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Citations
... A total of 59 articles were included in the final analysis. [2,[4][5][6][10][11][12][13][14][15][16][17][18][19][20][21][23][24][25][26][27][28][29][31][32][33][35][36][37]39,42,[44][45][46][47]49,50,52,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][70][71][72][73][74][75] e majority of studies included in this review were conducted in LMICs, with single-center retrospective or prospective designs. ...
Background
Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.
Methods
A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The data was extracted, processed, and organized using Microsoft Excel.
Results
A total of 59 out of 553 articles screened were included in the final analysis. The sensitivity and specificity of the intraoperative smear of brain tumors were found to be over 90% in most studies. The PPV was consistently above 90% in 11 studies, reaching 100% in one study and the NPV varied, ranging from 63% to 100%, and the accuracy was found to be >80% in most studies. One recurrent theme in the majority of the included studies was that an intraoperative brain smear is a cost-effective, quick, accessible, and accurate method of diagnosing brain tumors, requiring minimal training and infrastructure.
Conclusion
Intraoperative brain smear is a simple, rapid, cost-effective, and highly sensitive diagnostic modality for brain tumors. It can be a viable and accessible alternative to more traditional methods such as frozen sections and can be incorporated into neurosurgical practice in LMICs as a reliable and efficient diagnostic tool.
... The presence of a fibrillary background in smears was a useful feature for the diagnosis of gliomas ( Figure 3A). Bhagyalakshmi et al 14 offered without considering the fact that the tumour was located at a parietal location. 15 Kobayashi et al 17 in 1993 pointed out that in schwannoma, the length to breadth ratio of nuclei is greater than 2, whereas in fibroblastic meningioma it is less than 2. Also, all of the cases of schwannoma in the present study were correctly diagnosed ( Figure 3C). ...
The squash smear technique was introduced in intra-operative neurosurgical diagnosis as early as 1930. It is becoming increasingly popular in diagnosing CNS lesions being fairly accurate even with a small sample. The current study is undertaken to assess the accuracy and utility of intraoperative consultations by squash smear and frozen section (FS) technique and correlate with histopathological diagnosis.
To compare the intra-operative squash smear cytology and FS examination in CNS tumors
A total of 53 cases of CNS tumors were included in the study and all were subjected to squash smear examination. FS were made for 39 of these samples. The results of two techniques were compared and correlated with histopathological diagnosis. The observed results were then analysed using SPSS software.
The most common primary CNS tumors were gliomas and meningiomas (28.3% each). The sensitivity, specificity, positive predictive value and negative predictive value for squash cytology were 86.67%, 87.5%, 81.25% and 91.3% and for FS were 91.67%, 93.10%, 91.67%, 93.10% respectively with corresponding comparative p-value 0.56 (insignificant). Cytological diagnosis showed complete correlation with histopathological diagnosis in 39 (73.58%) cases, partial correlation in 8 (15.1%) cases and no correlation in 6 (11.32%) cases. FS diagnosis showed complete correlation in 29 (74.35%) cases, partial correlation in 8 (20.5%) cases and no correlation in 2 (5.1%) cases.
Squash smear is a rapid, self-sufficient and cost-effective method for intraoperative diagnosis of CNS tumors. Squash technique and FS are complementary procedures that assist the pathologist in defining a diagnosis.
... Squash smear has gained importance due to image guided stereotactic techniques [1] . It helps the neurosurgeons to decide the extent of the surgery [2] . Intraoperative diagnosis of space occupying lesions of the Central Nervous System helps neurosurgeons to modify the approach at surgery. ...
