A surgical strategy for lower grade gliomas using intraoperative molecular diagnosis
A surgical strategy for lower grade gliomas using intraoperative molecular diagnosis
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DOI：
10.1007/s10014-018-0324-1
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发表时间：
2018-07-01
影响因子：
3.3
通讯作者：
Kawamata, Takakazu
中科院分区：
文献类型：
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作者：
Koriyama, Shunichi;Nitta, Masayuki;Kawamata, Takakazu
低级别胶质瘤可通过手术切除进行治疗和诊断。最大程度地切除肿瘤是目前的护理标准；然而，这可能会导致大脑功能丧失。根据异柠檬酸脱氢酶 (IDH) 突变状态和 1p/19q 联合缺失的存在，神经胶质瘤可在基因上细分为三种不同类型，这三种类型的预后和对辅助治疗的反应截然不同。因此，在手术过程中识别亚型并评估周围组织的方法将是有利的。在这项研究中，我们根据世界卫生组织脑肿瘤分类第四版制定了一种针对低级别胶质瘤的新手术策略，涉及术中分子诊断。高分辨率熔解分析用于评估 IDH 突变状态，而 p53 和 X 连锁α地中海贫血/智力迟钝综合征 (ATRX) 的快速免疫组织化学用于评估 1p/19q 共缺失状态，以便在手术期间进行遗传分类。此外，术中流式细胞术用于评估手术腔内是否存在其他肿瘤病变，从而实现最大程度的切除，同时降低功能丧失的风险。该策略允许对低级别胶质瘤进行快速的术中诊断和绘图，其临床应用可以显着改善其预后。
Lower grade gliomas are both treated and diagnosed via surgical resection. Maximum tumor resection is currently the standard of care; however, this risks the loss of brain function. Glioma can be genetically subdivided into three different types, based on isocitrate dehydrogenase (IDH) mutation status and the presence of 1p/19q codeletion, which have radically different prognoses and responses to adjuvant therapies. Therefore, the means to identify the subtype and evaluate the surrounding tissues during surgery would be advantageous. In this study, we have developed a new surgical strategy for lower grade glioma based on the fourth edition of the World Health Organization Brain Tumor Classification, involving intraoperative molecular diagnosis. High-resolution melting analysis was used to evaluate IDH mutational status, while rapid immunohistochemistry of p53 and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) was used to evaluate the 1p/19q codeletion status, allowing genetic classification during surgery. In addition, intraoperative flow cytometry was used to evaluate the surgical cavity for additional tumor lesions, allowing maximal resection while mitigating the risk of functional losses. This strategy allows the rapid intraoperative diagnosis and mapping of lower grade gliomas, and its clinical use could dramatically improve its prognosis.