Resection margin status evaluation in gastric cancer surgery by intraoperative flow cytometry

Μαρκόπουλος, Γεώργιος; Vartholomatos, George; Alexiou, George Α.; Tatsis, Vasileios A.; Bali, Christina; Mitsis, Michail

doi:10.1002/jso.27187

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“…Intraoperative Flow Cytometry has been introduced as a novel technique mainly for the evaluation of the grade of malignancy and the presence of cancerous tissue in resection margins during solid tumor surgery [12,13]. Among other things, iFC has been evaluated and verified as a valuable tool for the surgeon during the excision of breast cancer, head and neck tumors, gynecological malignancies, bladder cancer, and liver, pancreatic, gastric, and colorectal cancer [14][15][16][17][18][19][20][21][22]. In CNS tumors, iFC permits the differentiation of low-from high-grade tumors in both children and adults, the analysis of neoplastic tissue during stereotactic biopsies, the diagnosis of central nervous system lymphoma, and the assessment of the meningioma grade of malignancy [13,[23][24][25][26][27].…”

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confidence: 99%

Assessment of Gliomas’ Grade of Malignancy and Extent of Resection Using Intraoperative Flow Cytometry

Vartholomatos

Μαρκόπουλος

Vartholomatos

et al. 2023

Cancers

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Background: Intraoperative Flow Cytometry (iFC) is a novel technique for the assessment of the grade of malignancy and the diagnosis of tumor type and resection margins during solid tumor surgery. Herein, we set out to analyze the role of iFC in the grading of gliomas and the evaluation of resection margins. Material and Methods: iFC uses a fast cell cycle analysis protocol (Ioannina Protocol) that permits the analysis of tissue samples within 5–6 min. Cell cycle analysis evaluated the G0/G1 phase, S-phase, mitosis, and tumor index (S + mitosis phase fraction) and ploidy status. In the current study, we evaluated tumor samples and samples from the peripheral borders from patients with gliomas who underwent surgery over an 8-year period. Results: Eighty-one patients were included in the study. There were sixty-eight glioblastoma cases, five anaplastic astrocytomas, two anaplastic oligodendrogliomas, one pilocytic astrocytoma, three oligodendrogliomas and two diffuse astrocytomas. High-grade gliomas had a significantly higher tumor index than low grade gliomas (median value 22 vs. 7.5, respectively, p = 0.002). Using ROC curve analysis, a cut-off value of 17% in the tumor index could differentiate low- from high-grade gliomas with a 61.4% sensitivity and 100% specificity. All low-grade gliomas were diploid. From the high-grade gliomas, 22 tumors were aneuploid. In glioblastomas, aneuploid tumors had a significantly higher tumor index (p = 0.0018). Twenty-three samples from glioma margins were evaluated. iFC verified the presence of malignant tissue in every case, using histology as the gold standard. Conclusion: iFC constitutes a promising intraoperative technique for glioma grading and resection margin assessment. Comparative studies with additional intraoperative adjuncts are necessary.

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