术中冰冻切片联合快速免疫组化在中枢神经系统淋巴瘤和高级别胶质瘤诊断中的价值

Value of intraoperative frozen section combined with rapid immunohistochemistry in the diagnosis of central nervous system lymphoma and high-grade glioma

目的:探讨术中冰冻切片联合快速免疫组化(rapid immunohistochemistry,RD-IHC)诊断中枢神经系统淋巴瘤(central nervous system lymphomas,CNSL)和高级别胶质瘤(high-grade gliomas,HGG)的可行性及意义。方法:收集我院2019年01月至2023年12月CNSL术中标本18例,设为CNSL组;高级别胶质瘤24例,设为高级别胶质瘤组,使用术中冰冻切片HE染色和术中冰冻切片RD-IHC检测白细胞共同抗原(LCA)、胶质纤维酸性蛋白(GFAP)在两种疾病中的表达,以石蜡切片免疫组化结果为金标准,对比术中冰冻切片HE染色和RD-IHC两种方法诊断CNSL和高级别胶质瘤的准确率。结果:术中冰冻切片RD-IHC和术中冰冻切片HE染色诊断CNSL正确率分别为100.00%、72.22%,差异有统计学意义(P=0.045)。术中冰冻切片RD-IHC结果显示LCA阳性及GFAP阴性表达率在CNSL组中显著高于高级别胶质瘤组,差异有统计学意义(P<0.001)。结论:术中冰冻切片RD-IHC诊断CNSL和高级别胶质瘤显著优于术中冰冻切片HE染色,LCA和GFAP联合可作为术中冰冻切片快速免疫组化指标来鉴别CNSL和高级别胶质瘤。

Objective:To investigate the feasibility and significance of intraoperative frozen section combined with rapid immunohistochemistry(RD-IHC)in the diagnosis of central nervous system lymphomas(CNSL)and high-grade gliomas(HGG).Methods:A total of 18 cases of CNSL and 24 cases of high-grade gliomas from January 2019 to December 2023 in our hospital were collected.Intraoperative frozen sections with hematoxylin and eosin(HE)staining and RD-IHC were used to detect the leukocyte common antigen(LCA)and glial fibrillary acidic protein(GFAP)expression in the two diseases.Immunohistochemistry results of paraffin sections were used as the gold standard to compare the accuracy of diagnosing CNSL and high-grade gliomas using intraoperative frozen sections with HE staining and RD-IHC.Results:The accuracy of diagnosis using intraoperative frozen section RD-IHC and HE staining for CNSL was 100.00%and 72.22%,respectively,with a statistically significant difference(P=0.045).The expression rates of LCA positivity and GFAP negativity in CNSL were significantly higher than those in high-grade gliomas using intraoperative frozen section RD-IHC(P<0.001).Conclusion:Intraoperative frozen section RD-IHC is superior to HE staining for the diagnosis of CNSL and high-grade gliomas.The combination of LCA and GFAP can serve as rapid immunohistochemical markers for distinguishing CNSL from high-grade gliomas on intraoperative frozen sections.