Prognostic value of histological features in diffuse astrocytomas WHO grade II (original) (raw)
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Clinicohistopathological study of astrocytomas along with Ki-67 proliferative index
International Journal of Research in Medical Sciences, 2018
Astrocytic tumors are the most common primary tumors of the central nervous system. 1 Several grading systems are used to grade astrocytomas. The most widely used system is the World Health Organization (WHO) classification (1979, 1993, 2000, and 2007) that grades astrocytomas (I-IV) based on cytological atypia, mitotic activity, vascular proliferation, and necrosis: pilocytic astrocytoma (grade I), diffuse astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV). 2 Though histopathological features largely help in the determination of prognosis, histological differentiation may not be clear in some cases, especially when only small fragments of tissue biopsies are available. Studies have employed a wide range of parameters from tumor suppressor genes to proliferation indices for predicting clinical outcome and survival. 3 A variety of methods have been employed to estimate the proliferative index of central nervous system tumors. Of these, one of the most potent methods is the Ki-67 labeling index (Ki-67 LI). The value of Ki-67 LI in the
Proliferative activity and prognosis of low-grade astrocytomas
1997
Well-differentiated astrocytomas may transform into malignant astrocytomas in time. In surgical specimens, when the histological picture strictly corresponds to that of grade II glioma, the transformation is unpredictable. Clinically, the bad outcome of a quota of astrocytomas is a well known phenomenon. The use of proliferation markers, and recently of MIB-1 LI, for detecting the proliferation potential comes out to be a useful tool for prognosis. A survival analysis of fifty astrocytomas grade II according to the WHO classification was performed with univariate and multivariate analysis of a series of clinical and histological parameters. MIB-1 LI was calculated and compared with all the other parameters. A cut-off of 8% of MIB-1 LI divided the astrocytomas in two groups with significantly different survival (p = 0.0066): median survival time of 1062 versus 1686 days. According to multivariate analysis MIB-1 LI resulted to be an independent factor (p = 0.002) along with extension of surgical removal (partial versus total), postoperative Karnofsky status (≥ 70 versus < 70) and age (≤ 30 versus > 30). The interpretation of well-differentiated astrocytomas with high MIB-1LI is that the increasing number of cycling cells precedes phenotypic transformation. MIB-1 LI can be used as a prognostic factor.
Comparison of KI-67/MIB-1 Labelling Index and Histopathological Grading of Astrocytoma
2017
Background: Astrocytomas are common malignant brain tumours. Ki-67/MIB-1 index serves as an important supplementary tool in the diagnosis and prognosis of human astrocytoma. Methods: Forty (40) cases of various histopathological (WHO) grades of astrocytoma (Pilocytic, diffuse, Anaplastic and Glioblastoma multiforme) were included in this study. Ki-67/MIB-1 labelling index of these tumours was estimated by immunohistochemistry, performed on paraffin sections. Histopathological grading and Ki-67/MIB-1 labelling index were compared. The results were analyzed by one way ANOVA. Results: Out of 40 cases two were diagnosed as pilocytic astrocytoma (WHO grade-1) with a mean Ki-67/MIB-1 labelling index of 0.7±1.4 (range 0.6–0.8%). Thirteen cases were of diffuse astrocytoma (WHO grade II), with a mean Ki-67/MIB-1 labelling index of 3.07±3.7 (range 1–15%). Nine cases were diagnosed as Anaplastic astrocytoma (WHO grade III) with a mean Ki-67/MIB-1 labelling Index of 11.55±7.8 (range 2–...
Immunohistochemical markers for prognosis of anaplastic astrocytomas
Journal of neuro-oncology, 2002
Among the entire spectrum of astrocytic neoplasms, just anaplastic astrocytoma (or grade III astrocytoma) appears to be a more enigmatic tumor entity with vague criteria for pathological diagnosis, unclear biological behavior and diverse clinical outcome. Attempts have been made to identify biological markers that would be useful in prediction of prognosis of anaplastic astrocytomas but the results obtained are controversial. In the present study, survival data on 63 patients with anaplastic astrocytoma were studied to evaluate a possible association between clinical outcome and expression of some immunohistochemical variables. Both the progression-free (PFS) and overall (OS) survival times were significantly reduced for patients older than 45 years, for anaplastic astrocytomas containing multiple mitoses, for Ki-67 LI > 5%, for cyclin A LI > 4% and for PTEN-negative tumors. We found no differences in survival times in patients with or without p53 immunoreactivity and also in ...
The clinical value of Ki-67/MIB-1 labeling index in human astrocytomas
Pathology oncology research : POR, 2006
The current WHO classification of human astrocytomas has limitations in predicting prognosis and diagnosis, and there is a need for additional factors. Several studies have investigated the clinical value of proliferative activity in these tumors, especially the Ki-67/MIB-1 labeling index (LI). The aim of this study was to review the literature on this topic to get a survey of the current experience. All studies show increasing values of Ki-67/MIB-1 LI with increasing grade of malignancy. Most of them demonstrate that MIB-1 LI differentiates well between diffuse astrocytomas WHO grade II (AII) and anaplastic astrocytomas (AA) and between AII and glioblastomas (GM), but not between AA and GM. There is, however, considerable overlap of indices between the different malignancy groups. Further, in most studies positive correlations between MIB-1 LI and survival are found, though the proposed cut-off values vary substantially between the reports. The studies reviewed report MIB-1 LI as a...
