Shakir Muhammad, Altaf Ahmed, Hussain Hawra, Abidi Syed Muhammad Aqeel, Petitt Zoey, Tariq Mahnoor, Gilani Ahmed, Enam S Ather
Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
Medical School, Aga Khan University Hospital, Karachi, Pakistan.
Surg Neurol Int. 2023 Sep 8;14:325. doi: 10.25259/SNI_491_2023. eCollection 2023.
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.
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.
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.
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.
肿瘤组织的术中即时组织病理学检查对于神经外科医生追踪手术切除情况而言必不可少。脑涂片是一种简单、快速且经济高效的技术，在脑肿瘤诊断中尤为重要。本研究旨在确定术中脑涂片在低收入和中等收入国家（LMICs）脑肿瘤诊断中的有效性，同时评估其敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及总体准确性。
使用PubMed、Scopus和谷歌学术对文献进行全面检索。检索到的文章由两名审稿人独立筛选。数据使用Microsoft Excel进行提取、处理和整理。
最终分析纳入了从553篇筛选文章中选出的59篇。多数研究发现，脑肿瘤术中涂片的敏感性和特异性超过90%。11项研究中PPV始终高于90%，一项研究中达到100%，NPV有所不同，范围在63%至100%之间，多数研究发现准确性>80%。纳入的多数研究中一个反复出现的主题是，术中脑涂片是一种经济高效、快速、易于操作且准确的脑肿瘤诊断方法，所需培训和基础设施极少。
术中脑涂片是一种用于脑肿瘤的简单、快速、经济高效且高度敏感的诊断方式。它可以作为冷冻切片等更传统方法的可行且易于采用的替代方法，并可作为一种可靠且高效的诊断工具纳入LMICs的神经外科实践中。
