DOI: https://dx.doi.org/10.18203/2349-3933.ijam20222398
Published: 2022-09-23

A prospective study on the relevance of crush or squash cytology of central nervous system lesions, in the present-day surgery

Roma Singh, Nipun Saproo

Abstract


Background: The intra-operative cytology in the evaluation of central nervous system (CNS) lesions is a simple and rapid technique, and a useful tool. There is not much literature available on the value of crush cytology during the operation. The current study was planned to assess the feasibility and efficacy of intra-operative squash cytology as standalone method in the rapid intra-operative diagnosis of intracranial tumor.

Methods: A prospective observational study was carried out in the department of neurology in collaboration with department of pathology, Medanta: The Medicity, Gurugram, for a period of six months from January 2019 to June 2019, on randomly selected 60 patients, aged: 18 years and above. Two to three tissue bits, from different sites of the mass, were taken to prepare squash cytology smear.

Results: Out of 60 patients operated, 54 had neoplastic and 6 had non-neoplastic lesions. Neoplastic benign lesions were observed in 41 patients and neoplastic malignant lesions were diagnosed in 13 patients. There was 17.67% offering a wrong diagnosis on crush cytology. Out of the 13 cases of meningioma, there was a discrepancy in 3 (three) cases.

Conclusions: Crush cytology is a useful adjunct to the diagnosis in neurosurgical practice. This study suggests and confirms the reliability of squash cytology, but further multicentre studies with larger number of patients may help to decide its use in clinical practice.


Keywords


Crush cytology, Central nervous system tumors, Intra-operative diagnosis

Full Text:

PDF

References


Parkin DM WS, Ferlay J, Raymond L, Young J. Cancer incidence in five continents. IARC Scientific Publications No. 143, Lyon. 1997.

Kumar VAA, Fausto N, Aster JA. Pathologic basis of disease. 7th edition. Cotran R, editor. Philadeiphia: Elsevier. 2004.

Sundaram C. Diagnostic utility of squash [smear] technique in the inflammatory lesions of central nervous system. Indian J Pathol Microbiol. 2003;46(4):569-72.

Eisenhardt L, Cushing H. Diagnosis of intracranial tumors by supravital technique. Am J Pathol. 1930;6:541‑52.

Jaiswal S, Vij M, Jaiswal AK, Behari S. Intraoperative squash cytology of central nervous system lesions: A single center study of 326 cases. Diagn Cytopathol. 2012;40:104‑12.

Kondziolka D, Lunsford LD, Martinez AJ. Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial [low-grade] astrocytoma. J Neurosurg. 1993;79(4):533-6.

Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15‑year experience based on 4,172 patients. Acta Cytol. 2002;46:667‑74.

Olasode BJ, Ironside JW. The brain smear, a rapid affordable intraoperative diagnostic technique for brain tumours appropriate for Africa. Trop Doctor. 2004;34(4):223-5.

Firlik KS, Martinez AJ, Lunsford LD. Use of cytological preparations for the intraoperative diagnosis of stereotactically obtained brain biopsies: a 19- year experience and survey of neuropathologists. J Neurosurg. 1999;91(3):454-8.

Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients. Acta Cytologica. 2002;46(4):667-74.

Asha T, Shankar SK, Rao TV, Das S. Role of squash-smear technique for rapid diagnosis of neurosurgical biopsies--a cytomorphological evaluation. Indian J Pathol Microbiol. 1989;32(3):152-60.

Cahill EM, Hidvegi DF. Crush preparations of lesions of the central nervous system. A useful adjunct to the frozen section. Acta Cytol. 1985;29:279‑85.

Kim SH, Lee KG, Kim TS. Cytologic characteristics of subependymal giant cell astrocytoma in squash smears: morphometric comparisons with gemistocytic astrocytoma and giant cell glioblastoma. Acta Cytologica. 2007;51(3):375-9.

Liwnicz BH, Henderson KS, Masukawa T, Smith RD. Needle aspiration cytology of intracranial lesions. A review of 84 cases. Acta Cytol. 1982;26:779‑86.

Marshall LF, Adams H, Doyle D, Graham DI. The histological accuracy of the smear technique for neurosurgical biopsies. J Neurosurg. 1973;39:82‑8.

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.

Ud Din N, Memon A, Idress R, Ahmad Z, Hasan S. Central nervous system lesions: correlation of intraoperative and final diagnoses, six-year experience at a referral centre in a developing country, Pakistan. Asian Pacific J Cancer Prevention. 2011;12(6):1435-7.