histopathologic, intraoperative, and radiologic diagnosis of paediatric posterior fossa tumours and evaluates whether combining diagnostic modalities improves the accuracy of the final diagnosis. Methodology: This retrospective study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. Hospital Management Information System (HMIS) records of all paediatric patients, aged birth to 16 years, who underwent surgery in the department for paediatric posterior fossa tumours between January 2020 and December 2024, were reviewed. Radiologic diagnosis, surgeon intraoperative diagnosis and combined diagnosis (surgeon diagnosis + radiologic diagnosis) were compared with the final histopathologic diagnosis to calculate discrepancy rates. Results: A total of 112 paediatric patients were enrolled in the study. The discrepancy rate for radiologic diagnosis, surgeon (intraoperative) diagnosis and combined diagnosis (radiologic diagnosis + surgeon diagnosis) remained 19.64%, 21.43% and 7.14% respectively. The concordance analysis using Cohen's Kappa statistic concluded that radiologic diagnosis and surgeon (intraoperative) diagnosis both showed moderate agreement with histopathology having Cohen's kappa (k) values of 0.738 and 0.714 respectively while combined diagnosis exhibited the highest concordance (κ = 0.905) with histopathology. Conclusion: Combining radiologic and intraoperative surgeon diagnoses enhances accuracy in paediatric posterior fossa tumours, achieving the highest concordance with histopathology and reducing discrepancies. This combined approach represents best practice to improve diagnostic precision, especially in LMICs where multidisciplinary tumour boards are not readily available.