Cytohistopathological Study of Central Nervous System Neoplasms

Introduction: In the neurosurgical practice, a rapid pathological diagnosis of the space occupying lesions of the nervous system is an asset and helps the neurosurgeons to plan the extent of surgery and modify it accordingly. The squash smear preparation is fairly accurate, simple and reliable tool for intraoperative diagnosis of neurosurgical biopsies. The current study was undertaken to assess the diagnostic accuracy of intraoperative cytomorphological diagnosis by squash smear technique and its correlation with histopathological diagnosis, which has been considered as ‘gold standard. ’ Aims: 1. Study of squash / imprint cytological smears of freshly excised CNS neoplasms biopsies, after staining with hematoxylin& eosin, MGG& methylene blue stain.2. To correlate with histopathological findings and study the diagnostic accuracy of squash smear vs paraffin sections. Settings and Design: Prospective, observational study. Subjects and methods: The prospective study was conducted in the Department of Pathology in collaboration with the Department of Neurosurgery of Vivekananda polyclinic and institute of medical sciences, Lucknow from May 2009 to May 2011. One hundred and two samples with symptomatic and radiologically assessed CNS neoplasms were included in the study. Intraoperative squash smears were stained by rapid methylene blue stain, hematoxylin and eosin and MGG stain. Cytological diagnoses were correlated with histopathological diagnosis which was taken as gold standard, keeping in view the clinicoradiological diagnosis as well. Diagnostic accuracy of cytosmears was calculated. Results: The overall diagnostic accuracy among the central nervous system neoplasms in our study was 93.1 % (95/102). Conclusion: Squash smear technique is a fairly accurate, simple, rapid and reliable tool for rapid intraoperative diagnosis of neurosurgical biopsies.