荧光导航下切除胶质母细胞瘤及分子病理的表达意义

Fluorescence-guided tumor resection and expressive significance of molecular pathology in glioblastoma

目的分析胶质母细胞瘤(GBM)分子病理在不同荧光显影区域的表达差异,探讨应用荧光导航技术在GBM手术中的临床意义。方法回顾性选取荧光素钠导航下经显微手术切除经病理确诊的21例GBM,对不同肿瘤区域的荧光强度和分子病理标志物表达进行比较。结果肿瘤全切除19例,次全切除2例。GBM荧光表现:肿瘤实质呈强荧光18例,弱或无荧光3例;瘤脑边界呈强荧光14例,弱或无荧光7例;瘤周水肿强荧光显影2例,弱荧光或无荧光显影19例(P<0.05)。免疫组织化学检测结果提示:不同肿瘤区域的P53、胶质纤维酸性蛋白(GFAP)和CD28表达水平差异无统计学意义(P>0.05),而Ki-67表达水平差异有统计学意义(P<0.05);在不同荧光强度GBM组织中,Ki-67表达水平差异也有统计学意义(P<0.05)。结论应用荧光素钠标记GBM,利于判断肿瘤边界;不同肿瘤区域和荧光强度的GBM,其分子病理表达具有差异,为荧光导航术中更准确辨析肿瘤浸润程度,增加安全切除范围提供病理学依据。

Objective To analyze the expression difference of molecular pathology in different fluorescence intensity regions in glioblastoma, and explore the clinical significance of fluorescence-guided technology in glioblastoma surgery. Methods Twenty-one cases of glioblastoma confirmed by pathology during the fluorescence-guided microsurgery were chose retrospectively. The fluorescence intensity and expression of molecular markers were compared between the different tumor regions. Results Total amaor resection was achieved in 19 patients and subtotal resection in 2. Glioblastoma fluorescence intensity in surgery was showed as follows： strong fluorescence imaging was seen in 18 patients and weak or no fluorescence imaging in 3 in the tumor parenchyma, strong fluorescence imaging in 14 and weak or no fluorescence imaging in 7 in the boundary of the tumor, strong fluorescence imaging in 2 and weak or no fluorescence imaging in 19 in the zone of peritumoral edema （P 〈 0.05）. Immunohistochemistry results indicated that no significant differences were found in the expression levels of P53, GFAP and CD28 between the different tumor regions （P 〉 0.05）, while significant differences were found in Ki-67 expression level betwen the different tumor regions and glioblastomas with different fluorescence intensity （P 〈 0.05）. Conclusions Labeling ofglioblastoma with sodium fluorescein is helpful to identify the boundary of the tumor. The expression of molecular pathology would show difference between different tumor regions and fluorescence intensity of glioblastoma, which provide a pathological basis for more accurate analysis of tumor infiltration and for increasing safe resection range in fluorescence-guided surgery.