High Diagnostic Accuracy of Cytologic Smears of Central Nervous System Tumors

Rössler, Karl; Dietrich, Wolfgang; Kitz, K.

doi:10.1159/000326973

Cited by 84 publications

(105 citation statements)

References 23 publications

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“…However, partial correlation was due to grades and mixed tumors. The tumors which required more tissue, special stains and/or immunohistochemical confirmation for final diagnosis posed problems for diagnosis on smear [5,6]. It is believed that our results are supportive of the accuracy of the procedure and comparable to other reported series Clinical prerequisites for a cytological diagnosis of brain tumors included; age of the patients, tumor location, and tumor size were considered.…”

Section: Discussionsupporting

confidence: 82%

“…Metachromatic stroma in between large physaliferous cells containing bubbly, vacuolated cytoplasm and small round nucleus. In contrast, the benign lesions consisted of intraosseous sheets of bland physaliferous cells without any extracellular matrix [6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…The frozen section technique is less popular for brain biopsies as it uses a substantial amount of tissue and produces freezing artefacts [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Chordomas; Crush Intraoperative Analysis

Ml¹,

Estrada-Natoli²,

Le³

et al. 2015

J Cytol Histol

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Chordomas are known by primary malign tumors that have formed from primitive notochord remains and exhibit different epithelial properties. Morphologically these cells have distinct borders; the nucleus displays a monotony and blandness. It was found few cases of pleomorphism, atypia, anaplasia and hipercromatic nuclei. Vacuoles were seen in the cytoplasm. This study was realized during January 1995 until June 2005, with 22 surgeries of chordomas and intraoperative crush. The background was dirty with myxoid appearance, myxoid matrix growing in sheets or cord and had vacuoles showed more evidence of physaliferous cells. Chondroid chordoma showed vacuolated cells as well as other cells with eosinophilic cytoplasm and myxoid background. Single cells were observed only in two cases and high cellularity was observed in 8(42%) cases. Two cases were frank errors, only one had a partial correlation. The percentage of mistakes was 30% and our diagnosis accuracy was 70%. The correlation with clinical details and radiological findings were helpful in improving the accuracy rate. There was no differentiation between cytomorphological features smear of intracranial tumours and the sacrococcygeal location. Intraoperative analysis of chordomas could be helpful to have a good diagnosis and to have a better surgical resection.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Chordomas; Crush Intraoperative Analysis

Ml¹,

Estrada-Natoli²,

Le³

et al. 2015

J Cytol Histol

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“…In permanent sections, the nuclei were seen floating in a clear bubble, and lying retracted away from their cytoplasmic membrane, giving the characteristic fried egg appearance. A study conducted by Roessler et al has reported similar discrepancies due to the presence of variable cytoplasmic processes and lack of monotonous appearing cells [9]. Anaplastic oligodendroglioma was mistaken for anaplastic astrocytoma in a similar study conducted by Kini et al [10].…”

Section: Discussionmentioning

confidence: 90%

Comparison of squash smears and frozen sections versus paraffin sections in the intra-operative diagnosis of central nervous system lesions

et al. 2014

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IntroductionBrain tissue by virtue of its high water content is like a sea of water wrapped in tubes of fat with a bit of protein thrown in to hold it all together [1]. This inherently soft nature of brain tissue and high water content results in poor quality frozen sections due to ice-crystal artefacts. At the same time, this soft texture facilitates smear preparation which reveals the cytomorphology in detail. For intra-operative diagnosis of brain lesions, the neuropathologists use squash smear, imprints and frozen section techniques. Implementing cytology smears for intra-operative diagnosis of brain tumors is now well established in many neurosurgical centers [1][2][3] The aims of the present study were to evaluate the diagnostic accuracy and limitations of squash smears and frozen sections in the diagnosis of intracranial lesions, in comparison with paraffin sections and also to study the discordant cases. Materials and MethodsA total of two hundred and twenty one neurosurgical specimens including brain and spinal lesions were received in the Department of Pathology from January 2010 to December 2012, of which the neurosurgeon sent 110 cases for intra-operative consultation. These cases were studied retrospectively. Both frozen and squash preparation were performed on all cases and stained with hematoxylin & eosin (H&E). Squash smears were prepared by crushing (squashing) a small bit of tissue, about 1 cubic mm size, in between two microscopic glass slides and pulling it apart with gentle pressure to make it a thinner smear. Smears were immediately fixed in 95% alcohol and stained with rapid hematoxylin and eosin stain. Smears were stained in hematoxylin stain for 1 min followed by differentiation in 1% alcohol, and dipped in eosin for 1-2 dips, washed in water, and then mounted. In some cases smears were even stained with Pap and May-Grünwald (MGG) stains, wherever tissue was adequate enough. Frozen sections of 6 to 10 micrometer thickness were taken in Leica CE/CN cryostat. Sections were stained with H&E stain. Sections were stained with hematoxylin for 1 min, differentiated in 1% alcohol, dipped in eosin (1-2 dips), washed in water and mounted. The clinical (age, location, chief complaints) and radiological data was retrieved along with squash smear, frozen section and paraffin section slides. An intra-operative diagnosis was made after examination of the squash smears and frozen section slides. The diagnosis given on squash smears and frozen section was then compared with final diagnosis given on paraffin-embedded sections. Immunohistochemistry was performed in a few diagnostically challenging cases. Accuracy of squash versus paraffin section diagnosis and combined squash + frozen section diagnosis was determined. ResultsOf the 110 cases of open biopsies, 68 were males and 42 were females. The ages ranged from a minimum of 7 months to a maximum of 72 years. Majority of the cases were astrocytomas (32.7%) followed by meningiomas (21.8%) and schwannomas (10.9%). The diagnoses on squash smears correlated ...

