Cytopathology of fine‐needle aspiration biopsy of the brain and spinal cord

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Abstract
The cytomorphologic findings of 37 intraoperative fine‐needle aspiration (FNA) biopsies are presented. Thirty‐two of the biopsies were performed at the time of craniotomy, and five were performed through a burr‐hole. All cases used direct smear preparations stained with Papanicolaou and modified Wright stain (Diff‐Quik®). Immediate evaluation of the Diff‐Quik‐stained smears was performed for assessment of the adequacy of the specimen, and in most cases, a rapid preliminary diagnosis (similar to a frozen‐section report) was rendered in the operating room. Cytopathologic features of anaplastic astrocytomas, glioblastoma multiforme, pituitary adenoma, meningioma, metastatic carcinoma, epidermoid cyst, herniated disc, hemangioblastoma, cerebral hemorrhage, and malignant lymphoma are described and illustrated. The cytologic preparation demonstrated superior cellular detail, which served as a considerable aid for diagnosis, and lacked the artifactural distortion often seen in the frozen‐section preparations. Reliance on the fine‐needle aspiration biopsy specimen enabled better triage of the small amount of tissue often available for permanent sections and special studies including electron microscopy and immunohistochemistry. Although not meant to replace tissue biopsy, FNA of the central nervous system through burr holes under radiologic guidance can be advantageous in selective cases. Diagn Cytology 1986;2:312‐319.