脑立体定向活检与开颅手术切除病理结果差异分析  

Analysis of differences in pathological results between stereotactic brain biopsy and craniotomy resection

作　　者：李敏 涂斌锋[1] 罗庆丰[2] 李东海 李剑斌 邓国军 钟方平 LI Min;TU Bin-feng;LUO Qing-feng;LI Dong-hai;LI Jian-bin;DENG Guo-jun;ZHONG Fang-ping(Department of Neurosurgery,Jiangxi Cancer Hospital,Nanchang 330029,Jiangxi,China;不详)

机构地区：[1]江西省肿瘤医院神经外科,江西南昌330029 [2]江西省肿瘤医院病理科,江西南昌330029

出　　处：《广东医学》2025年第2期261-266,共6页Guangdong Medical Journal

基　　金：江西省卫生健康委员会科技计划项目(202110079)。

摘　　要：目的探讨脑立体定向技术在颅内病灶活检中的实用价值,分析脑立体定向活检与开颅手术切除病理差异,探索提高脑立体定向活检诊断水平。方法回顾性收集江西省肿瘤医院2018年9月至2023年10月行脑立体定向活检后并行手术切除活检33例,对比脑立体定向活检与开颅手术切除病理差异,探索脑立体定向活检实用价值,并分析其结果差异。结果33例患者年龄25~80岁,均值53.1岁,男20例,女13例。33例患者中常规病理脑立体定向活检星形细胞瘤23例,恶性肿瘤4例,异型细胞1例,胶质增生3例,脑膜瘤1例,室管膜瘤1例;开颅手术常规病理证实星形细胞瘤27例,脑膜瘤1例,梭形细胞肿瘤1例,转移癌3例,淋巴瘤1例;免疫组化脑立体定向星形细胞瘤27例(Ⅱ级15例,Ⅲ级5例,Ⅳ级7例),转移癌3例,室管膜瘤1例,脑膜瘤1例,弥漫大B淋巴瘤1例,开颅手术切除星形细胞瘤共28例(Ⅱ级13例,Ⅲ级6例,Ⅳ级9例),转移癌3例,脑膜瘤1例,弥漫大B淋巴瘤1例。常规组织学病理差异占12.12%(4例),免疫组化诊断分类分级差异率18.18%(6例),而免疫指标(Ki-67)差异高达36.36%(12例),其余指标均符合。结论脑立体定向活检是颅内病灶诊断的可靠方法,虽不能完全体现病灶生物学性质,但能够满足临床应用。提高影像阅片和穿刺技巧有利于获取更具代表性结果。Objective To evaluate the practical value of stereotactic brain biopsy in diagnosing intracranial lesions,analyze the pathological differences between stereotactic brain biopsy and craniotomy resection,and explore ways to improve the diagnostic accuracy of stereotactic brain biopsy.Methods A retrospective analysis was conducted on 33 cases from Jiangxi Cancer Hospital between September 2018 and October 2023,where patients underwent stereotactic brain biopsy followed by craniotomy resection.The pathological differences between the two procedures were compared to assess the practical value of stereotactic brain biopsy and identify areas for improvement.Results The average age of the 33 patients was 53.1 years(range:25-80 years),including 20 males and 13 females.Conventional histopathology of stereotactic biopsy identified astrocytoma in 23 cases,malignant tumors in 4 cases,atypical cells in 1 case,gliosis in 3 cases,meningioma in 1 case,and ependymoma in 1 case.Craniotomy resection confirmed astrocytoma in 27 cases,metastatic cancer in 3 cases,meningioma in 1 case,spindle cell tumor in 1 case,and lymphoma in 1 case.Immunohistochemical results from stereotactic biopsy revealed astrocytoma in 27 cases(GradeⅡ:15 cases;GradeⅢ:5 cases;GradeⅣ:7 cases),metastatic cancer in 3 cases,ependymoma in 1 case,meningioma in 1 case,and diffuse large B-cell lymphoma in 1 case.Craniotomy resection confirmed astrocytoma in 28 cases(GradeⅡ:13 cases;GradeⅢ:6 cases;GradeⅣ:9 cases),metastatic cancer in 3 cases,meningioma in 1 case,and diffuse large B-cell lymphoma in 1 case.The overall discrepancy rate in conventional histopathology was 12.12%(4 cases),while differences in immunohistochemical diagnostic classification and grading were 18.18%(6 cases).Differences in immunomarkers,especially Ki-67,were as high as 36.36%(12 cases).Conclusion Stereotactic brain biopsy is a reliable method for diagnosing intracranial lesions.Although it may not fully capture the biological characteristics of the lesions,it meets clinical diagnostic

关 键 词：脑立体定向活检 开颅手术 病理 差异分析 

分 类 号：R739.41[医药卫生—肿瘤] R446.8[医药卫生—临床医学]