Diagnostic accuracy and limitations of intraoperative cytology in diagnosis of gliomas-A two year study in a tertiary care hospital in South India (original) (raw)
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Evaluation Study of Intraoperative Cytology Smear and Frozen Section of Glioma
Asian Pacific Journal of Cancer Prevention
Objective: Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient's future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques. Methods: A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis. Results: The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05). Conclusion: Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Gliomas are most common primary Central Nervous System (CNS) neoplasm in adult population. Gliomas predominantly arise from brain parenchyma. Invasion of adjacent normal parenchyma is a prominent feature. Aim: To study the epidemiological incidence of glial tumours and the viability and accuracy of intraoperative cytology in diagnosis and grading glial tumours. Materials and Methods: A cross-sectional study was done on 30 patients who underwent excision surgery at Department of Neurosurgery at Institute of Postgraduate Medical Education and Research IPGMER and SSKM, Kolkata, West Bengal, India. Clinically, radiologically confirmed cases of Space Occupying Lesion (SOL) of brain with a history of neurosurgical intervention were included. Patients medically unfit for surgery or without radiological evidence of SOL in the brain were excluded from the study. Intraoperative imprint touch cytology of the specimens was done. Part of the tissue was kept for Formalin Fixation an...
Introduction: Tumors of the nervous system constitute less than 2% of the cancers globally. They are the second most common form of cancer in children and seventeenth most common in adults. However the morbidity and mortality due to tumors of the nervous system is high. Hence prompt and correct diagnosis is essential for early intervention. In the era of stereotactic biopsies where the amount of tissue is very small, accurate diagnosis is imperative and it can be achieved with squash cytology which is a simple, non-invasive, cost effective and rapid technique. Aim of the study: The aim of the study was to assess the diagnostic accuracy of Squash cytology for rapid Intraoperative diagnosis in tumors of nervous system by comparing histopathology. Materials and methods: This was a prospective study conducted in department of Pathology in a tertiary care teaching medical college hospital for a period of two years. The study subjects were 50 consecutive patients operated for tumors of nervous system in department of neurosurgery. During surgery, small bits of tissue measuring 1-2mm 2 were removed and sent in a gauge moistened with saline for squash cytology. The squash smears were correlated with histopathology. Results: The overall diagnostic accuracy of squash cytology in the present study was 82%.Conclusion: Squash cytology in tumors of the nervous system provides an efficient means of pathological assessment which in experienced hands of a neuropathologist will provide high degree of diagnostic accuracy.
Study of intraoperative squash cytology of intracranial and spinal cord tumors
International Journal of Research in Medical Sciences, 2015
The alternative diagnostic modality is small tissue squash cytology/crush smear cytology of CNS lesions obtained intra-operatively. This technique is dependable because of lifelike preservation of the cell morphology, minimal technicality involved and rapidity by which a diagnosis ABSTRACT Background: The aim was to study the cytomorphology of neoplastic lesions of brain and spinal cord by intraoperative squash cytology, compare it with the histopathological diagnosis on excision biopsy/surgical specimen and establish a correlation. The causes of erroneous diagnoses achieved at squash cytology of intracranial and spinal cord tumors were ascertained. Tumor types having the advantage of diagnostic certainty by squash cytology of intracranial and spinal cord lesions was also determined. Methods: Squash preparations of 70 patients suspected to have neoplasia were made and stained with rapid hematoxylin and eosin stain and rapid Papanicolaou stain. A few squash smears were also dry fixed and stained with Giemsa stain. The smears were typed according to the cytomorphological criteria and the cytodiagnoses was compared with the histopathological diagnoses and a correlation was established. Results: A positive predictive value for intraoperative squash cytology for diagnosis of intracranial and spinal cord tumors was seen to be 100% and a negative predictive value of 97.22% were established by this study. The sensitivity was found to be 97.22% and the specificity was 100%. Thus, the accuracy of the study was 98.57%. Conclusions: Squash smear cytology of the brain and spinal cord tumors performed intraoperatively for diagnostic consultation fulfills all the determinants of an excellent diagnostic modality.
Diagnostic accuracy of squash cytology in central nervous system tumors
Journal of Society of Surgeons of Nepal
Introduction: CNS tumor requires intraoperative decision making regarding the extent of tumor removal. Clinical examination and imaging studies are not sufficient enough to predict the biological behavior of the tumors. Squash cytology is a quick method of evaluation of cytomorphologic features prepared from smear technique and provide the preliminary diagnosis and aid in intraoperative decision making by differentiating neoplastic from non neoplastic and benign from malignant lesions. The aim of this study is compare the diagnostic accuracy of squash cytology to that of histopathological examination. Methods: This study consists of 36 specimens from both brain and spine subjected to both squash cytology and histopathological evaluation. The squash preparation and histopathological finding were later compared and diagnostic accuracy calculated. Results: Gliomas are the most common tumor encountered and the accuracy of Squash cytology obtained was 71%. In meningioma, 100% diagnostic ...
Journal of Evidence Based Medicine and Healthcare, 2016
BACKGROUND The causes of discordant diagnoses achieved at squash cytology of intracranial and spinal cord tumours were ascertained. Lesions having the advantage of diagnostic accuracy by squash cytology of intracranial and spinal cord lesions was also determined. METHODS Squash preparations of 72 patients suspected to have neoplasia were made and stained with rapid haematoxylin and eosin stain and toluidine blue stain. The smears were classified according to the cytomorphological criteria and the squash cytodiagnoses were compared. RESULTS Total 72 cases were studied, 93.9% were neoplastic and 6.1% non-neoplastic on histopathology. Amongst neoplasms, Astrocytic tumours constituted 26.3% of cases followed by Meningiomas comprising 20.8%. Amongst the benign lesions, Tuberculoma was seen most frequently (6.95%). Overall diagnostic accuracy of squash was 98.65%. On statistical analysis, Sensitivity, Specificity, Positive Predictive value (PPV) and Negative Predictive Value (NPV) of squash cytology were 98.6%, 100%, 100% and 80% respectively. CONCLUSION Intraoperative Squash is reliable, accurate, cost effective diagnostic modality when combined with histopathological and immunohistochemical techniques.
Intraoperative squash cytology of central nervous system lesions: A single center study of 326 cases
Diagnostic Cytopathology, 2012
Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis. A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis. Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for mennigiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology.