Correlation of intraoperative frozen section report and histopathological diagnosis of central nervous system tumors - a six-year retrospective study

Objectives: To evaluate the degree of agreement between the intraoperative frozen section [FS] reporting of central nervous system [CNS] tumors and final histopathological diagnosis based on permanent paraffin section

Methods: All CNS tumor cases with a diagnosis at FS and subsequent permanent section [n = 261] taken from 2007 to 2012 were retrospectively reviewed. Twenty percent of FS were double-checked by a senior pathologist as part of the study and the intraobserver agreement between the pathologist and the agreement between final report, and initial FS report was estimated by the intraclass correlation coefficient [ICC]

Results: A total of 261 cases were reviewed. The most common diagnosis was glioblastoma [grade IV] and meningioma [grade I-II] forming 45.6% of cases. Fifty-three cases were subjected to intraobserver agreement of histological diagnosis. There was nearly perfect intraobserver agreement on histopathology [ICC = 0.9]. Out of 261 cases, 224 cases showed a strong agreement between the FS diagnosis and final histological diagnosis [ICC = 0.747]. A discrepancy between the FS and final diagnosis were found in eight cases. The disagreement did not relate to any specific tumor type. However, in three cases, the discrepancy was in the grading of the glioma. In 29 cases, a definite opinion could not be given on FS as the samples examined were nonrepresentative

Conclusions: Histopathological slides classified by World Health Organization criteria of CNS tumors had excellent intraobserver agreement. Our results show a moderate to high degree of agreement in the intraoperative diagnosis of CNS lesions using FS. However, there are limitations, and some lesions are a diagnostic challenge. There is a need to improve our diagnostic skills and knowledge of possible errors and establish better communication with neurosurgeons

Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease?

To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhinosinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients [87%]. Of these patients, 60/65 [92%] showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 [60%] had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% [95% CI: 81-97] and 44% [95% CI: 14-79], respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhinosinusitis. When clinical suspicion is low [<50%] and endoscopy is negative, the probability of rhino-sinusitis is very low [<17%] and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high [88%] as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.

Tuberculous meningitis: a comparison of scoring systems for diagnosis

Tuberculous meningitis [TBM] is a major clinical and public health problem, both for diagnosis and management. We compare two established scoring systems, Thwaites and the Lancet consensus scoring system for the diagnosis of TB and compare the clinical outcome in a tertiary care setting. We analyzed 306 patients with central nervous system [CNS] infection over a 5-year period and classified them based on the unit's diagnosis, the Thwaites classification as well as the newer Lancet consensus scoring system. Patients with discordant results-reasons for discordance as well as differences in outcome were also analyzed. Among the 306 patients, the final diagnosis of the treating physician was TBM in 84.6% [260/306], acute CNS infections in 9.5% [29/306], pyogenic meningitis in 4.2% [13/306] and aseptic meningitis in 1.3% [4/306]. Among these 306 patients, 284 [92.8%] were classified as "TBM" by the Thwaites" score and the rest as "Pyogenic". The Lancet score on these patients classified 29 cases [9.5%] as 'Definite-TBM', 43 cases [14.1%] as "Probable-TBM", 186 cases [60.8%] as "Possible-TBM" and the rest as "Non TBM". There was moderate agreement between the unit diagnosis and Thwaites classification [Kappa statistic = 0.53], as well as the Lancet scoring systems. There is only moderate agreement between the Thwaites classification as well as the Lancet scoring systems. It was noted that 32/ 284 [11%] of patients who were classified as TBM by the Thwaites system were classified as "Non TBM" by the Lancet score and 6/258 [2%] of those who were diagnosed as possible, probable or definite TB were classified as Non TB by the Thwaites score. However, patients who had discordant results between these scores were not different from those who had concordant results when treatment was initiated based on expert clinical evaluation in the tertiary care setting. There was only moderate agreement between the Thwaites' score and the Lancet consensus scoring systems. There is need to prospectively evaluate the cost effectiveness of simple but more effective rapid diagnostic alogrithm in the diagnosis of TB, particularly in a setting without CT and MRI facilities