Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori, 036-8562, Japan.
Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori, 036-8562, Japan.
Brain Tumor Pathol. 2018 Jul;35(3):131-140. doi: 10.1007/s10014-018-0320-5. Epub 2018 Jun 14.
For effective implantation of carmustine (BCNU) wafers, it is important to determine the order of priority with reference to the intraoperative frozen section diagnosis of the resection margin (IOFM). The accuracy of IOFM and patterns of tumor recurrence with implantation of BCNU wafers were studied retrospectively. Forty-six cases of newly diagnosed malignant glioma were evaluated. Tumors were resected after intraoperative frozen section diagnosis (IOFD). IOFM was performed for resection walls and evaluated on a three-level scale (-, no tumor invasion; 1+, minor cell invasion; 2+, evident cell invasion). The results were used for effective BCNU wafer implantation. The IOFM sections were then thawed, frozen-paraffin marginal (FPM) sections were prepared, and IOFM was evaluated with FPM sections. The accuracy of IOFD grading was compared to that of the formalin fixed paraffin-embedded section and was 76.1%. The accuracy of IOFM was compared with the FPM section in 148 specimens from 42 patients. The IOFM accuracy was 80.4%. BCNU wafers were implanted in 25 patients and there was recurrence in 15. Local recurrence was seen in 40% (6 patients). However, there was no recurrence immediately below the BCNU wafers. With properly performed IOFM, BCNU wafers can be efficiently implanted, and local recurrence immediately below the BCNU wafers can be inhibited.
为了实现卡莫司汀（BCNU）植入物的有效植入，重要的是要参照术中冷冻切片诊断的切除边缘（IOFM）来确定优先级。本研究回顾性分析了 IOFM 的准确性和 BCNU 植入物治疗后肿瘤复发的模式。评估了 46 例新诊断的恶性胶质瘤病例。肿瘤在术中冷冻切片诊断（IOFD）后进行切除。对切除壁进行 IOFM 评估，并分为三个级别（-，无肿瘤侵犯；1+，少量细胞侵犯；2+，明显细胞侵犯）。结果用于有效的 BCNU 植入物植入。然后将 IOFM 切片解冻，制备冷冻石蜡边缘（FPM）切片，并使用 FPM 切片评估 IOFM。将 IOFD 分级的准确性与福尔马林固定石蜡包埋切片进行比较，其准确率为 76.1%。将 42 例患者的 148 个标本的 IOFM 与 FPM 切片进行比较，IOFM 的准确率为 80.4%。25 例患者植入了 BCNU 植入物，其中 15 例复发。局部复发率为 40%（6 例）。然而，在 BCNU 植入物下方没有立即复发。通过适当的 IOFM 操作，可以有效地植入 BCNU 植入物，并抑制 BCNU 植入物下方的局部复发。
