Intraoperative cytologic diagnosis: Evaluation of 370 consecutive intraoperative cytologies

Abstract

Three-hundred and seventy intraoperative cytologies are presented and compared with synchronously performed frozen sections. Cytologic smears and frozen sections were misinterpreted in 1.6% and 0.8% of cases, respectively; the rate of diagnostic errors between the two techniques is comparable given the lack of experience with intraoperative cytology at the beginning of the study. Intraoperative cytology is a suitable technique for a variety of lesions, but it is most helpful in the field of neuro-oncological pathology, certain infectious diseases, lesions of the hematopoietic system, and most epithelial tumors. Cytologic smears afford better morphologic preservation and detail than frozen sections. Techniques are outlined and discussed. Diagnostic criteria of selected cases are presented, and pitfalls are analyzed.

Squash Cytology in Neurosurgical Practice: A Useful Method in Resource-Limited Setting with Lack of Frozen Section Facility

“…In our study, the overall diagnostic accuracy of squash cytology was 95% when compared with histology as the gold standard, which correspond to or even better than some of the studies [11][12][13]. Few studies also compared results of squash cytology with frozen section and concluded that the accuracy of cytology was as good as frozen section [14][15][16]. In fact, studies have shown that the use of intra-operative cytology has great value in providing diagnostic information when frozen section was equivocal or when frozen-section evaluation could not be done [e.g., excessively small sample] [17].…”

“…Further, elimination of freezing artifact [12] and reduced cryostat contamination from potentially infected tissue make squash cytology superior over frozen section [10]. some authors suggest that cytological preparation provides better morphology than frozen section with even minute biopsy material [11,14,19]. Thus, though frozen section was considered complementary to squash cytology [5], the latter alone can guide neurosurgeon during intra-operative period in many of the institutes where frozen section is not performed routinely for various logistic and technical reasons [9].…”

Utility of touch imprint cytology as an adjunct to core needle biopsy of breast lump

“…[5]Since then it has been used by many investigators to evaluate sentinel node in breast cancer [3], mucosal cut margins in oral cancer [6] and as an adjunct to intraoperative frozen section [7].…”

Valor do exame citológico per-operatório em neurocirurgias

“…O exame microscópico per-operatório, seja pela técnica do esfregaço ou pela realização de cortes congelados, é amplamente utilizado desde a sua introdução no início do século 20 (9,24,37) . As vantagens do exame citológico (esfregaço) sobre o corte congelado incluem a maior rapidez (em geral é realizado em cerca de 5 minutos), o menor custo, pois não necessita de aparelhagem para corte nem de técnico especializado, e, em se tratando de suspeita de lesões infecciosas, evita a contaminação do criostato (15,27,31) . No caso específico das neurocirurgias, onde as amostras são em geral escassas e diminutas, o exame citológico apresenta mais vantagens em relação ao corte congelado, pois requer menor quantidade de material, permitindo a preservação de tecido para inclusão em parafina e para a realização de estudo imuno-histoquímico.…”