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Intraoperative cytologic diagnosis of granulomas: a retrospective study of 156 cases
1Department of Pathology, George Washington University Medical Center, Washington, DC, USA.
Insights
Intraoperative cytology (IOC) aids in diagnosing granulomas, offering high specificity (99%) and accuracy, though rare misdiagnoses with neoplasms occur. This method is a valuable tool for infectious disease diagnosis.
Area of Science:
- Cytopathology
- Surgical Pathology
- Infectious Diseases
Background:
- Intraoperative cytology (IOC) is an alternative to frozen sections for diagnosing infectious diseases, minimizing contamination risks.
- Granulomas, a common infection pattern, can present diagnostic challenges in cytological evaluation.
- Assessing the accuracy and limitations of IOC in granuloma diagnosis is crucial.
Purpose of the Study:
- To evaluate the accuracy and identify pitfalls of intraoperative cytology (IOC) in diagnosing granulomas.
- To compare IOC findings with permanent section (PS) diagnoses for cyto-histologic correlation.
- To determine the diagnostic utility of IOC for granulomatous inflammation.
Main Methods:
- Retrospective review of 5,901 IOC cases from September 1990 to March 1996.
- Cyto-histologic correlation for cases diagnosed with granuloma on IOC or permanent sections (PS).
- Analysis of diagnostic accuracy, sensitivity, specificity, and predictive values of IOC for granulomas.
Main Results:
- Of 156 cases with granuloma diagnosis, 85 were accurately identified by both IOC and PS.
- IOC demonstrated high specificity (99%) and positive predictive value (98%) for granulomas.
- Misdiagnoses occurred rarely, including neoplasms mistaken for granulomas and vice versa, with some deferred for PS.
Conclusions:
- Intraoperative cytology (IOC) is a valuable tool for diagnosing granulomas, exhibiting high specificity and accuracy.
- While generally reliable, rare instances of misclassification between granulomas and neoplasms necessitate careful interpretation.
- IOC offers a safe and effective method for intraoperative assessment of infectious disease patterns like granulomas.
Abstract:
To avoid contamination of equipment and reduce risks of infection, intraoperative cytology (IOC) is a useful substitute to conventional frozen section in the diagnosis of infectious diseases. One of the various histomorphologic patterns of infections is the granuloma, which sometimes may be difficult to diagnose cytologically. In an attempt to assess accuracy and pitfalls of IOC in the diagnosis of granuloma, cases diagnosed as granuloma on IOC or on permanent sections (PS) at George Washington University Medical Center were collected for the period of September 1990 to March 1996. Cyto-histologic correlation was performed. During that time, a diagnosis of granuloma in either the IOC or PS was rendered in 156 of 5,901 IOC cases. IOC showed definite granuloma (87), suspicious for granuloma (23), and neither definite nor suspicious for granuloma in 46 cases. The latter group corresponded to neoplasms (5) and benign conditions (41). Eighty-five cases were accurately diagnosed as definite granuloma by both IOC and PS. Fifty-seven cases diagnosed as granuloma by PS corresponded on IOC to suspicious for granuloma (11), benign smear (41), and neoplasms (5). Only two cases were incorrectly diagnosed as granuloma on IOC: a neoplasm and a case of fibrosis. Overall, four cases of neoplasms were interpreted as suspicious for granuloma (3) or definite granuloma (1) on IOC, and five cases of granulomas were misdiagnosed as neoplasms on IOC. Four of these nine case were deferred for a PS diagnosis. IOC is a useful tool in the diagnosis of granulomas with a sensitivity of 60% and specificity of 99% and positive and negative predictive values of 98% and 99%, respectively. Rarely, neoplasms may be misdiagnosed as granulomas and vice versa.