Transcript PowerPoint Presentation - Accuracy of intra

Accuracy of intra-operative rapid diagnosis
by Squash smear in CNS lesions –
An early institutional experience.
KK Bansal,
Monika Bansal, Sanjeev Kishore, Anuradha K, Meena H,
Dushyant G.
Department of Neurosurgery & Pathology
Himalayan Institute of Medical Sciences
Dehradun, India.
Introduction
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Squash smear preparation - fairly accurate,
simple and reliable tool for rapid intraoperative diagnosis of central nervous system
lesions.
Based on two essential factors:
Availability of very small tissue fragments &
good preservation of fine cellular details.
Not effected by edema, hemorrhage,
necrosis & calcification.
Surgery is easy in such cases ---------but
Here – where ICA encased & infiltrating tumor, Surgical challenge..
Material and Methods
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Prospective study
Included 118 patients
Period of October 2004- October 2006.
All patients operated for CNS mass lesions
were included
Squash cytology reported by pathologists
All
were
subjected
for
routine
histopathological processing.
Squash smear technique
Minimum 2 air dried & 4 wet smear ( MGG, H & E, PAP Stain).
Age wise distribution
Sex wise distribution
Site wise distribution of CNS lesions (n=118)
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S.No.
Site
No. of Tumors
Percentage (%)
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1.
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2.
3.
4.
5.
6
7.
8.
Cerebral Hemisphere
-Frontal
-Parietal
-Temporal
-Overlapping lesions
Cerebellum
Pineal region
Ventricles
Suprasellar region
Cerebellopontine angle
Spinal cord
Non-Specific
Total
49
18
04
08
19
09
04
11
05
09
14
14
118
41.5
15.3
3.4
6.8
16.1
7.7
3.4
9.3
4.2
7.7
11.8
11.8
100
Distribution of cases based on clinical
diagnosis (n=118)
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S. No. Clinical / Provisional Diagnosis No. of cases
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
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Glioma
Pituitary adenoma
Craniopharyngioma
Meningioma
Schwannoma
Neurofibroma
Metastatic
Epidermoid cysts
Arachnoid cysts
Vascular lesion
Tuberculosis
Seizure related lesion
Nonspecific diagnosis
Others
Total
43
04
04
19
07
03
06
05
02
03
07
05
06
04
118
Percentage
36.4
3.4
3.4
16.1
5.9
2.5
5.1
4.2
1.7
4.2
5.9
4.2
5.1
3.4
100
Distribution of cases based on intraoperative squash
smear cytologic diagnosis (n=118)
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S. No. Cytopathological Diagnosis
No. of cases
Percentage
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1
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2
3
4
5
6
7
8
9
10
Glioma
-Astrocytoma
-Glioblastoma Multiforme
-Oligodendroglioma
-Ependymoma
Pituitary adenoma
Craniopharyngioma
Meningioma
Schwannoma
Neurofibroma
Metastatic tumors
Tuberculosis
Aspergillosis
Others
Total
36
30
02
01
03
04
03
17
08
03
10
05
02
20
118
30.5
25.4
1.7
0.84
2.5
3.4
2.5
14.4
6.8
2.5
8.5
4.2
1.7
16.9
100
Distribution of cases based on Histopathologic
diagnosis (n=118)
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S. No. Histopathological Diagnosis
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1
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2
3
4
5
6
7
8
9
10
11
12
Glioma
-Astrocytoma
-Glioblastoma Multiforme
-Oligodendroglioma
-Ependymoma
-Gliosarcoma
Ganglioglioma
Pituitary adenoma
Craniopharyngioma
Meningioma
Schwannoma
Neurofibroma
Metastatic
Tuberculosis
Aspergillosis
Seizure related lesion
Other
Total
No. of cases
34
20
07
01
04
02
03
06
03
18
09
02
09
06
02
05
21
118
Percentage
28.8
16.9
5.9
0.84
3.4
1.7
2.5
5.08
2.5
15.3
7.7
1.7
7.7
5.08
1.7
4.2
17.8
100
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Cyto-histological correlation of CNS lesions (n=118)
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S. No
Cytological Diagnosis
No. of Cases Histological Diagnosis
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1
Glioma / Astrocytoma
30
2
Glioblastoma Multiformae
02
3
Ependymoma
03
4
5
6
Pituitary Adenoma
Craniopharyngioma
Meningioma
04
03
17
7
Schwannoma
08
8
Neurofibroma
03
9
Metastatic
10
10
11
12
Tuberculoma
Aspergillosis
Others
Total
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05
02
31
118
Astrocytoma
Glioblastoma
Oligodendroglioma
Ependymoma
Ganglioglioma
Glioblastoma
Gliosarcoma
Ependymoma
Ganglioglioma
Pituitary Adenoma
Craniopharyngioma
Meningioma
Ependymoma
Gliosarcoma
Schwannoma
Meningioma
Neurofibroma
Meningioma
Metastatic
Meningioma
Tuberculoma
Aspergillosis
No. of Cases Percentage
20
06
01
01
02
01
01
02
01
04
03
15
01
01
07
01
02
01
09
01
05
02
31
118
66.6
20.0
50
66.6
100
100
88.2
87.5
66.6
90
100
100
Conclusion
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The cytohistological correlation of all 118 lesions
diagnosed on cytology was 89.7%.
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Common reasons for no opinion on cytology were
fibrosis, inflammation, calcification, necrosis and lack of
definite cytologic criteria.
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Common causes for erroneous diagnosis on
cytology were
increased fibrous component,
biopsy from cyst wall,
increased and morphology obscuring
inflammation and necrosis,
lack of architecture on cytology,
reactive changes,
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resistance to desegregation.
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Pilocytic Astrocytoma
Astrocytoma grade 2
Astrocytoma grade 3
Astrocytoma grade 4
Astrocytoma grade 4
Ependymoma
Meningioma
Psammomatous Meningioma
Metastatic lesion
Bronchogenic cyst
Granulomatous lesion
Aspergilloma