Correlation Study of Squash Smear With Histopathology and Radiological Diagnosis of Space-Occupying Lesions of Brain and Spinal Cord.

BACKGROUND

The precise evaluation of tissue samples is crucial for diagnosing and managing central nervous system (CNS) tumors. Squash smear cytology offers a rapid intraoperative pathological assessment of space-occupying lesions in the nervous system. This study aims to evaluate the validity of intraoperative squash smear cytology for CNS tumors and compare its findings with histopathological and radiological diagnoses.

MATERIAL AND

METHODS

This prospective hospital-based observational study was conducted in the Department of Pathology in association with the Departments of Neurosurgery and Radiodiagnosis, from October 2022 to July 2024. Fifty patients with neurological symptoms, such as headaches, vomiting, seizures, and paralysis, who were diagnosed radiologically with intracranial or intraspinal space-occupying lesions and underwent surgery, were included. Institutional ethical approval was obtained, and preoperative radiological examinations (CT scan or MRI) were recorded. Squash smear cytology was performed using 100% methanol-fixed smears stained with rapid hematoxylin and eosin (H&E). The cytological diagnosis was correlated with histopathological examination, which was used for definitive diagnosis and comparison.

RESULTS

The study included 50 patients aged 10 to 78 years (median age: 41 years), with 32 males (64%) and 18 females (36%). The most common radiological diagnosis was glioma (20, 40%), followed by meningioma (15, 30%). The frontal lobe was the most common tumor site (18, 36%), followed by the spinal cord (7, 14%). Squash smear cytology diagnosed gliomas (20, 40%), meningiomas (17, 34%), and brain metastases (2, 4%). A statistically significant correlation (p = 0.001) was found between squash smear and histopathological diagnosis, highlighting its accuracy.

CONCLUSION

Squash smear cytology is a sensitive, specific, rapid, and cost-effective modality for diagnosing CNS lesions. It requires minimal tissue and is valuable in settings where frozen section facilities are unavailable. When performed by an experienced pathologist, it serves as a reliable intraoperative diagnostic tool, aiding neurosurgeons in decision-making and ensuring effective patient management.