Comparative study of intra-operative cytology, frozen sections, and histology of tumor and tumor-like lesions of nose and paranasal sinuses

Abstract

Background: The nasal cavity and paranasal sinuses - including the maxillary, ethmoid, sphenoid, and frontal sinuses are collectively referred to as the sinonasal tract. Fine needle aspiration (FNA) of paranasal sinus lesions for early diagnosis of neoplastic lesions is difficult due to closed architecture, and only one study has been documented in the literature.

Aims: To find the efficacy of intra-operative cytology and frozen section for frequently encountered tumor and tumor-like lesions of the nose and paranasal sinuses.

Materials and methods: Thirty cases were included in this study. The material for cytologic examination and frozen sections were taken per-operatively. Cytological smears were prepared by imprint/squash methods from the representative tissue pieces and stained with Leishman-Giemsa and Papanicolaou. Frozen section and paraffin-embedded section were stained with hematoxylin and eosin stain. A rapid opinion regarding the benign or malignant nature of the lesion and the type of tumor was given.

Results: The sensitivity, specificity, and positive predictive value of imprint cytology, squash cytology, and frozen section were 100%, 100%, and 100%; 100%, 96.15%, and 80.0%; and 100%, 96.15%, and 80.0%, respectively. Overall diagnostic accuracy of imprint smears, squash smears, and frozen section was100%, 96.7%, and 96.7%, respectively. Imprint smears had better specificity as cells morphology could be more accurately appreciated.

Conclusions: Intra-operative cytology and frozen section examinations of lesions of nose and paranasal sinuses are useful, quick, and reliable diagnostic technique for rapid diagnosis in the operation theatre and can be used as an adjunct to histopathology for better management of patients.

Keywords: Nose; imprint smears; paranasal sinuses; tumor like lesions; tumors.

Figure 1

(a) Imprint from a nasal polyp showing clusters of columnar epithelial cells (Giemsa, ×400), (b) Polyp with pseudo stratified squamous epithelial lining with edematous stroma (Paraffin block; H and E, ×100); (c) Imprint from angiofibroma showing columnar epithelial cells, endothelial cells and fibroblasts (Giemsa, ×400); (d) Numerous thin walled blood vessels with fibrous stroma (Frozen section; H and E, ×100)

Figure 2

(a) Clusters of pleomorphic hyperchromatic squamous cells (Imprint; Giemsa, ×400); (b) Clusters of pleomorphic hyperchromatic cells with high nuclear: cytoplasmic ratio. (Squash smear; Giemsa, ×400); (c) Frozen section suggestive of malignant lesion probably squamous cell carcinoma (H and E, ×100); (d) Section from paraffin block suggestive of Non keratinizing squamous cell carcinoma (H and E, ×100)