Nöropatolojide İntraoperatif Konsültasyonda Tanısal Yaklaşımın Kurumsal Deneyimi

Abstract

Amaç: Nöropatolojide intraoperatif konsültasyonda kullanılan squash/smear sitolojisinin donma artefaktlarının önlenmesi, doku korunması, hızlı sonuç alınması ve dondurulmuş kesitlere göre düşük maliyet gibi avantajları vardır. Bu çalışmada smear ve frozen tekniklerinin tanısal doğruluk, etkinlik, avantaj ve dezavantajları açısından karşılaştırılması amaçlandı. Yöntem: Doksan iki neoplastik ve 16 non-neoplastik olmak üzere toplam 108 merkezi sinir sistemi olgusu frozen kesit (n=101) ve yayma (n=104) teknikleri kullanılarak incelendi. Frozen ve smear bulguları arasındaki farklar Fisher's Exact Test ile değerlendirildi, sensitivite ve spesifisite %95 güven aralığında belirlendi. Bulgular: Smear ve frozen kesitlerin tanısal doğruluk oranları sırasıyla %80 ve %85,7; sensitiviteleri %86 ve %93; ve spesifiteleri %70 ve %72,7 idi. Frozen tekniği ile elde edilen daha yüksek oranlar istatistiksel olarak anlamlı bulunmadı (P>0.05). Primer merkezi sinir sistemi tümörlerinde spesifik tanı oranları smear için %58, frozen teknik için %50,7 idi ve her ikisinin birlikte kullanılması tanısal doğruluk, sensitivite ve spesifisite oranlarını arttırdı. Sonuç: Frozen ve smear yöntemlerinin tanısal doğruluk oranlarının benzerliği, nöroşirürji IOT uygulamalarında sitolojinin tek başına kullanılabileceğini düşündürmektedir.

Keywords

• Frozen kesit
• intraoperatif tanı
• santral sinir sistemi
• smear
• squash

Supporting Institution

Çalışma, İzmir Atatürk Eğitim ve Araştırma Hastanesi, Patoloji Bölümü laboratuvarında yürütülmüştür.

Ethical Statement

Bu araştırma 2006 tarihli, Doç. Dr Mine Tunakan’ın danışmanlığında yürütülmüş ve “Cerrahi Nöropatolojide İntraoperatif Tanıda Frozen Kesit ve Smear Yöntemlerinin Karşılaştırılması” başlıklı tıpta uzmanlık tezindeki veriler temelinde hazırlanıp, 2020 yılı öncesi araştırma verileri kullanıldığından etik kurul izni gerektirmeyen çalışmalar arasında yer almaktadır.

Institutional Experience of Diagnostic Approach in Intraoperative Consultation in Neuropathology

Abstract

Aim: Squash/smear cytology, used in intraoperative consultation in neuropathology, has advantages such as avoiding freezing artifacts, tissue preservation, rapid results, and low cost compared to frozen sections. This study aimed to compare the smear and frozen techniques regarding diagnostic accuracy, efficiency, advantages, and disadvantages. Method: Hundred-eight central nervous system cases, including 92 neoplastic and 16 non-neoplastic specimens, were examined using a frozen section (n=101) and smear (n=104). Differences between frozen and smear findings were evaluated with Fisher's Exact Test, and sensitivity and specificity were determined within a 95% confidence interval. Results: Diagnostic accuracy rates of smear and frozen sections were 80% and 85.7%; sensitivities were 86% and 93%; and specificities were 70% and 72.7%, respectively. The higher rates obtained with the frozen technique did not have a statistical significance (P>0.05). Specific diagnosis rates for primary central nervous system tumors were 58% for smear and 50.7% for frozen techniques, and using both increased the diagnostic accuracy, sensitivity, and specificity rates. Conclusion: The similarity of diagnostic accuracy rates of frozen and smear methods suggests that cytology can be used alone in neurosurgical IOT applications.

Keywords

• frozen section
• intraoperative diagnosis
• central nervous system
• smear
• squash

Supporting Institution

The study was conducted in the Pathology Department laboratory of Izmir Ataturk Training and Research Hospital.

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