Challenges in neurosurgical intraoperative consultation

Rao, Shalinee; Rajkumar, Aarthi; Ehtesham,; Prathiba, D

doi:10.4103/0028-3886.55598

Cited by 36 publications

(24 citation statements)

References 9 publications

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“…Intraoperative consultation of brain lesions are requested to differentiate neoplastic from reactive lesions; to differentiate metastatic from primary lesions; to estimate the degree of malignancy and to determine the tumor margins. 7,8 Diagnostic accuracy (88%) achieved in the present study were comparable with the series of other studies (86% to 97%). 4,[9][10][11] Most of the gliomas were easily identified in the smears.…”

Section: Discussionsupporting

confidence: 91%

“…As Gliomas could be heterogeneous, many studies have also concluded that it would be unwise to grade the tumors in every cases in rapid diagnosis. 1,7,10,12 In the study conducted by Jennifer et al, the most common and distinctive findings in 23 cases of pilocytic astrocytoma were markedly elongated bipolar cells, Rosenthal fibers and eosinophillic granular bodies. 13 All these features were evident in our case of pilocytic astrocytoma ( fig.…”

Section: Discussionmentioning

confidence: 99%

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Smear technique for intraoperative diagnosis of central nervous system neoplasms

2014

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Background: Smear cytology has become increasily popular as an alternative to frozen section for the rapid diagnosis of most of central nervous system lesions. The aim of this study was to assess the utility of smear technique for the rapid diagnosis in the neurosurgical biopsies and to compare the smear cytological features with the final histopathological examination. Materials and Methods:This was a prospective study conducted in the Department of Pathology of BP Koirala Memorial cancer Hospital for a period of one year. Sixty cases of clinically suspected CNS tumors were sent for intraoperative smear cytological examination and histological examination. Both techniques were then compared for their ability to diagnose as well as grade the tumors.Results: Gliomas (51.6%) were the most frequently occurring tumors in the total cases. Diagnostic accuracy of squash/smear technique achieved was 88 %( 53/60) when compared with histopathological diagnoses. In two cases, smears comprised of blood clots and no opinion was possible in cytology. Complete discrepancy was seen in five cases that included two cases of atypical meningioma, a one case each of germinoma, glioblastoma and metastatic tumor. Conclusion:Smear technique is a fairly accurate, rapid, easily reproducible and cost effective tool to diagnose brain tumours. Smear cytology is of great value in Intraoperative consultation of central nervous system lesions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Smear technique for intraoperative diagnosis of central nervous system neoplasms

2014

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“…There are no freezing artifacts. It is simple rapid, reliable and inexpensive[8] However, it also has limitations; that is, tissue architecture is not apparent and with firm tissue, smear preparation becomes a difficult task. The utility of the imprint/squash preparation technique could be beneficial in centers where a facility for frozen sections is unavailable, in case of a power break-down, or a lack of trained technical personnel.…”

Section: Discussionmentioning

confidence: 99%

“…The utility of the imprint/squash preparation technique could be beneficial in centers where a facility for frozen sections is unavailable, in case of a power break-down, or a lack of trained technical personnel. [8]…”

Section: Discussionmentioning

confidence: 99%

Clear-cell meningioma: Intraoperative diagnosis by squash cytology: Case report and review of the literature

et al. 2017

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Clear-cell meningioma (CCM), an unusual subset of meningioma has prominent, clear-cell morphology. It is a wolf in sheep's clothing characterized by benign histologic attributes, but tendency for recurrence (61%) and metastasis. Therefore, WHO has classified it as grade II meningioma. Fine-needle aspiration cytology diagnosis is simple, rapid, cost-effective and reliable procedure primarily aimed at preoperative diagnosis of advanced and metastatic extracranial tumor. Preoperative and/or intraoperative cytodiagnosis of CCM demand expertise in the evaluation of cytology smears. However in case of intra operative evaluation of squash smears there is a time constraint and a very small tissue material obtained by stereotactic biopsy are available for interpretation. Knowledge of clinical features including age, anatomical locations, neuroimaging findings and cytomorphologic features, are prerequisites for arriving at definitive cytodiagnosis. We describe intra operative squash cytology of CCM in a 16-year-old female, located in cerebello-pontine angle. The diagnosis of CCM offered on squash cytology was subsequently confirmed on histopathology and immunohistochemistry. It typically showed pattern less sheets and groups of polyhedral, clear cells with monomorphic, round nuclei having a bland chromatin and inconspicuous nucleoli. Separation of CCM from other tumors having clear -cell morphology and variants of meningioma is important because of its high recurrence rate and mortality.

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“…However, intraoperative consultation for spinal lesions by crush smear cytology can provide a preliminary diagnosis so that surgeon can decide further management on the operating table. [ 1 ]…”

Section: Introductionmentioning

confidence: 99%

Utility and challenges in intraoperative consultation of spinal lesions by crush smear cytology

et al. 2016

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Background:Various methods are used for intraoperative consultation of spinal lesions. Crush smear cytology is one such method that is accurate, rapid, and allows preservation of tissue for paraffin-embedded sections.Aims:To study the cytomorphology of various neoplastic and nonneoplastic lesions involving and compressing the spinal cord. To evaluate accuracy and discuss diagnostic pitfalls of crush smear cytology.Materials and Methods:Over a period of 5 years (January 2008 to October 2012), a total of 57 spinal lesions were referred for intraoperative cytology. In four cases, material was inadequate for evaluation, so we analyzed 53 cases.Results:Majority of lesions were neoplastic accounting for 86.79% whereas nonneoplastic lesions constituted 13.20%. Most of the tumors were low grade (82.92%). Overall accuracy rate was 90.56% with accuracy of 91.30% and 85.71% for neoplastic and inflammatory lesions, respectively.Conclusion:Crush smear technique is a simple, reliable, easy, and rapid method for diagnosing neoplastic and inflammatory lesions involving and compressing the spinal cord. It gives an immediate idea of prognosis so that surgeon can modify the operative procedure, if necessary.

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Challenges in neurosurgical intraoperative consultation

Abstract: The discrepant cases need to be reviewed regularly by pathologists to familiarize themselves with the morphological changes and artifacts. The knowledge of possible errors could minimize misinterpretation and help in providing a more conclusive opinion to the operating surgeon.

Cited by 36 publications

References 9 publications

Smear technique for intraoperative diagnosis of central nervous system neoplasms

Smear technique for intraoperative diagnosis of central nervous system neoplasms

Clear-cell meningioma: Intraoperative diagnosis by squash cytology: Case report and review of the literature

Utility and challenges in intraoperative consultation of spinal lesions by crush smear cytology

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