Inoue Akihiro, Miyazaki Yukihiro, Watanabe Hideaki, Nishikawa Masahiro, Kusakabe Kosuke, Ohnishi Takanori, Taniwaki Mashio, Honda Takatsugu, Kondo Takuya, Kinnami Shingo, Katayama Eiji, Shigekawa Seiji, Kurata Mie, Kitazawa Riko, Kunieda Takeharu
Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Hospital, Shitsukawa, Toon, Ehime, 454, 791-0295, Japan.
Acta Neurol Belg. 2025 Feb;125(1):99-108. doi: 10.1007/s13760-024-02637-3. Epub 2024 Sep 21.
Primary central nervous system lymphoma (PCNSL) is a rapidly growing malignant tumor that typically shows sensitivity to high-dose methotrexate-based chemotherapy. Rapid diagnosis and early chemotherapy are thus essential to obtain the best outcome. To accomplish this, we have performed intraoperative rapid immunohistochemistry (IHC) as an examination method for obtaining accurate diagnosis during surgery. Here, to markedly enhance the accuracy of intraoperative rapid IHC, the utility of adding intraoperative rapid examinations of cytology and flow cytometry (FCM) in addition to rapid IHC was investigated.
From April 2020 to January 2024, we performed intraoperative rapid IHC in 35 patients with intracranial lesions, including PCNSL. In the last 17 of these cases, intraoperative cytology and FCM were also performed simultaneously. We examined the utility of examination methods in determining treatment strategies for brain tumors, particularly early therapeutic intervention for PCNSL.
Postoperative final pathological diagnoses from paraffin-embedded sections were as follows: 20 PCNSLs, 9 glioblastomas, 4 diffuse gliomas, 1 meningioma, and 1 inflammatory disorder. In all cases, results from intraoperative rapid IHC were consistent with final pathological diagnoses from paraffin-embedded sections. In two cases, results from conventional intraoperative rapid pathological diagnoses based on morphological assessments using frozen sections changed with the addition of intraoperative rapid IHC. Further, the time from surgery to initiation of chemotherapy for PCNSL was significantly reduced by adding cytology and FCM to rapid IHC alone (only rapid IHC group: 7.3 days, combination group: 1.6 days; p = 0.015).
The combination of rapid intraoperative IHC, cytology, and FCM contributes to deciding appropriate treatment strategies and facilitating early initiation of chemotherapy for PCNSL. These examination methods may allow new therapeutic strategies for not only PCNSL, but also other brain tumors.
原发性中枢神经系统淋巴瘤（PCNSL）是一种快速生长的恶性肿瘤，通常对基于大剂量甲氨蝶呤的化疗敏感。因此，快速诊断和早期化疗对于获得最佳治疗效果至关重要。为实现这一目标，我们开展了术中快速免疫组织化学（IHC），作为手术期间获取准确诊断的一种检查方法。在此，为显著提高术中快速IHC的准确性，我们研究了除快速IHC外，增加术中细胞学和流式细胞术（FCM）快速检查的效用。
2020年4月至2024年1月，我们对35例颅内病变患者（包括PCNSL患者）进行了术中快速IHC检查。在其中17例病例中，同时进行了术中细胞学和FCM检查。我们研究了这些检查方法在确定脑肿瘤治疗策略，特别是PCNSL早期治疗干预方面的效用。
石蜡包埋切片的术后最终病理诊断如下：20例PCNSL、9例胶质母细胞瘤、4例弥漫性胶质瘤、1例脑膜瘤和1例炎症性疾病。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。在2例病例中，基于冰冻切片形态学评估的传统术中快速病理诊断结果，在增加术中快速IHC后发生了改变。此外，仅对快速IHC增加细胞学和FCM检查后，PCNSL从手术到开始化疗的时间显著缩短（仅快速IHC组：7.3天，联合检查组：1.6天；p = 0.015）。
术中快速IHC、细胞学和FCM相结合，有助于为PCNSL确定合适的治疗策略，并促进早期化疗的开始。这些检查方法不仅可能为PCNSL，也可能为其他脑肿瘤带来新的治疗策略。
