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Value of cytology as an adjunctive intraoperative diagnostic method. An audit of 2,250 consecutive cases
L F Scucchi1, D Di Stefano, L Cosentino
1Department of Experimental Medicine and Pathology, University La Sapienza, Rome, Italy.
Insights
Intraoperative cytology (IC) significantly improves diagnostic accuracy when used with frozen section (FS) analysis. This combined approach enhances the detection of benign versus malignant lesions, offering a more reliable intraoperative diagnosis.
Area of Science:
- Surgical Pathology
- Cytopathology
- Diagnostic Accuracy
Background:
- Frozen section (FS) analysis is a standard method for intraoperative diagnosis.
- Limitations exist in FS accuracy, potentially delaying definitive surgical decisions.
- Intraoperative cytology (IC) offers an alternative or complementary diagnostic method.
Purpose of the Study:
- To assess the impact of combining intraoperative cytology (IC) with frozen section (FS) on diagnostic accuracy.
- To compare the diagnostic performance of the combined technique against FS alone.
Main Methods:
- A retrospective analysis of 2,250 cases where both IC and FS were performed.
- Comparison of diagnoses from combined IC and FS with final paraffin section diagnoses.
- Calculation of sensitivity, specificity, and overall accuracy for each method.
Main Results:
- The combined IC and FS approach achieved a diagnostic accuracy of 99.2% in distinguishing benign from malignant lesions.
- This accuracy rate is significantly higher than that reported for FS alone.
- IC alone had 96% accuracy, while FS alone had 94.9% accuracy. Combined sensitivity was 98.2% and specificity was 100%.
Conclusions:
- Intraoperative cytology serves as a valuable adjunct to frozen section analysis, enhancing diagnostic reliability.
- The combined approach improves the accuracy of intraoperative diagnoses, aiding surgical management.
- While effective, the combined method has certain limitations that warrant consideration.
Objective:
To evaluate the role of intraoperative cytology (IC) in the improvement of diagnostic accuracy obtained by frozen section (FS) alone.
Study Design:
Comparison of 2,250 intraoperative cytologies performed along with frozen sections, with the final diagnoses achieved on paraffin sections.
Results:
In 18 cases the diagnoses were deferred until the paraffin sections at the time of intraoperative consultation. The diagnostic accuracy in distinguishing benign from malignant lesions by combined intraoperative cytology and frozen section was 99.2%. The accuracy rate is significantly higher than that reported in large series based on frozen section preparations alone. Sensitivity and specificity were, respectively, 98.2% and 100%. The diagnostic accuracy of each technique alone was 94.9% for FS (sensitivity 89.9%, specificity 97.9%) and 96% for IC (sensitivity 94.9%, and specificity 96.8%). Although specific diagnoses were more frequently formulated on the bases of frozen section examination, FSs were not diagnostic in 113 case in which cytology allowed a specific diagnosis.
Conclusion:
Our results emphasize the increasingly important diagnostic role of intraoperative cytology as an adjunct to frozen section. The approach does have limitations.
