Utility of intraoperative squash cytology in diagnosis of paediatric central nervous system lesions

The utilization of cytology for intraoperative diagnosis of primary central nervous system lymphoma

To investigate the diagnostic value of intraoperative cytology and rapid immunocytochemistry in primary central nervous system lymphoma. 254 cases of lymphoma and 82 cases of non-lymphoma were collected from 2010 to 2023. Frozen section(FS) was using alone in 44 cases during 2010-2014, FS and intraoperative cytology(IC) were using in 251 cases during 2015 to 2022. Rapid immunocytochemical(RICC, CD20, GFAP) were using with FS + IC in 41 cases during 2021 to 2023. Method One: According to the results of archives, statistic the diagnostic accuracy of lymphoma during three time periods. Method Two: All cases were randomly renumbered, 4 neuropathologists compared the accuracy of independent histology and that of combining cytology. The archives showed the diagnostic accuracy of FS in PCNSL was 77.27%, FS + IC was 86.06%, FS + IC + RICC was 92.68%. The retrospective study demonstrated the diagnostic accuracy of FS was 79.76%, FS + IC was 87.33% and FS + IC + RICC was 92.68%. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CD20 were 100%, 76.92%, 90.32%, 100% and 92.68%, respectively. The results of the paired χ2 test was no statistically significant difference (0.05 < P < 0.1) between FS + IC + RICC and immunohistochemical (IHC) diagnosis of paraffin sections. The integration of IC + RICC + FS diagnosis can significantly enhance the intraoperative diagnostic accuracy of PCNSL and rectify potential errors that may occurred when relying solely on FS diagnosis.

Diagnostic Accuracy of Intraoperative Brain Smear: A Meta-Analysis of Studies from Resource-Limited Settings

BACKGROUND

Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful, is still undetermined. To investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors.

METHODS

A systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMICs) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0.

RESULTS

Twelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while 4 investigated adults and 2 included pediatric patients. The pooled diagnostic odds ratio (OR) was calculated to be 212.52 (CI: [104.27-433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively.

CONCLUSIONS

Our study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis.

Unveiling the potential application of intraoperative brain smear for brain tumor diagnosis in low-middle-income countries: A comprehensive systematic review

Background

Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.

Methods

A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The data was extracted, processed, and organized using Microsoft Excel.

Results

A total of 59 out of 553 articles screened were included in the final analysis. The sensitivity and specificity of the intraoperative smear of brain tumors were found to be over 90% in most studies. The PPV was consistently above 90% in 11 studies, reaching 100% in one study and the NPV varied, ranging from 63% to 100%, and the accuracy was found to be >80% in most studies. One recurrent theme in the majority of the included studies was that an intraoperative brain smear is a cost-effective, quick, accessible, and accurate method of diagnosing brain tumors, requiring minimal training and infrastructure.

Conclusion

Intraoperative brain smear is a simple, rapid, cost-effective, and highly sensitive diagnostic modality for brain tumors. It can be a viable and accessible alternative to more traditional methods such as frozen sections and can be incorporated into neurosurgical practice in LMICs as a reliable and efficient diagnostic tool.