Accuracy of Intraoperative Consultation of Central Nervous System Lesions in Siriraj Hospital

Objective: To describe accuracy, identify diagnostic discordances and pitfalls of intraoperative neuropathology diagnosis in Siriraj Hospital. Methods: All central nervous system lesions requested for rapid intraoperative consultation in Siriraj Hospital from 1998 to 2011 were reviewed. Accuracy rate and causes of diagnostic discrepancies were identified and discussed. Results: Intraoperative neuropathology consultation was performed in 774 cases during the study period. Non- representative specimens (40 cases, 5.2%) and cases with deferred diagnosis (36 cases, 4.7%) were excluded from the study. Of 698 cases analysed, 85.5% were neoplastic and 14.5% were non-neoplastic. The overall accuracy rate was 89%. In the neoplastic category, the most common pitfall was tumor type misclassification (66.7%) especially misclassified astrocytic and oligodendroglial tumors as other tumors (23.8%). In non-neoplastic category, the most common error was misdiagnosis of non-tumor pathology as gliomas (64.3%). Conclusion: Intraoperative neuropathology diagnosis has a crucial role in clinical management. Multidisciplinary and systematic approaches are required to overcome diagnostic limitations on small tissue samples and increase diagnostic accuracy. Keywords: Central nervous system, intraoperative, frozen section, accuracy