Intraoperative touch-imprint cytology of germ cell neoplasms

Fourteen-year experience with the intraoperative frozen section examination of testicular lesion in a tertiary university center

Most testicular tumors are germ cell neoplasias. The number of incidentally detected small-sized, nonpalpable testicular lesions is increasing with the use of high-frequency ultrasound for infertility or trauma. These lesions are benign in 80% of cases and can be treated by organ-sparing surgery on the basis of frozen section examination (FSE). We assess the reliability of FSE in testicular and paratesticular lesions and its possible impact on surgical management. We performed a retrospective review of intraoperative FSE in testicular/paratesticular lesions at Geneva University Hospital during a 14-year period. A total of 170 cases were identified, with 159 testicular and 11 paratesticular lesions. The FSE results, permanent sections, and orchiectomy slides were reviewed and compared. Frozen section examinations were reported to be benign in 9 paratesticular and in 43 testicular lesions, and malignant in 2 paratesticular and 105 testicular lesions. Comparing FSE and final diagnosis, FSE correctly identified all nontumor lesions. There was a failure rate of 3.5% to identify tumor. Specificity was 100%, sensitivity was 95%, positive predictive value was 100%, and negative predictive value was 89%. Frozen section examination is a highly sensitive and specific intraoperative procedure, which allows to differentiate between benign and malignant testicular and paratesticular lesions, with a possibility of organ-sparing surgery when they are benign.

Intraoperative Frozen Section Diagnosis in Urological Oncology

The intraoperative frozen sections are indicated if the pathological findings change the surgical procedure. In urological oncology is not recommended, as a general attitude, in the tumor diagnosis/staging during the surgery. The assessment of the surgical margins is recommended in partial surgical resections but the literature discourages its systematic use in the radical surgical resections. The assessment of the lymph nodes is specially indicated in the penile cancer with intermediate or high risk and non-palpable nodes, and is debated its utility in non-palpable lymph nodes of cystectomies and prostatectomies.

Touch preparation of breast core needle specimens is a new method for same-day diagnosis

BACKGROUND

Touch preparation cytology (TPC) has proven to be a quick and accurate intraoperative diagnostic tool for excisional breast biopsy, margins and sentinel nodes. We hypothesized that TPC of core needle biopsy (CNB) specimens can provide a same-day diagnosis in the outpatient setting.

METHODS

Outpatients presenting with breast lesions underwent TPC of biopsy cores performed by biopsy gun or vacuum-assisted CNB. The TPC results were compared with the final diagnosis of CNB specimens.

RESULTS

In all, 199 CNB and TP were performed between August 1997 and October 2002. Twenty-nine percent of lesions were malignant. Touch preparation was deferred in 21% of cases. In the remaining 157 evaluable cases, TPC had an accuracy of 89% and a false negative rate of 26%. The sensitivity, specificity, positive predictive value and negative predictive value of TPC were 74%, 97%, 93%, and 86% respectively.

CONCLUSIONS

Touch preparation cytology on CNB can be performed simply in the outpatient setting. Collaboration between the surgeon and pathologist allows TP to be an accurate means of same-day pathological determination.

Fine-needle aspiration biopsy of nonteratomatous germ cell tumors of the mediastinum

We assessed the usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis of mediastinal germ cell tumors (GCTs). In the archives of 3 pathology departments, we found records of 7 patients with mediastinal GCTs who underwent mediastinal FNAB as part of the diagnostic workup. The FNAB smears, results of the immunocytochemical analysis, the corresponding histologic findings, and the clinical charts were reviewed. All patients were men (age range, 24-44 years; mean, 32 years). One patient had a history of testicular mixed GCT 10 years earlier. The 6 primary mediastinal GCTs consisted of 3 seminomas and 3 yolk sac tumors. Based on the cytologic features and immunocytochemicalfindings, a cytologic diagnosis of GCT was made in 5 cases, including the case of metastatic GCT In 2 cases, the differential diagnosis was between poorly differentiated carcinoma and GCT Results of ancillary studies were noncontributory in 1 case, and the aspirate of the second case demonstrated extensive necrosis. Our findings demonstrate that a diagnosis of mediastinal GCT, primary or secondary, can be established with a high degree of accuracy on the basis of FNAB. Immunocytochemical analysis helps confirm the diagnosis.