Abstract
Objective:Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient’s future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques. Methods:A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis. Results:The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05). Conclusion:Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.
Highlights
Glioma is a primary central nervous system tumour arises in glial tissue and it can be further divided as astrocytoma, oligodendroglioma, oligoastrocytoma or ependymoma
Case and sample selection This study was a cross-sectional study conducted at Hospital Universiti Sains Malaysia (USM) involving 22 cases of glioma diagnosed intraoperatively within period of 6 years and 7 months from January 2013 until August 2019
The median age of glioma cases diagnosed in Hospital USM by cytology smear and frozen section was 31.7
Summary
Glioma is a primary central nervous system tumour arises in glial tissue and it can be further divided as astrocytoma, oligodendroglioma, oligoastrocytoma or ependymoma. Glioma is the most common primary intracranial malignancy. Glioma accounts for 75% of malignant brain tumours, and more than half out of these are glioblastomas (Ostrom et al, 2017). Intraoperative histopathological diagnosis plays a crucial role in optimizing the surgical procedure and determining the treatment plan of the patient. Frozen section has been an established intraoperative histopathological evaluation worldwide since it was first introduced in 1891. Cytology smear was introduced later and there was an increased usage of this technique for supplementing or replacing the use of frozen section technique (Jaiswal et al, 2012)
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