Intraoperative squash cytology provides a qualitative intraoperative diagnosis for cases in which frozen section yields a diagnosis of equivocal brain tumour

Objective We assessed whether intraoperative squash cytology could provide surgeons with a qualitative diagnosis of brain lesions when frozen section diagnosis is equivocal. Methods The study included 51 lesions that were diagnosed intraoperatively as equivocal brain tumour on the basis of frozen section. We retrospectively classified the lesions into five groups according to the final histopathological diagnoses (I: malignant lymphomas; II: diffuse astrocytic and oligodendroglia tumours; III: pituitary adenomas, IV: metastatic carcinomas; V: others). We assessed the squash cytology features of Groups I–IV and of the specific lesion types, and compared features among the groups. Results The four groups differed in a range of salient cytomorphological features: lymphoglandular bodies in Group I (eight of nine cases), cytoplasmic fibrillary processes in Group II (six of eight cases), low‐grade nuclear atypia in Group III (seven of seven cases), and large nuclei (approximately 80 μm2) and nuclear crush artefacts in Group IV (seven of nine cases). Conclusion Findings of lymphoglandular bodies on intraoperative squash cytology can be considered characteristic of malignant lymphomas, while cytoplasmic fibrillary processes indicate diffuse astrocytic and oligodendroglial tumours. We conclude that squash cytology could yield a qualitative intraoperative diagnosis in over 25% of cases for which frozen section yields a diagnosis of equivocal brain tumour. This study retrospectively assessed the value of intraoperative cytology of squash preparations in cases for which frozen section yielded an intraoperative diagnosis of “equivocal brain tumor”. Based on the squash preparations, the authors were able to provide a qualitative intraoperative diagnosis in 27% of equivocal cases and in the majority of these finally diagnosed as malignant lymphoma or glioma.