Pathologic analysis of glioblastoma via multiple stereotactic biopsies             of active tumor and necrosis.
To obtain more representative biopsy specimens in glioblastoma, we performed             multiple stereotactic biopsies of active tumor and necrosis. We investigated their             pathologic differences of diagnosis and also examined the pathologic features             that varied with 11C-methionine uptake on PET. From December 2009 to October 2010,             we performed stereotactic biopsies in 12 patients with radiologically heterogeneous,             ring-enhanced lesions. We biopsied the MR enhanced lesions for active tumor and             the MR non-enhanced lesions for necrosis and analyzed differences of pathologic             diagnoses between them. As correlating factors of the degree of 11C-methionine             uptake (T/N ratio), the pathologic findings, including cell density, Ki‑67 LI,             microvessel density, number of endothelial proliferations, the immunopositivity             for L-amino acid transporter 1 (LAT1) were analyzed. The final diagnosis of each             specimen was glio-blastoma. The diagnostic failure rate was 33.3% (4/12 patients)             when we selected only active tumors and 40% (4/10 patients) when we selected necrotic             lesions. The T/N ratio showed a statistical correlation with cell density depending             on the degree of necrosis and LAT1 immunopositivity (P=0.002 and 0.032). LAT1             was localized in the tumor cells, vascular endothelium, and the vicinity of endothelial             proliferation. Multiple stereotactic biopsies of active tumor and necrosis could             provide the diagnostic yield in glioblastoma. The 11C-methionine uptake mostly             reflected cell densities depending on the degree of necrosis.
Department of Neuro-surgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, Republic of Korea. jung-ty@chonnam.ac.kr
Tae-Young
TY
Jung
Shin
S
Jung
In-Young
IY
Kim
Kyung-Sub
KS
Moon
Woo-Youl
WY
Jang
Seung-Jin
SJ
Park
Young-Hee
YH
Kim
Hyung-Seok
HS
Kim
Jung-Joon
JJ
Min
Jahae
J
Kim
D000368:Aged; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002250:Carbon Radioisotopes; D002452:Cell Count / Q000379:methods; D049109:Cell Proliferation; D004730:Endothelium, Vascular / Q000378:metabolism / Q000473:pathology; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D027283:Large Neutral Amino Acid-Transporter 1 / Q000378:metabolism; D008297:Male; D008715:Methionine / Q000378:metabolism; D055806:Microvessels / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D013238:Stereotaxic Techniques
D002250:Carbon Radioisotopes; D027283:Large Neutral Amino Acid-Transporter 1; D019275:Radiopharmaceuticals; D008715:Methionine