Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis
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Background: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. Methods: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. Results: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. Conclusions: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.
Abstract
Background: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. Methods: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. Results: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. Conclusions: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.
참고문헌 (30)
- Marshall LF, "The histological accuracy of the smear technique for neurosurgical biopsies", J Neurosurg, 39, pp.82~88 (1973)
- Eisenhardt L, "Diagnosis of intracranial tumors by supravital technique", Am J Pathol, 6, pp.541~552 (1930)
- Gal AA, "The 100-year anniversary of the description of the frozen section procedure", JAMA, 294, pp.3135~3137 (2005)
- Cahill EM, "Crush preparations of lesions of the central nervous system : a useful adjunct to the frozen section", Acta Cytol, 29, pp.279~285 (1985)
- Louis DN, "WHO classification of tumours of the central nervous system" (2016), IARC Press
- Louis DN, "WHO classification of tumours of the central nervous system" (2007), IARC Press
- Folkerth RD, "Smears and frozen sections in the intraoperative diagnosis of central nervous system lesions", Neurosurg Clin N Am, 5, pp.1~18 (1994)
- Rushing EJ, "Towards an integrated morphological and molecular WHO diagnosis of central nervous system tumors : a paradigm shift", Curr Opin Neurol, 28, pp.628~632 (2015)
- Inagawa H, "Qualitative and quantitative analysis of cytologic assessment of astrocytoma, oligodendroglioma and oligoastrocytoma", Acta Cytol, 51, pp.900~906 (2007)
- Kang M, "Crush cytologic findings of a cerebral granular cell astrocytoma", Acta Cytol, 56, pp.571~575 (2012)
- Shioyama T, "Intraoperative flow cytometry analysis of glioma tissue for rapid determination of tumor presence and its histopathological grade : clinical article", J Neurosurg, 118, pp.1232~1238 (2013)
- Lampert PW, "Delayed effects of radiation on the human central nervous system : "early"and"late"delayed reactions", Neurology, 14, pp.912~917 (1964)
- Lee S, "Squash cytology of a dural-based high-grade chondrosarcoma may mimic that of glioblastoma in the central nervous system", Acta Cytol, 59, pp.219~224 (2015)
- Plesec TP, "Frozen section discrepancy in the evaluation of central nervous system tumors", Arch Pathol Lab Med, 131, pp.1532~1540 (2007)
- Lee HS, "The basics of intraoperative diagnosis in neuropathology", Surg Pathol Clin, 8, pp.27~47 (2015)
- Yamada SM, "Glioblastoma multiforme versus pleomorphic xanthoastrocytoma with anaplastic features in the pathological diagnosis : a case report", Diagn Pathol, 11, pp.65~ (2016)
- 석재연, "Crush Cytology of Microcystic Meningioma with Extensive Sclerosis", Journal of Pathology and Translational Medicine, 48(1), pp.77~80 (2014), 대한병리학회[DOI]
- Jeong J, "Crush cytology of a primary intraspinal rhabdoid papillary meningioma : a case report", Acta Cytol, 57, pp.528~533 (2013)
- Raisanen J, "Atypical teratoid", rhabdoid tumor : cytology and differential diagnosis in adults, 2004, pp.31, 60~63
- Kobayashi S, "Meningioma, neurilemmoma and astrocytoma specimens obtained with the squash method for cytodiagnosis : a cytologic and immunochemical study", Acta Cytol, 37, pp.913~922 (1993)
- NaRae Kim, "Primary Intrasellar Schwannoma - A Case Report -", Journal of Pathology and Translational Medicine, 36(4), pp.274~277 (2002), 대한병리학회
- Plesec TP, "Frozen section discrepancy in the evaluation of nonneoplastic central nervous system samples", Ann Diagn Pathol, 13, pp.359~366 (2009)
- Can B, "Fine-needle aspiration cytology of metastatic oligodendroglioma : case report and literature review", Acta Cytol, 56, pp.97~103 (2012)
- Hernández-Martínez SJ, "Cytologic features during intraoperative assessment of central neurocytoma : a report of three cases and review of the literature", Acta Cytol, 57, pp.400~405 (2013)
- Deb P, "Intraparenchymal clear cell ependymoma", J Cytol, 28, pp.73~76 (2011)
- Chaudhuri PM, "Squash cytology of tanycytic ependymoma : a report of two cases", Diagn Cytopathol, 45, pp.270~273 (2017)
- Wang M, "A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions : a systematic review and meta-analysis", Breast, 31, pp.157~166 (2017)
- Mahe E, "Intraoperative pathology consultation : error, cause and impact", Can J Surg, 56, pp.E13~E18 (2013)
- Monabati A, "Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess : a report of three cases", Acta Cytol, 44, pp.437~441 (2000)
- Chand P, "Errors, limitations, and pitfalls in the diagnosis of central and peripheral nervous system lesions in intraoperative cytology and frozen sections", J Cytol, 33, pp.93~97 (2016)