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“…Apresenta, ainda, elevada acurácia, já que, quando realizados por patologistas experientes, vários estudos demonstraram haver mais de 90% de correlação positiva do esfregaço com o resultado final do material incluído em parafina (3,7,11,14,27,28,32,35,36) , sendo essa também a nossa realidade. No caso das biópsias estereotáxicas, indicadas em casos de lesões da linha média inacessíveis à remoção cirúrgica direta ou lesões que tendem a infiltrar estruturas vitais adjacentes (22) , o exame per-operatório é imprescindível para confirmar se o posicionamento da agulha orientado por estereotaxia é adequado, ou seja, se o material obtido é representativo de lesão (18,19) .…”

Section: Introductionunclassified

Valor do exame citológico per-operatório em neurocirurgias

Correia¹,

Esperança²,

Silva³

et al. 2005

J. Bras. Patol. Med. Lab.

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y unitermos key words resumo Introdução: Mais de 90% dos resultados citológicos per-operatórios neurocirúrgicos correlacionam-se com o histopatológico. Porém, a sua real necessidade é por vezes questionada. Objetivo: Avaliar a necessidade do exame per-operatório tendo-se em vista a conduta neurocirúrgica imediata. Material e métodos: Revimos 130 casos de exames per-operatórios solicitados de um total de 293 procedimentos cirúrgicos para tratamento de lesões expansivas do sistema nervoso central (SNC), extra ou intra-axiais, sendo 46 biópsias estereotáxicas e 84 cirurgias abertas, realizados de 1998 a 2001. Foram realizados esfregaços, o diagnóstico foi comparado com o histopatológico, e os neurocirurgiões, questionados sobre a implicação do resultado do exame na conduta, caso a caso. Resultados: O exame per-operatório foi solicitado em 44,4% do total de cirurgias, tendo sido considerado relevante para a conduta em 84% destes casos ou, nas biópsias, para avaliar a representatividade do material, o que corresponde a 37,2% do total de cirurgias realizadas no período. Excluindo-se as biópsias estereotáxicas, com indicação inquestionável, o exame foi necessário em 75%, sendo considerado desnecessário, sobretudo nas lesões extra-axiais, em geral solicitado por curiosidade do cirurgião. Conclusão: Apesar de ser um exame com acurácia demonstrada, a realização de exames per-operatórios sem utilidade para a conduta neurocirúrgica pode vir a sobrecarregar patologistas em tarefas desnecessárias. Nossos resultados demonstraram que o exame foi necessário na grande maioria dos casos, mesmo após a exclusão das biópsias estereotáxicas, sobretudo nas lesões intra-axiais, auxiliando na avaliação da demanda desses exames, por vezes excessiva, apesar de útil para treinamento e ensino. Neurocirurgia

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High Diagnostic Accuracy of Cytologic Smears of Central Nervous System Tumors

Cited by 84 publications

References 23 publications

Chordomas; Crush Intraoperative Analysis

Chordomas; Crush Intraoperative Analysis

Comparison of squash smears and frozen sections versus paraffin sections in the intra-operative diagnosis of central nervous system lesions

Valor do exame citológico per-operatório em neurocirurgias

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