Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Faculty of Advanced Techno-Surgery, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Brain Tumor Pathol. 2018 Jul;35(3):159-167. doi: 10.1007/s10014-018-0324-1. Epub 2018 Jul 6.
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.
低级别胶质瘤通过手术切除进行治疗和诊断。最大限度地切除肿瘤是目前的标准治疗方法；然而，这有丧失脑功能的风险。根据异柠檬酸脱氢酶 (IDH) 突变状态和 1p/19q 缺失情况，胶质瘤可在基因上分为三种不同类型，它们具有截然不同的预后和对辅助治疗的反应。因此，在手术过程中识别亚型和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第四版脑肿瘤分类制定了一种新的低级别胶质瘤手术策略，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 α-地中海贫血/智力迟钝综合征 X 连锁（ATRX）的快速免疫组织化学用于评估 1p/19q 缺失状态，允许在手术过程中进行遗传分类。此外，术中流式细胞术用于评估手术腔中的其他肿瘤病变，允许最大限度地切除肿瘤，同时降低功能丧失的风险。这种策略允许快速进行术中诊断和绘制低级别胶质瘤图谱，其临床应用可能会显著改善其预后。
