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<p>Rapid intraoperative differentiation between high-grade gliomas (HGGs) and primary central nervous system lymphomas (PCNSLs) is critical because surgical strategies and adjuvant therapies differ substantially. We conducted a multicenter prospective observational study to evaluate rapid immunohistochemistry (R-IHC) on frozen sections using alternating current electric field mixing. Forty-eight adults with newly suspected malignant intra-axial brain tumors underwent tumor resection or biopsy with intraoperative frozen section consultation. The prespecified primary endpoint was antibody level concordance between R-IHC and conventional immunohistochemistry on permanent formalin-fixed, paraffin-embedded sections. Intraoperative diagnostic performance using hematoxylin and eosin (HE) alone versus HE plus R-IHC was assessed descriptively. Final diagnoses were HGG in 37 patients, PCNSL in 8, and other lesions in 3. For HGG, HE-based intraoperative diagnosis showed 91.9% sensitivity and 90.9% specificity, whereas HE plus R-IHC showed 100% sensitivity in this cohort and unchanged specificity (90.9%). CD20 showed complete concordance between rapid and permanent staining. Ki-67 labeling indices were strongly correlated between the two methods (Spearman <i>r</i> = 0.821). Therefore, R-IHC provides reliable immunostaining results on frozen sections and may serve as a practical adjunct to HE-based intraoperative differentiation between HGGs and PCNSLs in this diagnostic setting.</p>

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Rapid immunohistochemistry for intraoperative differentiation between high-grade gliomas and primary central nervous system lymphomas: a multicenter prospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Takahiro Ono,
  • Hiroaki Shimizu,
  • Yuko Hiroshima,
  • Hiroshi Nanjo,
  • Kazutoshi Hida,
  • Kazuhiro Tanaka,
  • Shunsuke Terasaka,
  • Hirokazu Sugino,
  • Zenichi Tanei,
  • Yoshinori Kodama,
  • Tomoo Itoh,
  • Takashi Sasayama,
  • Kyoko Nomura,
  • Shinya Tanaka,
  • Kazuhiro Imai,
  • Yoshihiro Minamiya,
  • Akiteru Goto,
  • Yasufumi Omori,
  • Mishie Tanino,
  • Ryuta Nakamura,
  • Yoichi Akagami

摘要

Rapid intraoperative differentiation between high-grade gliomas (HGGs) and primary central nervous system lymphomas (PCNSLs) is critical because surgical strategies and adjuvant therapies differ substantially. We conducted a multicenter prospective observational study to evaluate rapid immunohistochemistry (R-IHC) on frozen sections using alternating current electric field mixing. Forty-eight adults with newly suspected malignant intra-axial brain tumors underwent tumor resection or biopsy with intraoperative frozen section consultation. The prespecified primary endpoint was antibody level concordance between R-IHC and conventional immunohistochemistry on permanent formalin-fixed, paraffin-embedded sections. Intraoperative diagnostic performance using hematoxylin and eosin (HE) alone versus HE plus R-IHC was assessed descriptively. Final diagnoses were HGG in 37 patients, PCNSL in 8, and other lesions in 3. For HGG, HE-based intraoperative diagnosis showed 91.9% sensitivity and 90.9% specificity, whereas HE plus R-IHC showed 100% sensitivity in this cohort and unchanged specificity (90.9%). CD20 showed complete concordance between rapid and permanent staining. Ki-67 labeling indices were strongly correlated between the two methods (Spearman r = 0.821). Therefore, R-IHC provides reliable immunostaining results on frozen sections and may serve as a practical adjunct to HE-based intraoperative differentiation between HGGs and PCNSLs in this diagnostic setting.