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Intraoperative cytology when cryostat is not available. A 7-year experience in a Peruvian cancer center
Milagros Abad-Licham1,2,3, Juan Astigueta1,2, Luis De Las Casas4
1Escuela de Medicina, Universidad Privada Antenor Orrego, Trujillo, Peru.
Insights
Intraoperative cytology (IC) provides accurate diagnoses when frozen-section (FS) is unavailable. This study shows IC is a rapid, cost-effective alternative for intraoperative pathology.
Area of Science:
- Pathology
- Surgical Pathology
- Cytopathology
Background:
- Intraoperative cytology (IC) serves as an alternative to frozen-section (FS) diagnosis.
- This study evaluates the diagnostic utility of IC during a 7-year period at a Peruvian Cancer Center where FS was not accessible.
Purpose of the Study:
- To assess the diagnostic value and accuracy of intraoperative cytology (IC).
- To determine the sensitivity, specificity, and predictive values of IC compared to gold standard histologic diagnoses.
Main Methods:
- A retrospective review of 1814 IC procedures performed between 2012 and 2018.
- IC preparations (imprint, scrape, crush smears) were stained with hematoxylin and eosin.
- IC interpretations were correlated with definitive histologic diagnoses for accuracy assessment.
Main Results:
- Of 1712 eligible cases, IC achieved a sensitivity of 91.6% and specificity of 97.7%.
- Positive predictive value (PPV) was 94.1%, negative predictive value (NPV) was 96.7%, and overall diagnostic accuracy was 96%.
- Malignant, benign, and atypical diagnoses constituted 26.3%, 68.9%, and 3.7% of cases, respectively.
Conclusions:
- Intraoperative cytology (IC) is a rapid, cost-effective, and accurate diagnostic method.
- IC is a valuable alternative for intraoperative diagnosis, especially when frozen-section (FS) is unavailable.
- The findings support the use of IC in experienced hands for timely patient management.
Background:
Intraoperative cytology (IC) is an alternative to frozen-section (FS) diagnosis. We present our experience with and the diagnostic value of IC during a 7-year period when FS was not available in a Peruvian Cancer Center.
Material And Methods:
This 7-year retrospective single-arm review study includes IC procedures performed by three pathologists between 2012 and 2018. These IC reports were reviewed independently by one pathologist and were correlated with the histologic diagnoses, which were used as the gold standard. All IC preparations (imprint, scrape, and crush smears) were stained with hematoxylin and eosin. IC interpretations were categorized as: malignant, benign, atypical, and "deferred to permanent sections." Sensitivity, specificity, and positive and negative predictive values were calculated by use of standard methods.
Results:
A total of 1814 IC cases prepared from various organs obtained from 887 patients were reviewed. Malignant, benign, atypical, and "deferred to permanent sections" IC diagnoses were 26.3%, 68.9%, 3.7%, and 1.9%, respectively. Atypical and deferred cases were excluded from the statistical analysis; thus 1712 cases were found to be eligible. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were 91.6%, 97.7%, 94.1%, 96.7%, and 96%, respectively.
Conclusion:
In experienced hands, IC is a rapid, cost-effective, and accurate alternative diagnostic modality for intraoperative diagnosis when FS is not available.
