J Pathol Transl Med.  2019 Mar;53(2):104-111. 10.4132/jptm.2018.11.10.

Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis

• Kang M
• Chung DH
• Kim NR
• Cho HY
• Ha SY
• Lee S
• An J
• Seok JY
• Yie GT
• Yoo CJ
• Lee SG
• Kim EY
• Kim WK
• Son S
• Sym SJ
• Shin DB
• Hwang HY
• Kim EY
• Lee KC

• KMID: 2465449
• DOI: http://doi.org/10.4132/jptm.2018.11.10

Abstract

BACKGROUND
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.
METHODS
Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated.
RESULTS
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). 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%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 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.
CONCLUSIONS
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.

Keyword

Crush cytology; Central nervous system; Neoplasm; Frozen sections

MeSH Terms

Brain Neoplasms
Central Nervous System Neoplasms*
Central Nervous System*
Cytogenetics
Diagnosis*
Frozen Sections
Humans
Meningeal Neoplasms
Methods
Neurilemmoma
Pituitary Neoplasms
Retrospective Studies

Figure

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  Fig. 1. (A, B) Ependymoma. Spindle-shaped tumor cells around thin capillaries. Note fibrillary cytoplasm and occasional nuclear inclusion. (C, D) Glioblastoma. Clusters show ovoid to slightly elongated hyperchromatic nuclei with occasional mitosis. Note necrosis in the extracellular area. (E, F) Fibrous meningioma. Ovoid to spindle cells have round to elongated nuclei with fine chromatin. Note nuclear pseudoinclusion and meningothelial whorls. (G, H) Rhabdoid and papillary meningioma. Papillae have thick collagenous cytoplasm rather than fibrillary features that are commonly found in ependymoma.

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  Fig. 2. Discordant cases. (A, B) Spindle cells with occasional atypical cells are mixed with karyorrhectic debris (A), and glioblastoma is diagnosed in the permanent section (B). (C, D) A tiny focus of round cells shows eosinophilic fibrillary cytoplasm in a bloody background (C), and diffuse astrocytoma is diagnosed in the permanent section (D). (E) Only one cluster of squamoid epithelium is seen in frozen smears. (F) Immature teratoma with neuroepithelium is finally diagnosed in permanent section.

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