Rapid immunohistochemistry for intraoperative differentiation between high-grade gliomas and primary central nervous system lymphomas: a multicenter prospective study.

Authors

Takahiro Ono, Hiroaki Shimizu, Yuko Hiroshima, Hiroshi Nanjo, Kazutoshi Hida, Kazuhiro Tanaka, Shunsuke Terasaka, Hirokazu Sugino, Zenichi Tanei, Yoshinori Kodama, Tomoo Itoh, Takashi Sasayama, Kyoko Nomura, Shinya Tanaka, Kazuhiro Imai, Yoshihiro Minamiya, R-IHC Study Group

Published in

Brain tumor pathology. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

Rapid intraoperative differentiation between high-grade gliomas (HGGs) and primary central nervous system lymphomas (PCNSLs) is critical because surgical strategies and adjuvant therapies differ substantially. We conducted a multicenter prospective observational study to evaluate rapid immunohistochemistry (R-IHC) on frozen sections using alternating current electric field mixing. Forty-eight adults with newly suspected malignant intra-axial brain tumors underwent tumor resection or biopsy with intraoperative frozen section consultation. The prespecified primary endpoint was antibody level concordance between R-IHC and conventional immunohistochemistry on permanent formalin-fixed, paraffin-embedded sections. Intraoperative diagnostic performance using hematoxylin and eosin (HE) alone versus HE plus R-IHC was assessed descriptively. Final diagnoses were HGG in 37 patients, PCNSL in 8, and other lesions in 3. For HGG, HE-based intraoperative diagnosis showed 91.9% sensitivity and 90.9% specificity, whereas HE plus R-IHC showed 100% sensitivity in this cohort and unchanged specificity (90.9%). CD20 showed complete concordance between rapid and permanent staining. Ki-67 labeling indices were strongly correlated between the two methods (Spearman r = 0.821). Therefore, R-IHC provides reliable immunostaining results on frozen sections and may serve as a practical adjunct to HE-based intraoperative differentiation between HGGs and PCNSLs in this diagnostic setting.

PMID:
42295621
Bibliographic data and abstract were imported from PubMed on 15 Jun 2026.

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