Usefulness of intraoperative rapid immunohistochemistry in the surgical treatment of brain tumors
Usefulness of intraoperative rapid immunohistochemistry in the surgical treatment of brain tumors
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DOI：
10.1111/neup.12864
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发表时间：
2022-09-20
期刊：
影响因子：
2.3
通讯作者：
Kunieda, Takeharu
中科院分区：
文献类型：
--
作者：
Inoue, Akihiro;Watanabe, Hideaki;Kunieda, Takeharu
在原发性中枢神经系统淋巴瘤（PCNSL）的治疗中，术中快速病理诊断可以极大地改变手术策略，需要更准确的诊断方法。2020年4月，我们在常规的基于形态学评估的术中快速诊断基础上，采用了术中快速免疫组化（IHC），主要针对PCNSL患者。在这里，我们调查的有用性和意义，术中快速免疫组化的基础上，我们的初步经验。我们于2020年4月至2022年7月对25例患者（包括PCNSL患者）使用酶标抗体方法，使用分化抗原簇（CD）20、CD 3、白细胞共同抗原（LCA）和胶质细胞酸性蛋白（GFAP）的抗体进行了术中快速IHC。我们研究了这种方法在确定脑肿瘤治疗策略中的实用性。术后石蜡包埋切片的最终病理诊断如下：弥漫性大B细胞淋巴瘤，16例;胶质母细胞瘤，6例;毛细胞性星形细胞瘤，1例;腺癌，1例;和炎症性疾病，1例。整个过程耗时32分钟，CD 20、CD 3、LCA和GFAP染色与石蜡包埋切片相当。在所有病例中，术中快速IHC的结果与石蜡包埋切片的最终病理诊断一致。此外，在2例病例中，通过增加术中快速IHC，基于使用冷冻切片的形态学评估的常规术中快速病理诊断结果发生了显著变化。术中快速免疫组化有助于决定适当的治疗策略，并促进PCNSL的早期化疗。这可能不仅为PCNSL而且为其他脑肿瘤提供新的治疗策略。
In the treatment of primary central nervous system lymphoma (PCNSL), intraoperative rapid pathological diagnosis can dramatically change the surgical strategy, and more accurate diagnostic methods are required. In April 2020, we adopted intraoperative rapid immunohistochemistry (IHC) in addition to conventional rapid intraoperative diagnosis based on morphological assessment, mainly for patients with PCNSL. Here, we investigate the usefulness and significance of intraoperative rapid IHC based on our initial experience. We performed intraoperative rapid IHC using antibodies for cluster of differentiation (CD)20, CD3, leukocyte common antigen (LCA) and glial fibrillary acidic protein (GFAP) using enzyme-labeled antibody methods in 25 patients, including PCNSL patients, from April 2020 to July 2022. We examined the utility of this approach in determining treatment strategies for brain tumors. Postoperative final pathological diagnoses from paraffin-embedded sections were as follows: diffuse large B-cell lymphoma, 16 cases; glioblastoma, six cases; pilocytic astrocytoma, one case; adenocarcinoma, one case; and inflammatory disorder, one case. The entire process took 32 min and staining for CD20, CD3, LCA, and GFAP was comparable to that using paraffin-embedded sections. In all cases, the results of intraoperative rapid IHC were consistent with final pathological diagnoses from paraffin-embedded sections. In addition, in two cases, the results of conventional intraoperative rapid pathological diagnosis based on morphological assessments using frozen sections were drastically changed by adding intraoperative rapid IHC. Intraoperative rapid IHC contributes to deciding appropriate treatment strategies and facilitating early initiation of chemotherapy for PCNSL. This may allow new therapeutic strategies not only for PCNSL but also for other brain tumors.