Institutional Experience of Diagnostic Approach in Intraoperative Consultation in Neuropathology

Yıl 2023, , 890 - 902, 05.01.2024

Zuhal Kuş Silav

https://doi.org/10.38079/igusabder.1379432

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

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

Nöropatolojide İntraoperatif Konsültasyonda Tanısal Yaklaşımın Kurumsal Deneyimi

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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.

Destekleyen Kurum

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

Kaynakça

• 1. Philip SA, Bai EL, Padmaja GJV, Kumari S. Analysis of ıntraoperative squash cytology of central nervous system lesions and its correlation with ımmunohistopathology and radiology. J Cytol. 2023;40(1):1-4.
• 2. Eisenhardt L, Cushing H. Diagnosis of intracranial tumors by supravital technique. Am J Pathol. 6: 541-552, 1930.
• 3. Folkerth RD. Smears and frozen sections in the intraoperative diagnosis of central nervous system lesions. Neurosurg Clin N Am. 1994;5(1):1-18.
• 4. Yachnis AT. Intraoperative consultation for nervous system lesions. Semin Diagn Pathol. 2002;19(4):192-206.
• 5. Cakır E, Oran G, Yüksek GE, Ding C, Tihan T. Intraoperative consultations of central nervous system tumors: a review for practicing pathologists and testing of an algorithmic approach. Turk Patoloji Derg. 2019;35:173-184.
• 6. Fujita H, Tajiri T, Machida T, et al. Intraoperative squash cytology provides a qualitative intraoperative diagnosis for cases in which frozen section yields a diagnosis of “equivocal brain tumor”. Cytopathology. 2020;31(2):106-114.
• 7. Lacruz SR, Catalina-Fernandez I, Bardales RH, Pimentel J, Lopez-Presa D, Saenz-Santamaria J. Intraoperative consultation on pediatric central nervous system tumors by squash cytology. Cancer Cytopathol. 2015;123(6):331-46.
• 8. Maity P, Sengupta M, Jain K, et al. Utility of intraoperative squash cytology in diagnosis of pediatric central nervous system lesions. Diagn Cytopathol. 2019;47(5):428-433.
• 9. Lee HS, Tihan T. The basics of intraoperative diagnosis in neuropathology. Surg Pathol Clin. 2015;8(1):27-47.
• 10. Krishnani N, Kumari N, Behari S, Rana C, Gupta P. Intraoperative squash cytology: accuracy and impact on immediate surgical management of central nervous system tumours. Cytopathology. 2012;23(5):308-14.
• 11. Jindal A, Diwan H, Kaur K, Sinha VD. Intraoperative squash smear in central nervous system tumors and its correlation with histopathology: 1 year study at a tertiary care centre. J Neurosci Rural Pract. 2017;8(2):221-224.
• 12. Çolakoğlu N, Canda MŞ, Canda T. Merkezi sinir sistemi tümörlerinin intraoperatif tanısında imprint yönteminin önemi. Türkiye Ekopatoloji Dergisi. 2003;9(1-2):1-10.
• 13. Ironside JW. Update on central nervous system cytopathology. II. Brain smear technique. J Clin Pathol. 1994;47(8):683-8.
• 14. Scucchi LF, DiStefano D, Cosentino L, Vecchione A. Value of cytology as an adjunctive intraoperative diagnostic method. An audit of 2,250 consecutive cases. Acta Cytol. 1997;41(5):1489-96.
• 15. Sharma S, Deb P. Intraoperative neurocytology of primary central nervous system neoplasia: A simplified and practical diagnostic approach. J Cytol. 2011;28(4):147-58.
• 16. Savargaonkar P, Farmer PM. Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci. 2001;31(2):133-9.
• 17. Reyes MG, Homsi MF, McDonald LW, Glick RP. Imprints, smears, and frozen sections of brain tumors. Neurosurgery. 1991;29(4):575-9.
• 18. Patil SS, Kudrimoti JK, Agarwal RD, Jadhav MV, Chuge A. Utility of squash smear cytology in intraoperative diagnosis of central nervous system tumors. Journal of Cytology. 2016;33(4):205-209.
• 19. WHO Classification of Tumours Editorial Board. Central Nervous System Tumors. Lyon (France): International Agency for Research on Cancer, 5th ed., Vol.6, 2021.
• 20. Goel D, Sundaram C, Paul TR, et al. Intraoperative cytology (squash smear) in neurosurgical practice-pitfalls in diagnosis experience based on 3057 samples from a single institution. Cytopathology. 2007;18(5):300-8.
• 21. Torres LF, Collaco LM. Smear technique for the intraoperative examination of nervous system lesions. Acta Cytol. 1993;37(1):34-9.
• 22. Atılmış ÜÜ, Aker FV, Güneş P, Peker Ö. Santral sinir sistemi tümörlerinin intraoperatif acil tanısında sitolojinin tanı değeri. The Turkish Journal of Path. 2001;17(3-4):67-71.
• 23. Mitra M, Kumar M, Sharma V, Mukhopadhyay D. Squash Preparation: A reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors. J Cytol. 2010;27(3):81-85.
• 24. Hamasaki M, Chang KHF, Nabeshima K, Tauchi-Nishi PS. Intraoperative squash and touch preparation cytology of brain lesions stained with H+E and Diff-QuikTM: A 20-year retrospective analysis and comparative literature review. Acta Cytologica. 2018;62:44-53.
• 25. Collaco LM, Tani E, Lindblom I, Skoog L. Stereotactic biopsy and cytologic diagnosis of solid and cystic intracranial lesions. Cytopathology. 2003;14(3):131-5.
• 26. Liu Y, Silverman JF, Sturgis CD, Brown HG, Dabbs DJ, Raab SS. Utility of intraoperative consultation touch preparations. Diagn Cytopathol. 2002;26(5):329-33.
• 27. Shah AB, Muzumdar GA, Chitale AR, Bhagwati SN. Squash preparation and frozen section in intraoperative diagnosis of central nervous system tumors. Acta Cytol. 1998;42(5):1149-54.