Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany.
Department of Neuropathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
J Neurooncol. 2019 Jan;141(1):183-194. doi: 10.1007/s11060-018-03024-8. Epub 2018 Nov 2.
With the 2016 World Health Organization Classification of Tumors of the Central Nervous System (2016 CNS WHO), diagnosis of glioma is based on molecular parameters in addition to histology potentially leading to additional demands on quality of tissue samples. This may challenge the role of minimally invasive biopsy procedures. This study aims to evaluate the diagnostic yield of glioma samples from frameless stereotactic biopsies with focus on molecular information and explore the neuromolecular profile of a glioma biopsy cohort.
In a case series analysis, 180 consecutive frameless stereotactic biopsies with the Brainlab® Varioguide system from January 2011 to October 2017 were reviewed and patients with suspected or verified glioma were identified. Neuropathological samples were reprocessed in accordance with 2016 CNS WHO standards.
One hundred nineteen glioma patients were identified. Analysis of IDH status could be performed in 95.8% resulting in a cumulative mutation rate of 9.6%. A complete diagnosis according to 2016 CNS WHO including grading and molecular features was achieved in 110 cases (92.4%). Entities were revised in four cases. Most common diagnosis was IDH-wildtype glioblastoma (66.4%) followed by IDH-wildtype anaplastic astrocytoma (21.8%).
A formally complete diagnosis according to 2016 CNS WHO was achieved in the majority of cases. The biopsy cohort showed a prognostically unfavorable distribution of diagnoses and molecular features. Frameless stereotactic biopsy seems to be confirmed as a useful diagnostic tool in contemporary neuro-oncology-however, certain potential limitations should be considered.
随着 2016 年世界卫生组织中枢神经系统肿瘤分类（2016 年 CNSWHO）的出现，除了组织病理学以外，诊断胶质瘤还需要考虑分子参数，这可能会增加对组织样本质量的要求。这可能会对微创活检程序的作用提出挑战。本研究旨在评估无框架立体定向活检获取的胶质瘤样本的诊断产量，重点关注分子信息，并探索胶质瘤活检队列的神经分子谱。
在病例系列分析中，回顾了 2011 年 1 月至 2017 年 10 月期间使用 Brainlab®Varioguide 系统进行的 180 例连续无框架立体定向活检，确定了疑似或确诊的胶质瘤患者。神经病理学样本按照 2016 年 CNSWHO 标准进行重新处理。
共发现 119 例胶质瘤患者。可以对 IDH 状态进行分析，结果显示累积突变率为 9.6%，其中 95.8%的病例可进行分析。按照 2016 年 CNSWHO 标准，有 110 例（92.4%）可完成完整诊断，包括分级和分子特征。4 例病例进行了修订。最常见的诊断是 IDH 野生型胶质母细胞瘤（66.4%），其次是 IDH 野生型间变性星形细胞瘤（21.8%）。
大多数病例根据 2016 年 CNSWHO 达到了正式的完整诊断。活检队列的诊断和分子特征具有预后不良的分布。无框架立体定向活检似乎已被确认为当代神经肿瘤学中有用的诊断工具，但应考虑到某些潜在的局限性。