Factors predicting progression of low-grade diffusely infiltrating astrocytoma
Neurology India, 2011
Background: Low-grade diffuse astrocytoma (DA) is considered benign tumor (World Health Organization [WHO] grade II), but it has an inherent tendency for malignant progression, which is quite variable. Aim: To identify malignant progression in an individual case of DA, we studied the clinico-radiological and immunohistochemical factors and correlated with progression of DA at a dedicated tertiary level neurosciences centre NIMHANS, Bangalore, India. Patients and Methods: Consecutive adult patients who had undergone tumor decompression for lobar supratentorial DA at our institute from 1994 to 1998 were retrospectively selected and followed up for clinico-radiological progression. The clinico-radiological and histomorphological features were studied. With the use of immunohistochemistry, proliferation index [MIB-1 labeling index (LI)], p53 protein expression, microvessel density (MVD) count [assessed using anti-CD34 antibody] were analyzed and correlated with progression-free survival (PFS) Results: There were 13 patients. Mean age was 34 years. The most common presenting symptom was seizures. The median follow-up was 54 months. There were four recurrences, with median interval of 75 months. Eight patients received radiotherapy. Younger patients (<40 years), seizure as the presenting symptom and postoperative radiotherapy were associated with longer PFS, while gemistocytic morphology (>20% gemistocytic cells), MVD value >20 correlated with shorter PFS, albeit statistically insignificant. MIB1 LI did not correlate with recurrence pattern. Moreover, p53 LI > 10% correlated with early progression (P = 0.04). Conclusion: Our study highlights some of the clinical, histological and immunohistochemical parameters that predict progression on DA. Validation on a larger sample may be useful to plan appropriate treatment in an individual case.
Prognostic value of histologic factors in adult cerebral astrocytoma
Cancer, 1988
Surgical specimens from 165 adults with cerebral astrocytoma were reviewed to establish the prognostic value of histologic factors when studied both individually and in combination. Glioblastomas were excluded. Nine morphologic parameters and 25 clinicotherapeutic factors were correlated with survival.
Prognostic implications of the proliferative potential of low-grade astrocytomas
Journal of Neurosurgery, 1988
✓ The proliferative potential of low-grade astrocytomas was estimated in 47 patients. Each patient received an intravenous infusion of bromodeoxyuridine (BUdR), 150 to 200 mg/sq m, at the time of craniotomy to label cells in deoxyribonucleic acid (DNA) synthesis; the percentage of S-phase cells, or BUdR labeling index (LI), of each tumor was determined immunohistochemically. In 29 patients (60%), the tumors had BUdR LI's of less than 1%, indicating a slow growth rate; only three (10%) of these patients died of recurrent tumor during a follow-up period of up to 3½ years. In contrast, of the 18 patients (40%) whose tumors had BUdR LI's of 1% or more, 12 (67%) had a recurrence and nine died during the same follow-up period. These results show that the proliferative potential, as reflected by the BUdR LI, is an important prognostic factor that separates low-grade astrocytomas into two groups and provides a more scientific rationale for selecting treatment for individual patients.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015
Background: Although radiological imaging and surgical techniques have substantially improved, assessment of prognosis by grading astrocytoma has been challenging task for pathologists. We have tried to assess these tumours intraoperatively for rapid diagnosis. Also MIB-1Labelling index (MIB-1 LI) was done to study their proliferative activity. Aims: To compare and grade squash smear technique with histopathology to study its utility in diagnosis of astrocytomas. Further, to study correlation of various grades with their MIB-1 labelling index. Setting and Designs: This study was carried out in the Department of Pathology, SMS Medical College, Jaipur over a period of one year. Materials and Methods: Forty five cases of radiologically suspected astrocytomas were submitted for intraoperative cytology and later for histopathology. Two techniques were compared for ability to diagnose as well as grade the tumour. Also, MIB-1 LI were performed in biopsy tissue. Histopathological and immunological grades were compared. Results: Out of 45 cases 44(97.7%) correctly diagnosed by squash smear technique. Further significant differences seen in values of MIB-1 LI of high-grade and low-grade astrocytomas. A progressive increase in the MIB-1 LI was observed with increasing grades. In grade I astrocytoma MIB-1 LI was <0.05%. In grade II astrocytoma it varied from 0.8-2.6% except in one case where it was 3.2% who presented with a recurrent mass. In grade III, MIB-1 LI was 3.5% to 7.5%. In grade IV was 10-20%. Conclusion: Intraoperative cytology is fairly accurate and useful in intraoperative consultation. Also, MIB-1 LI can be a useful adjunct for grading particularly in small biopsies.