Study of Squash Smear Cytology in Intraoperative Diagnosis of CNS Tumors- A Tertiary Care Centre Experience in Western Odisha

Authors

  • Abhayashrita Sahoo Senior Resident, Department of Pathology, VSSIMSAR, Burla, Sambalpur, Odisha, India
  • Anupa Toppo Associate Professor, Department of Pathology, VSSIMSAR, Burla, Sambalpur, Odisha, India
  • Sunanda Nayak Professor, Department of Pathology, VSSIMSAR, Burla, Sambalpur, Odisha, India
  • Acharya Suryakanta Pattajoshi Associate Professor & HOD, Department of Neurosurgery, VSSIMSAR, Burla, Sambalpur, Odisha, India
  • Alaka Sahu Professor & HOD, Department of Pathology, VSSIMSAR, Burla, Sambalpur, Odisha, India

Abstract

Background: Intraoperative squash smear cytology is an effective method for the prompt diagnosis of neurosurgical specimens. This method is easy, rapid, inexpensive and designed to evaluate the precision of intraoperative squash smear cytology in identifying space-occupying lesions within the Central Nervous System (CNS). Aims and Objectives: To evaluate the value of squash smear cytology for rapid intraoperative diagnosis of CNS tumors. To know the pattern of CNS tumors cytologically. To determine the limitations of squash smears. Methods: Intraoperatively, tumor tissues obtained from the neurosurgeon were subjected to a squash smear ex-amination at the Department of Pathology, VIMSAR, Burla. The tissue samples were gently squashed between glass slides, stained with rapid Hematoxylin and Eosin (H & E) and Diff-Quik stain, and examined under a mi-croscope. The cytological features were documented and correlated with subsequent histopathological diagnoses obtained from formalin-fixed, paraffin-embedded sections. Results: Eighty cases were received from the Department of Neurosurgery, of which 9 were non-neoplastic cases and 71 had neoplastic lesions. Meningioma accounted for the largest group of tumors among the neoplastic le-sions, with 35 cases (49.29%). A total of 65 cases (91.54%) showed complete correlation with histopathology, one case (1.40%) showed partial correlation, and 5 (7.04%) were discordant. Conclusion: Squash smear cytology is a reliable, rapid, and cost-effective method for intraoperative diagnosis of CNS tumors.

Keywords:

CNS Tumors, Squash Smear Cytology, Intraoperative Diagnosis

References

1. Bray F, Laversanne M, Sung H, et al Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74:229-63.

2. Eisenhardt L, Cushing H. Diagnosis of Intracranial Tumors by Supravital Technique. Am J Pathol 1930;6(5):541-52.

3. Patil SS, Kudrimoti JK, Agarwal RD, et al. Utility of squash smear cytology in intraoperative diagnosis of central nervous system tumors J Cytol 2016;33:205-9.

4. Tejaswi P, Shirisha K, Kumar DA. A study of squash smear cytology in intraoperative diagnosis of CNS tumors and its histopathological correlation. Indian J Pathol Oncol 2020;7(3):441-6.

5. Mitra S, Kumar M, Sharma V, et al. Squash preparation: A reliable diagnostic tool in the in-traoperative diagnosis of central nervous system tumors. J Cytol 2010;27(3):81-5.

6. Acharya S, Azad S, Kishore S, et al. Squash smear cytology, CNS lesions- Strengths and Limitations. Natl J Lab Med 2016; 5:1-7.

7. Omon HE, Komolafe EO, Olasode BJ, et al. Clinicopathological Profile of Central Nervous System Tumors in a Tertiary Hospital in South-west Nigeria. Journal of the West African Col-lege of Surgeons 2021;11(3):1-5.

8. Khuroo MS, Hamdani SM, Alam SS, et al. Accuracy and utility of intraoperative squash smear cytology in neurosurgical practice. Int J Med Sci Public Health 2019;8(2):130-5.

9. Tejaswi P, Shirisha K, Kumar DA. A study of squash smear cytology in intraoperative diagno-sis of CNS tumors and its histopathological correlation. Indian J Pathol Oncol 2020;7(3):441-6.

10. Jindal A, Diwan H, Kaur K, et al. Intraoperative squash smear in central nervous system tumors and its correlation with histopathology: 1 year study at a tertiary care centre. J Neurosci Rural Pract 2017;8(2):221-4.

11. Deshpande K, Surase S, Shedge R, D'costa G, Bharambe B. Accuracy and diagnostic yield of intraoperative squash smear technique in the rapid diagnosis of CNS lesions. Bombay Hosp J 2010; 52:153-60.

12. Patel PJ, Trupti RJ, Chaudhari VV. Clinico-pathological study of Meningioma. Trop J Pathol Microbiol 2019;6(1):9-17.

13. Ostrom QT, Patil N, Cioffi G, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013–2017. Neuro-Oncology 2020;22(12 Suppl 2): iv1-96.

14. Guevara P, Escobar-Arriaga E, Saavedra-Perez D, et al. Angiogenesis and expression of estro-gen and progesterone receptors as predictive factors for recurrence of meningioma. J Neurooncol 2010; 98:379–84.

15. Cea-Soriano L, Wallander MA, Garcia Rodri-guez LA. Epidemiology of meningioma in the United Kingdom. Neuroepidemiology 2012; 39:27-34.

16. Blitshteyn S, Crook JE, Jaeckle KA. Is there an association between meningioma and hormone replacement therapy? J Clin Oncol 2008; 26:279-82.

17. Cahill EM, Hidvegi DF. Crush preparations of lesions of the central nervous system. A useful adjunct to the frozen section. Acta Cytol 1985;29(3):279-85.

18. Becher MW, Abel TW, Thompson RC, et al. Immunohistochemical analysis of metastatic neoplasms of the central nervous system. J Neu-ropathol Exp Neurol 2006;65(10):935-44.

19. Kadiyala P, Nannapaneni S, Murari A, et al. Study of intraoperative squashcytology and fro-zen section diagnosis of central nervous system lesionswith histopathological correlation. J NTR Univ Health Sci 2022; 11:181-5.

20. Shukla K, Parikh B, Shukla J, et al. Accuracy of cytologic diagnosis of central nervous system tumours in crush preparation. Indian J Pathol Microbiol 2006;49(4):483-6.

21. Goel D, Sundaram C, Paul TR, et al. Intraoperative cytology [squash smear] in neurosurgical practice - pitfalls in diagnosis experience based on 3057 samples from a single institution. Cytopathology: Official Journal of the British Society for Clinical Cytology 2007;18(5):300-8.

Published

2025-09-25
Statistics
Abstract Display: 0
PDF Downloads: 0

Issue

Vol. 16 No. 9 (2025): Volume16,Issue9

Section

Articles