title: Relationship of intraoperative ultrasound characteristics with pathological grades and Ki-67 proliferation index in intracranial gliomas.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the relationship between the intraoperative ultrasonographic appearances and the histopathological characteristics of glial tumors using the pathological grading system and the Ki-67 proliferation index.
  
  
  METHODS
  Patients with glial tumors who underwent surgery with the aid of intraoperative ultrasonography (IOUS) between September 2013 and August 2014 were included in the study. The lesions' IOUS characteristics were analyzed and compared with the results of surgical histopathological characteristics. Lesions were classified as low-grade gliomas (grade I-II, LGG) and high-grade gliomas (grade III-IV, HGG). The glioblastoma multiforme (grade IV, GBM) group was classified according to the Ki-67 values for further evaluation. The Chi square test (Fisher's exact test) was used for comparing the ultrasonographic characteristics of the low-grade and high-grade gliomas; HGG with different Ki-proliferation indexes. A value of P < 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 41 patients were included. The histopathological findings revealed 15 LGG and 26 HGG. Twenty of the 26 HGG were GBM. Differences were found between the intraoperative ultrasonographic characteristics of the low-grade and high-grade glial tumors. The majority of LGGs were mildly hyperechoic and homogeneous, with distinct margins and a regular contour. HGGs were mostly highly hyperechoic, with indistinct margins, irregular contours, and a heterogeneous internal texture. Surrounding edema was seen more often in HGGs. The differences in the echogenicity of the solid parts, the internal echo patterns, margins, contours, and peripheral edema (P < 0.05) were statistically significant, but the difference in the presence of cysts (P > 0.05) was not significant. In the GBM group, all of the lesions with distinct margins and regular contours had Ki-67 values ≤15 %. We compared the intraoperative ultrasonographic characteristics of the Ki-67 > 15 % group with those of the Ki-67 ≤ 15 % group for statistical significance. The difference between the echogenicity of the solid parts, margins, and contours was statistically significant between the groups (P < 0.05). The difference in the internal echo pattern, presence of cyst, and peripheral edema was insignificant (P > 0.05).
  
  
  CONCLUSIONS
  IOUS is a very useful imaging technique not only in defining the borders but also in characterizing the tumoral tissue. The IOUS characteristics of the glial tumors were a valuable tool in differentiating the grades of the glial tumors and might have a relationship with the Ki-67 proliferation index. We think this theory requires further investigation in more detailed comparative studies with larger numbers of patients.
authors.affiliation: Department of Radiology School of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcılar, 34214, Istanbul, Turkey. ozdil.baskan@yahoo.com.|, Tasli Cikis sk. 8/4 Kabatas Beyoglu, 34427, Istanbul, Turkey. ozdil.baskan@yahoo.com.
authors.forename: Ozdil
authors.initials: O
authors.lastname: Baskan
authors.affiliation: Department of Neurosurgery, School of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcılar, 34214, Istanbul, Turkey.
authors.forename: Gokalp
authors.initials: G
authors.lastname: Silav
authors.affiliation: Department of Neurosurgery, School of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcılar, 34214, Istanbul, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Sari
authors.affiliation: Department of Medical Pathology, School of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcılar, 34214, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Canoz
authors.affiliation: Department of Neurosurgery, School of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcılar, 34214, Istanbul, Turkey.
authors.forename: Ilhan
authors.initials: I
authors.lastname: Elmaci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D049109:Cell Proliferation; D002648:Child; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen
keywords: Glial tumors; Grade; Histopathology; Intraoperative ultrasonography; Ki-67