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Role of intraoperative cytopathology in pediatric surgical pathology
P E Wakely1, W J Frable, M J Kornstein
1Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
Insights
Intraoperative cytopathology (IOC) is effective for pediatric surgical specimens, achieving high accuracy in diagnosing benign versus malignant conditions. It can supplement or even replace frozen section (FS) examination, especially with limited tissue samples.
Area of Science:
- Pediatric Pathology
- Surgical Pathology
- Cytopathology
Background:
- Intraoperative cytopathology (IOC) is increasingly used in adults but understudied in pediatric populations.
- Limited data exists on the efficacy of IOC for pediatric surgical specimens.
Purpose of the Study:
- To evaluate the diagnostic utility and accuracy of IOC in pediatric patients.
- To compare IOC alone versus combined IOC and frozen section (FS) examination.
Main Methods:
- Reviewed 58 pediatric cases (neonate to 18 years) using IOC smears.
- Pathologists independently diagnosed IOC smears, with some cases also undergoing FS examination.
- Assessed diagnostic accuracy for benign vs. malignant classification.
Main Results:
- Pathologists achieved high accuracy (94-98%) using IOC alone for malignancy classification.
- Combined IOC and FS examination showed similar high accuracy (94-98%).
- IOC alone correctly diagnosed benign vs. malignant disease in 96% of cases without concurrent FS, particularly useful with limited tissue (<2 cm).
Conclusions:
- Intraoperative cytopathology is a valuable tool in pediatric surgical pathology.
- IOC can serve as a useful supplement to frozen section analysis.
- In situations with limited tissue, IOC can potentially replace traditional frozen section examination.
Abstract:
Studies regarding the efficacy of intraoperative cytopathology (IOC) of surgical specimens in the pediatric population are almost non-existent, despite their recent popularity in adults. To determine the utility of IOC in children, we examined 58 cases from 54 pediatric patients (neonate to 18 years of age) who had cytologic smears performed in addition to or instead of frozen section (FS) examination during their surgical procedure. Knowing only the patient's age, sex, anatomic site, and any pertinent radiographic or historic data, three pathologists independently reviewed and issued a diagnosis using only the IOC smears. Subsequently, in 28 cases that also had accompanying FS examination, both IOC and FS analysis were interpreted for a composite final diagnosis. Three cases were judged unsatisfactory because of sparse cellularity of smears. Correct classification of the smears as being benign or malignant for each pathologist was 98%, 94%, and 94% using IOC alone and 98%, 94%, and 96% using combined IOC and FS examination. The most frequent anatomic sites were bone (15 cases) and lymph node (14 cases). The most common diagnoses were malignant small round cell tumor (22 cases) and benign lymphoid tissue (10 cases). The records of all 55 cases were reviewed in the second phase of our study. Twenty-seven cases (49%) were found in which IOC diagnoses were rendered without a concurrent FS examination. These were correctly interpreted in 26 of 27 cases (96%) in the determination of a benign versus malignant disease process. The tissue sample measured < or = 2 cm in 15 of 27 cases (56%) in this latter group. Intraoperative cytopathology diagnoses in this group were rendered by various faculty members on call for FS examination and, in some cases, by fifth-year residents with faculty supervision. Without minimizing the degree of difficulty in the interpretation of pediatric IOC, we conclude that it serves as a useful supplement in FS diagnosis and, in some situations (particularly when tissue is limited), can replace histologic FS examination.