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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2018.11.10    [Epub ahead of print]
Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis
Myunghee Kang1, Dong Hae Chung1, Na Rae Kim1, Hyun Yee Cho1, Seung Yeon Ha1, Sangho Lee1, Jungsuk An1, Jae Yeon Seok1, Gie-Taek Yie2, Chan Jong Yoo2, Sang Gu Lee2, Eun Young Kim2, Woo Kyung Kim2, Sung Son2, Sun Jin Sym3, Dong Bok Shin3, Hee Young Hwang4, Eung Yeop Kim4, Kyu Chan Lee5
1Department of Pathology Gachon University Gil Medical Center, Incheon, Korea
2Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
3Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
4Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
5Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea
Corresponding Author: Na Rae Kim ,Tel: +82 32 460 3073, Fax: +82 32 460 2394, Email: clara_nrk@gilhospital.com
Received: October 1, 2018;  Revised: October 7, 2018  Accepted: October 10, 2018.  Published online: January 14, 2019.

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. Materials and methods: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated.
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, 11.7%). 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% (396/454), and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (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.
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.
Key Words: Crush cytology · Central nervous system · Neoplasm · Frozen sections