Diagnostic Utility of Intraoperative Squash Cytology in Central Nervous System Tumors with Histopathological Correlation

Background: Intraoperative squash cytology is an important diagnostic tool for rapid and accurate diagnosis of central nervous system tumors. It has been proven to play a vital role in determining further surgical management of patients undergoing surgery. It can be ascertained as an alternative method to frozen sections in resource-limited settings. The objective of this study was to evaluate the value of squash smear cytology in rapid intra-operative diagnosis of central nervous system tumors and its correlation with final histopathological diagnosis. Methodology: This was a cross-sectional, descriptive study over a one-year duration. A total of 57 patients with nervous system tumors who underwent surgery at the Department of Neurosurgery, Tribhuvan University Teaching Hospital (TUTH) were included in the study. Intra-operatively, the biopsy was sent in isotonic saline; the unfixed tissue was crushed with slides to obtain smears. Cytological evaluation was performed and correlated with histopathology diagnosis as the gold standard. Results: Out of 57 cases, 46 cases (80.7%) showed complete correlation between squash cytology and histopathology diagnosis. The age-wise evaluation showed an increase in frequency in the elderly, with a peak incidence in the fifth decade. Glial tumors were the most common (42%), followed by meningioma (21%) and schwannoma (19%). Among glial tumors, Glioblastoma was the most common. Conclusion: Squash smear cytology is a reliable and rapid diagnostic tool, and it can assist in intra-operative decision-making and diagnosis of intracranial tumors in resource-limited settings.