Intraoperative Flow Cytometry in Neuro-Oncology

Intraoperative flow cytometry (iFC) has emerged as a transformative tool in neuro-oncological surgery, offering real-time cellular analysis to guide tumour resection and grade assessment. By rapidly quantifying DNA content and cell-cycle distribution in excised tissue samples, iFC enables surgeons to distinguish neoplastic from normal tissue within minutes. This technique typically evaluates the fraction of cells in G0/G1, S and mitotic phases, while also determining tumour index – the combined proportion of S-phase and mitotic cells – and ploidy status. Early clinical studies have demonstrated that iFC can accurately discriminate high-grade from low-grade gliomas and meningiomas, verify clear resection margins and inform intraoperative decision making. The speed and precision of iFC complement conventional approaches such as frozen section and intraoperative imaging, with the potential to reduce residual tumour burden, tailor the extent of resection and ultimately improve neurological and oncological outcomes. As methodologies and protocols mature, iFC is poised to become a standard adjunct in the surgical management of primary and metastatic brain tumours worldwide.

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Intraoperative Flow Cytometry in Neuro-Oncology publication trend

The graph below shows the total number of articles in intraoperative flow cytometry in neuro-oncology across all publications each year (not limited to Nature Index journals).

Technical terms

Intraoperative flow cytometry (iFC): A rapid analytical method for quantifying DNA content and cell-cycle phases in fresh surgical specimens during an operation.

Tumour index: The combined percentage of cells in S-phase and mitosis, used as a proxy for proliferative activity.

Ploidy: The DNA content of a cell population relative to normal diploid cells, indicating euploid or aneuploid status.

Cell-cycle analysis: The measurement of the proportion of cells in distinct phases (G0/G1, S, G2/M) to assess tumour growth kinetics.

References

1. Assessment of Gliomas’ Grade of Malignancy and Extent of Resection Using Intraoperative Flow Cytometry. Cancers (2023).
2. Intraoperative Flow Cytometry for the Evaluation of Meningioma Grade. Current Oncology (2023).
3. Advances in Intraoperative Flow Cytometry. International Journal of Molecular Sciences (2022).
4. Critical Assessment of Cancer Characterization and Margin Evaluation Techniques in Brain Malignancies: From Fast Biopsy to Intraoperative Flow Cytometry. Cancers (2023).