Intraoperative Cytology - An Overview

What Is Intraoperative Cytology?

Intraoperative pathology evaluation aids in the diagnosis and treatment of tumors. Touch imprint and crush cytology are easy, quick, and inexpensive. Imprint smears also provide good cytomorphology. Surgeons frequently aim to do reconstructive surgery soon following the definitive excision of head and neck tumors, and verifying the existence of negative margins intraoperatively is critical. The oncological clearing at margins severely limits the successful restoration of the defect. Based on the pathologist's intraoperative consultation, the surgeon alters his surgical strategy.

What Is the Goal Of Intraoperative Cytology?

• The fundamental goal of intraoperative (IO) cytology is to provide rapid surgical guidance. In addition, to diagnose a previously undiagnosed lesion, mostly benign versus malignant, assessment of margin status.

• To detect disease spread, such as lymph node metastasis.

• To the immediate assessment of the adequacy of lesional tissue.

What Are the Types of Intraoperative Cytology?

The two regularly used intraoperative cytology procedures are as follows:

1. Imprint Cytology - Imprints of freshly resected surgical tissues provide excellent cytomorphology, and when combined with fast pap staining, an utterly correct diagnosis may be provided in minutes. Touch imprint cytology is a vital resource for practically every element of experimental and diagnostic medicine due to its simplicity, speed, cost-effectiveness, and ability to optimize cell recovery from extremely minute tissue fragments.

2. Frozen Section - A frozen section is one of the most effective intraoperative tools for case management. However, tumor size, histologic type, and the pathologist's experience can all impact the accuracy of frozen section diagnosis.

What Are the Uses of Intraoperative Cytology?

Healthcare practitioners and pathologists most typically use intraoperative cytology to diagnose or test for cancer. If this is the case, the test correctly diagnoses the condition. A healthcare professional may utilize screening tests to determine if a person has an illness, such as cancer, even before symptoms appear. A Pap smear is a common form of a cytology screening test. Other applications for cytology testing include:

1. To identify inflammatory diseases.

2. To identify infectious illnesses.

3. To identify disorders involving specific bodily cavities, such as the pleural cavity of the lungs.

4. to identify disorders affecting specific organs

5. To investigate thyroid lesions.

What Is the Technique of Intraoperative Cytology?

A cytology test consists of four phases in general:

1. The sample cells are being collected.

2. The processing of the sample cells

3. The sample cells are being examined.

4. Sharing the outcomes.

• The most general approach is touch or imprint, in which a clean glass slide is touched to a freshly sliced raw lesion surface. Next, the scrape smear is made by scraping the surface with the edge of a glass slide and then gently spreading it over another clean and sterilized glass slide surface.

• This approach was chosen for lesions with a little more rigid consistency.

• For friable or necrotic lesions, the crushing procedure is performed.

• A piece of tissue is crushed and gently distributed between two clean glass slide surfaces.

• Smears are made in this manner and preserved in 95 % ethanol before being stained with the fast hematoxylin and eosin (H&E) procedure.

• The slides were immediately immersed in hematoxylin for one minute, rinsed quickly with distilled water, differentiated with ammonium hydroxide, counterstained with eosin by three slow dips, washed in tap water, dried, mounted on a slide, and covered with a coverslip.

• The whole thing takes about three minutes.

• The remaining tissue is promptly formalin-fixed and processed for paraffin blocks.

• The gold standard for statistical assessment of cytological diagnosis is a histological examination of paraffin-embedded tissue.

• Cases that were positive on both histology and cytology are labeled true positive, cases that were positive on histology but negative on cytology are labeled false-negative, cases that are negative on both histology and cytology are labeled true negative, and cases that are negative on histology but positive on cytology are labeled false-positive.

• Paucicellular cases in which no opinion can be formed were categorized as inconclusive. Descriptive statistics are used to assess sensitivity, specificity, and diagnostic accuracy.

What Is the Role of Squash Cytology in Intraoperative Cytology?

The role of squash cytology in the intraoperative diagnosis of central nervous system (CNS) lesions is well established. Intraoperative diagnosis is critical in pediatric central nervous system (CNS) lesions because of deciding between complete gross resection, near entire resection, or subtotal resection. Therefore, radiation and chemotherapy are best avoided in this age group.

The use of squash cytology in the intraoperative diagnosis (IOD) of central nervous system (CNS) lesions is well established. However, for greater diagnostic accuracy, some centers employ frozen section biopsy, while others use squash cytology and frozen section biopsy. Squash cytology is sometimes the only technique accessible for intraoperative diagnosis (IOD) in resource-constrained settings. Intraoperative diagnosis (IOD) is especially significant in pediatric central nervous system (CNS) lesions since the decision between gross total resection, near entire resection, and subtotal resection is critical. Radiation and chemotherapy should be avoided in this age group. Treatment with little influence on the development and cognitive behavior results in an improved quality of life.

What Are the Advantages of Intraoperative Cytology?

The advantages of intraoperative cytology are as follows:

• The rapidity of preparation with the same accuracy.

• Simplicity and low cost.

• Excellent preservation of cellular details without any freezing artifact.

• No tissue loss.

• Identifying focal, macroscopically undetectable neoplastic lesions in large tissue fragments.

• Examining adipose, necrotic, and calcified tissue.

• Diagnosis of malignancy when tissue quantity is limited.

What Are the Limitations of Intraoperative Cytology?

The limitations of intraoperative cytology are the same as those of cytology, such as:

• Sample inaccuracy.

• Inability to differentiate between in situ and invasive lesions.

• Inability to provide depth of invasion data.

Conclusion:

Intraoperative cytology is a simple, affordable, quick, and accurate cytodiagnostic procedure used in cancer detection when frozen section resources are unavailable. An intraoperative cytological examination should be performed consistently, as a prompt intraoperative diagnosis can speed timely and correct patient care and early postoperative therapy, avoiding aggravating delays. In addition, intraoperative cytology can be used to interpret fine needle aspirate smears. Thus, intraoperative cytology can serve as a valuable learning tool in cytopathology.