Journal of Cytology
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Year : 2019  |  Volume : 36  |  Issue : 2  |  Page : 134-135
Intraoperative flow cytometry for diagnosis of central nervous system lesions


1 Neurosurgical Institute, University of Ioannina School of Medicine; Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
2 Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
3 Department of Pathology, “Agia Sofia” Children's Hospital, Athens, Greece
4 Laboratory of Biology, University of Ioannina School of Medicine, Ioannina, Greece
5 Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece

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Date of Web Publication8-Mar-2019
 

How to cite this article:
Alexiou GA, Vartholomatos G, Stefanaki K, Markopoulos GS, Kyritsis AP. Intraoperative flow cytometry for diagnosis of central nervous system lesions. J Cytol 2019;36:134-5

How to cite this URL:
Alexiou GA, Vartholomatos G, Stefanaki K, Markopoulos GS, Kyritsis AP. Intraoperative flow cytometry for diagnosis of central nervous system lesions. J Cytol [serial online] 2019 [cited 2019 Jul 24];36:134-5. Available from: http://www.jcytol.org/text.asp?2019/36/2/134/251454




We read with great interest the article of Jindal et al. on the value of intraoperative squash cytology as a diagnostic aid to pediatric central nervous system (CNS) lesions. The authors studied intraoperative squash smears of CNS lesions from 150 pediatric patients and compared their findings to histopathological diagnosis. The results showed a 94.67% diagnostic accuracy of squash smear technique when compared with histological diagnosis. The most common tumor was medulloblastoma, followed by pilocyctic astrocytoma and ependymoma. The authors concluded that smear cytology can be used as an accurate tool for intraoperative CNS consultations.[1]

Intraoperative squash cytology is a valuable technique for brain tumor characterization, with implications for assessing the intraoperative extent of resection, however, several diagnostic difficulties exist such as estimation of cellularity and presence of necrosis.[2] Furthermore, several clinical details and imaging findings are necessary for correct diagnosis.[1] We are currently working on the implementation of cell cycle analysis using flow cytometry during brain tumor surgery for defining the tumor grade of malignancy and boundaries in both adults and pediatric brain tumors.[3],[4],[5] Cell cycle analysis by quantitation of DNA content was one of the first applications of flow cytometry, however, sample preparation required substantial time that hindered intraoperative use.[1] The development of a rapid cell-cycle analysis protocol (6 min) by our group permitted its intraoperative use.[1] In a series of 68 pediatric tumor samples, G0/G1 phase and mitosis fraction had 100% sensitivity and specificity for differentiation of malignant from normal brain tissue.[2] All neoplastic lesions had higher than 2% mitosis fraction and lower than 89% G0/G1 phase fraction compared to normal tissue. Apart from that, low grade tumors could be differentiated from high-grade tumors based on G0/G1 fraction. When the S-phase fraction was more than 10% or the mitosis fraction more than 13%, the tumor was always high grade. A correlation between S-phase fraction and Ki-67 index was found in medulloblastomas and anaplastic ependymomas.[4] Furthermore, cell cycle analysis by PI staining of CD56+ (gated) cells by flow cytometry could accurately differentiate neoplastic from non-neoplastic tissue, and S-phase fraction could be used to separate high-grade from low-grade tumors.[5]

Flow cytometry requires a small amount of sample and can rapidly analyze a large population of cells. Additional advantages of flow cytometry lie in its reproducibility and accuracy which are operator independent. Based on the results, so far intraoperative use of cell cycle analysis may provide rapid results to the assessment of pediatric brain tumor malignancy and to guide brain tumor surgery for complete tumor excision.[3],[4],[5] Further studies with a large number of patients are obviously needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jindal A, Kaur K, Mathur K, Kumari V, Diwan H. Intraoperative squash smear cytology in CNS lesions: A study of 150 pediatric cases. J Cytol 2017;34:217-20.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sharma S, Deb P. Intraoperative neurocytology of primary central nervous system neoplasia: A simplified and practical diagnostic approach. J Cytol 2011;28:147-58.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Alexiou GA, Vartholomatos G, Goussia A, Batistatou A, Tsamis K, Voulgaris S, et al. Fast cell cycle analysis for intraoperative characterization of brain tumor margins and malignancy. J Clin Neurosci 2015;22:129-32.  Back to cited text no. 3
    
4.
Alexiou GA, Vartholomatos G, Stefanaki K, Lykoudis EG, Patereli A, Tseka G, et al. The role of fast cell cycle analysis in pediatric brain tumors. Pediatr Neurosurg 2015;50:257-63.  Back to cited text no. 4
    
5.
Vartholomatos G, Alexiou GA, Stefanaki K, Lykoudis EG, Tseka G, Tzoufi M, et al. The value of cell cycle analysis by propidium-iodine staining of CD56+cells in pediatric brain tumors. Clin Neurol Neurosurg 2015;133:70-4.  Back to cited text no. 5
    

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Correspondence Address:
Prof. George A Alexiou
Neurosurgical Institute, University of Ioannina School of Medicine, PO BOx 103, Neohoropoulo, Ioannina 45500
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_45_18

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