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Mitosis identification in diffuse gliomas: implications for tumor grading

S W Coons1, D K Pearl

  • 1Division of Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.

Cancer
|April 29, 1998
PubMed
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Determining the extent of microscopic examination for glioma grading is crucial. Reviewing specific fields helps accurately assess mitotic activity for better prognostic information in astrocytomas and oligodendrogliomas.

Area of Science:

  • Neuropathology
  • Oncology
  • Histopathology

Background:

  • Histologic differentiation of mitotic figures is key for glioma grading.
  • Current grading systems lack defined criteria for the extent of microscopic examination needed to assess mitotic activity.
  • Accurate assessment of mitotic figures is critical for classifying astrocytomas as high-grade.

Purpose of the Study:

  • To determine the necessary extent of microscopic examination for accurately evaluating mitotic activity in gliomas.
  • To correlate the field of first mitosis identification with glioma diagnosis, grade, and patient survival.
  • To establish guidelines for microscopic diligence in glioma grading.

Main Methods:

  • Review of H&E-stained slides from 410 astrocytomas and 107 oligodendrogliomas/oligoastrocytomas.

Related Experiment Videos

  • Microscopic examination continued until the first mitosis was identified or 100 fields were reviewed.
  • Correlation of the field number of the first mitosis with diagnosis, grade, and survival data.

    • Main Results:

    • Over 90% sensitivity for mitosis detection in Grade 3 astrocytomas required reviewing 50 fields.
    • Anaplastic oligodendroglioma specimens (Grade 3 and 4) required only 20 fields for >90% sensitivity.
    • Mitotic activity field number significantly correlated with survival in Grade 3 astrocytomas (P=0.02) and grade in oligodendroglial tumors (P<0.0001).

    Conclusions:

    • Evaluating mitotic activity provides more prognostic information than simply noting its presence or absence.
    • A 1 cm x 0.1 cm needle biopsy is generally adequate for assessing mitotic activity if representative and cellular.
    • Data provide guidance on the diligence of microscopic examination required for accurate glioma grading.