Astrocytoma diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and biopsy results.The various investigations must be performed in the following order: Physical examination, imaging study (MRI is the preferred imaging technique) and tumor biopsy.
Diagnostic Study of Choice
Study of choice
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and biopsy results.
Investigations:
- Among the patients who present with clinical signs of intracranial mass, the tumor biopsy is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of intracranial mass, the imaging study is the most sensitive test for diagnosis.
Diagnostic results
The following findings on performing MRI are confirmatory for astrocytoma:[1][2]
- Low grade astrocytoma (pilocytic and diffuse astrocytoma)
- High grade astrocytoma
- Anaplastic astrocytomas
- Hypointense T1
- Hyperintense T2
- There might be some contrast enhancement and edema
- Glioblastoma multiform
- Irregular ring-nodular enhancing lesions
- Central necrosis
- Surrounding vasogenic edema
- Anaplastic astrocytomas
For more information on MRI findings, click here.
The following findings on performing biopsy are confirmatory for astrocytoma:
Pathological findings diagnostic of astrocytoma include:[3][4][5]
- Pilocytic:
- Cells appearance is normal and growth rate is slow.
- Biphasic pattern (dense fibrillar tissue within loose myxoid tissue)
- Calcification
- Vascular hyalinization
- Nested fibrotic pattern
- Diffuse:
- Anaplastic:
- Tumor cells are pleomorphic and malignant
- High mitosis rate
- Hyperchromatosis
- Prominent small vessels
- Glioblastoma:
- Pleomorphic cells
- Naked nuclei
- Multi-focal necrosis
- Pseudopalisading pattern
- Scattered pyknotic nuclear debris in the center
- Micro-vascular proliferation
- Vascular thrombi
For more information on biopsy findings, click here.
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
- Physical examination
- Imaging study (MRI is the preferred imaging technique)
- Tumor biopsy
Diagnostic Criteria
There are no established criteria for the diagnosis of astrocytoma.
References
- ↑ Sathornsumetee S, Rich JN, Reardon DA (November 2007). "Diagnosis and treatment of high-grade astrocytoma". Neurol Clin. 25 (4): 1111–39, x. doi:10.1016/j.ncl.2007.07.004. PMID 17964028.
- ↑ Pedersen CL, Romner B (January 2013). "Current treatment of low grade astrocytoma: a review". Clin Neurol Neurosurg. 115 (1): 1–8. doi:10.1016/j.clineuro.2012.07.002. PMID 22819718.
- ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
- ↑ Nafussi, Awatif (2005). Tumor diagnosis : practical approach and pattern analysis. London New York: Arnold Distributed in the U.S.A. by Oxford University Press. ISBN 0340809442.
- ↑ Schniederjan, Matthew (2011). Biopsy interpretation of the central nervous system. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 9780781799935.