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Published on: January 27, 2023
Ultrarapid Evaluation of Meningioma Malignancy by Intraoperative Flow Cytometry
Go Matsuoka1, Seiichiro Eguchi1, Hidenori Anami2
1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Background:
The prognosis for World Health Organization (WHO) grade II/III meningiomas is worse than for WHO grade I meningiomas. Histopathologic grade should ideally be identified during tumor resection, but current methods are time-consuming and have doubtful reliance. The aim of this study was to evaluate intraoperative flow cytometry (iFC) as a method for providing ultrarapid evaluation of meningioma malignancy.
Methods:
A total of 117 meningiomas were analyzed with iFC during surgery. For each, the malignancy index (MI) was calculated as the number of cells with a greater than normal DNA content as a proportion of the total number of cells. Each specimen was investigated histopathologically and was diagnostically graded according to the 2016 WHO grading system. MI results were compared with WHO grades of the meningiomas.
Results:
The automatic measurement of iFC took approximately 9 minutes on average. The difference in MI between grade I and grade II/III meningiomas was statistically significant (P < 0.001). Receiver operating characteristic analysis provided an optimal cutoff MI value of 8.0% for discrimination between grade I and grade II/III groups, with 64.7% sensitivity and 85.0% specificity for grade II/III meningiomas.
Conclusions:
Our method of calculating MI with iFC appears to be technically feasible and reliable for ultrarapid evaluation of meningioma malignancy. MI with iFC could potentially enable determination of an optimal treatment strategy during surgery, such as extent of resection of the tumor and management of invaded normal brain or nerves.
Insights
Intraoperative flow cytometry (iFC) offers a rapid and reliable method for assessing meningioma malignancy during surgery. This technique helps differentiate tumor grades, guiding treatment decisions for better patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- World Health Organization (WHO) grade II/III meningiomas have a poorer prognosis than grade I.
- Current histopathologic grading during surgery is slow and unreliable.
- Accurate intraoperative grading is crucial for determining optimal treatment strategies.
Purpose of the Study:
- To evaluate intraoperative flow cytometry (iFC) for rapid meningioma malignancy assessment.
- To compare iFC-derived malignancy index (MI) with established WHO grading.
- To determine the feasibility and reliability of iFC in surgical settings.
Main Methods:
- 117 meningiomas were analyzed using iFC during surgery.
- Malignancy index (MI) calculated as proportion of cells with abnormal DNA content.
- Results compared with histopathologic WHO grading (2016 system).
Main Results:
- iFC analysis averaged approximately 9 minutes.
- Statistically significant difference in MI between WHO grade I and II/III meningiomas (P < 0.001).
- Optimal MI cutoff of 8.0% demonstrated 64.7% sensitivity and 85.0% specificity for grade II/III tumors.
Conclusions:
- iFC provides a technically feasible and reliable method for ultrarapid meningioma malignancy evaluation.
- MI derived from iFC can aid in intraoperative treatment strategy decisions.
- Potential to guide extent of resection and management of invaded tissues.
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