Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan.
Neuropathology. 2023 Jun;43(3):209-220. doi: 10.1111/neup.12864. Epub 2022 Sep 20.
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.
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显著改变手术策略，因此需要更准确的诊断方法。2020 年 4 月，我们除了基于形态评估的常规术中快速诊断外，还采用了术中快速免疫组化 (IHC)，主要针对 PCNSL 患者。在此，我们根据初步经验探讨了术中快速 IHC 的有用性和意义。我们在 2020 年 4 月至 2022 年 7 月期间使用酶标记抗体方法对 25 名患者（包括 PCNSL 患者）进行了术中快速 IHC，使用的抗体包括分化群 (CD)20、CD3、白细胞共同抗原 (LCA) 和神经胶质纤维酸性蛋白 (GFAP)。我们检查了这种方法在确定脑肿瘤治疗策略中的效用。石蜡包埋切片的术后最终病理诊断如下：弥漫性大 B 细胞淋巴瘤 16 例；胶质母细胞瘤 6 例；毛细胞星形细胞瘤 1 例；腺癌 1 例；炎症性疾病 1 例。整个过程耗时 32 分钟，CD20、CD3、LCA 和 GFAP 的染色与使用石蜡包埋切片相当。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，在两例病例中，通过添加术中快速 IHC，基于冷冻切片形态评估的常规术中快速病理诊断结果发生了巨大变化。术中快速 IHC 有助于决定适当的治疗策略，并促进 PCNSL 的早期化疗。这不仅可能为 PCNSL 提供新的治疗策略，也可能为其他脑肿瘤提供新的治疗策略。
