Intraoperative cytology (squash smear) in neurosurgical practice – pitfalls in diagnosis experience based on 3057 samples from a single institution

Goel, Deepa; Sundaram, Chandru P.; Paul, T. R.; Uppin, Shantveer G; Prayaga, Aruna K; Panigrahi, Manas; Purohit, A K

doi:10.1111/j.1365-2303.2007.00484.x

Cited by 36 publications

(63 citation statements)

References 9 publications

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“…neoplastic lesions [table/ Fig-1 Fig-3] have shown the importance of squash cytology for offering intra-operative diagnosis of intracranial lesions [7][8][9][10]. In the present study, however, we have shown that using squash cytology as standalone diagnostic procedure, it is possible to achieve consistently high sensitivity and specificity for intra- *time interval between removal of mass from the body till intra-operative diagnosis given to surgeon operative diagnosis of intracranial lesions even in resource-limited setting where frozen section facility is not available.…”

Section: Resultsmentioning

confidence: 99%

“…As suggested by Powell et al, a squash cytology prepared with good amount of tissue is enriched with good cytological and histological details and a pathologist get benefits of both cytology as well as histology [20]. The cell type with differentiation of nuclear and cytoplasmic features of neurons, oligodeandroglial cells and astrocytes are well appreciated with this technique [8,20].…”

Section: Resultsmentioning

confidence: 99%

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

Agrawal

Chandrakar

Lokwani³

et al. 2014

JCDR

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Agrawal

Chandrakar

Lokwani³

et al. 2014

JCDR

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“…Toluidine blue method that we have used in our study was introduced by Russel et al 1 Goel et al 2 had also used toluidine blue in their study. In this method, smears prepared were fixed with absolute methanol for 1 min, stained with toluidine blue for 1 min, rinsed in tap water and then dried on the hot plate, cleared in xylene, and mounted in DPX.…”

Section: Methodsmentioning

confidence: 98%

Squash Smear Technique in Rapid Intraoperative Diagnosis of Non-neoplastic and Cystic Lesions of CNS

Sidhar¹,

Khatana

Kumar

et al. 2018

RAPL

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In neurosurgical practice, a rapid intraoperative diagnosis helps the neurosurgeon to monitor and modify the approach at surgery. Smears and frozen sections are the two rapid tissue preparations that may be used by neuropathologists for giving opinion on intraoperative biopsy specimens of suspected lesions. The smear technique, which could be either squash/crush smears or impression smears, has been applied in neurosurgical units worldwide. This method plays a very important role in the analysis of sample from craniotomies and the small specimens obtained from stereotactic biopsies.Squash smear technique is a very rapid technique and the study was designed to assess the accuracy of squash smear in the rapid intraoperative diagnosis of non-neoplastic and cystic lesions of CNS and to document the cytomorphology of these lesions. A total of 23 cases were studied. The tissue was removed at craniotomy or by burr hole biopsy.In all the cases clinicoradiological correlation was done with smear diagnosis. Smears were stained with 1% Toluidine blue and H&E. In all cases, results were compared with the paraffin section prepared from the tissue remaining after the squash smears. Immunohistochemistry was done in one case. Special stains were used as required.Amongst non-neoplastic lesions, tuberculous lesions comprised the maximum number of cases (n=9), two cases of PML, one case of fungal lesion, one case of non-specific abscess, one case of infarct, only reactive changes in one and normal cortex and white matter in one. In cystic lesions of the CNS, there was one case of Rathke's Cleft cyst, four cases of Epidermoid cyst and two cases of arachnoid cyst. Cases of PML and Rathke's cleft cyst could not be identified on smears. In all the cases, smear diagnosis was compared with histopathological diagnosis.

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“…Intraoperative examination can guide the neurosurgeon in selecting the appropriate surgical management [1-3]. Ideally, the examination should be accurate, fast, and allow tissue preservation for further study in paraffin [4-6]. The most commonly used techniques are squash and frozen section (FS) [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Intraoperative Examination in Central Nervous System Lesions: A Study of 133 Cases

et al. 2019

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Objective: Intraoperative examination is a highly valuable tool for the evaluation of central nervous system (CNS) lesions, helping the neurosurgeon to determine the best surgical management. This study aimed to evaluate the accuracy and to analyze the diagnostic disagreements and pitfalls of the intraoperative examinations through correlation with the final histopathological diagnosis in CNS lesions. Study Design: Retrospective analysis of intraoperative examination of CNS lesions and their final diagnosis obtained during 16 consecutive years. All diagnoses were reviewed and classified according to World Health Organization (WHO) grading for CNS tumors. Squash was performed in 119 cases, while frozen section and both methods were done in 7 cases each. Results: Among the 133 intraoperative examinations considered, 114 (85.7%) presented concordance and 19 (14.3%) diagnostic disagreement when compared with subsequent histopathological examinations. The sensitivity and specificity for the detection of neoplasia in intraoperative examination was 98 and 94%, respectively. The positive and negative predictive values were 99 and 88%, respectively. The accuracy for neoplastic and nonneoplastic disease was 85.7%. Disagreements were more frequent among low-grade (WHO grades I and II) neoplasms and nonmalignant cases. Conclusions: Our results showed good accuracy of the intraoperative assessments for diagnosis of CNS lesions, particularly in high-grade (grades III and IV) lesions and metastatic neoplasms.

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Intraoperative cytology (squash smear) in neurosurgical practice – pitfalls in diagnosis experience based on 3057 samples from a single institution

Abstract: This is the largest series reported from India to the best of our knowledge. Squash smear technique is a very reliable and rapid method of intraoperative diagnosis. Knowledge of clinical and neuroimaging details helps the experienced neuropathologist to improve the diagnostic accuracy.

Cited by 36 publications

References 9 publications

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

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

Squash Smear Technique in Rapid Intraoperative Diagnosis of Non-neoplastic and Cystic Lesions of CNS

Accuracy of Intraoperative Examination in Central Nervous System Lesions: A Study of 133 Cases

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