Abstract
Intraoperative pathologic consultation plays an essential role in therapeutic decision making, possibly avoiding under or overtreatment of the patient. Common indications for intraoperative consultation include obtaining a diagnosis in an unknown pathology, ruling out malignancy, confirming a provisional diagnosis, and assessing margin status. Fifty patients undergoing surgery for soft tissue tumors or tumor-like lesions were included in the present prospective study to evaluate the role of intraoperative pathologic consultation by imprint and scrape cytology. Careful and quick gross examination of the specimen was performed, followed by processing for imprint and scrape smears. The prepared smears were evaluated by three pathologists and the cytological diagnosis compared subsequently with final histopathological diagnosis. Intraoperative consultation was primarily requested to make or confirm preoperative diagnosis. In 44.0% cases, no previous tissue/cytological diagnosis was available. In 56.0% cases, previous pathological diagnosis was available, but the reports were inconclusive or were reported from outside our institute. The diagnostic yield of imprint smears was 24% (5 malignant, 6 benign, and 1 inconclusive), and scrape smears was 100% (10 malignant, 38 benign, and 2 inconclusive). Paraffin-embedded sections yielded diagnosis in 100% cases (11 malignant, 38 benign, and 1 nonneoplastic). Imprint smears alone were not of much help in intraoperative diagnosis. Scrape smears were found to be superior to imprint smears in terms of diagnostic yield and accuracy. Combined imprint and scrape smear cytology did not provide any advantage in intraoperative provisional tissue diagnosis in soft tissue tumors.
Highlights
Soft tissue sarcomas encompass a broad spectrum of clinically, histologically, and molecularly diverse neoplasms that share a mesenchymal origin. ese neoplasms present with unique diagnostic and therapeutic challenges [1]. e incidence of soft tissue sarcomas (STS) is relatively much lower than that of carcinomas and other neoplasms, constituting less than 1% of all malignant tumors [2]
Benign soft tissue tumors have a limited capacity for autonomous growth, exhibit little tendency to invade, and have a low rate of recurrence. ey are about 100 times more common than sarcomas [3]. e intermediate tumors have a high rate of local recurrence but a small risk of metastasis
In view of varying reports on intraoperative consultation by various techniques, the present study aims to assess the role of imprint and scrape cytology in establishing diagnosis of soft tissue tumors and compare the diagnostic utility of cytological smears with the final histopathological diagnosis
Summary
Received 16 December 2020; Revised 27 August 2021; Accepted 9 October 2021; Published 29 October 2021. Common indications for intraoperative consultation include obtaining a diagnosis in an unknown pathology, ruling out malignancy, confirming a provisional diagnosis, and assessing margin status. Fifty patients undergoing surgery for soft tissue tumors or tumor-like lesions were included in the present prospective study to evaluate the role of intraoperative pathologic consultation by imprint and scrape cytology. In 44.0% cases, no previous tissue/cytological diagnosis was available. In 56.0% cases, previous pathological diagnosis was available, but the reports were inconclusive or were reported from outside our institute. E diagnostic yield of imprint smears was 24% (5 malignant, 6 benign, and 1 inconclusive), and scrape smears was 100% (10 malignant, 38 benign, and 2 inconclusive). Combined imprint and scrape smear cytology did not provide any advantage in intraoperative provisional tissue diagnosis in soft tissue tumors
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