Rao Shalinee, Rajkumar Aarthi, Ehtesham M D, Duvuru Prathiba
Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai-600 116, India.
Neurol India. 2009 Jul-Aug;57(4):464-8. doi: 10.4103/0028-3886.55598.
Intraoperative consultation for neurosurgical specimens can be difficult at times, despite the use of both frozen section and squash preparation. Various factors influence the diagnostic accuracy of these procedures. This study was conducted to evaluate reasons for discordant case results in neurosurgical intraoperative consultations and make a comparative analysis of these two commonly used methods to identify the possible pitfalls, errors, and limitations.
All the neurosurgical cases received in the Department of Pathology for intraoperative consultation over a period of 3 years were studied retrospectively. The slides of frozen sections and squash preparation were retrieved and the diagnosis was compared with the final diagnosis given on paraffin-embedded sections.
A total of 6% of the cases were found to be discordant; these included angiomatous meningioma, Non-Hodgkins lymphoma, metastatic renal cell carcinoma, cerebellopontine angle fibrous meningioma, and craniopharyngioma. Highly vascular lesions, unavailability of squash preparation in a few cases and technical errors like thick smears, excessively crushed specimen, freezing, and cautery induced and crushing artifacts contributed to misdiagnosis.
The discrepant cases need to be reviewed regularly by pathologists to familiarize themselves with the morphological changes and artifacts. The knowledge of possible errors could minimize misinterpretation and help in providing a more conclusive opinion to the operating surgeon.
尽管使用了冰冻切片和压片制备技术，但神经外科手术标本的术中会诊有时仍很困难。多种因素影响这些操作的诊断准确性。本研究旨在评估神经外科术中会诊病例结果不一致的原因，并对这两种常用方法进行比较分析，以确定可能存在的陷阱、错误和局限性。
回顾性研究病理科在3年期间接收的所有神经外科术中会诊病例。检索冰冻切片和压片制备的玻片，并将诊断结果与石蜡包埋切片给出的最终诊断进行比较。
共发现6%的病例存在诊断不一致；这些病例包括血管瘤型脑膜瘤、非霍奇金淋巴瘤、转移性肾细胞癌、桥小脑角纤维性脑膜瘤和颅咽管瘤。血管丰富的病变、少数病例无法进行压片制备以及涂片过厚、标本过度挤压、冷冻和烧灼引起的伪像等技术错误导致了误诊。
病理学家需要定期复查诊断不一致的病例，以熟悉其形态学变化和伪像。了解可能出现的错误可以减少误解，并有助于为手术医生提供更具决定性的意见。
