Journal of Cytology
Home About us Ahead of print Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online:17
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size

 Table of Contents    
Year : 2019  |  Volume : 36  |  Issue : 2  |  Page : 134-135
Intraoperative flow cytometry for diagnosis of central nervous system lesions

1 Neurosurgical Institute, University of Ioannina School of Medicine; Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
2 Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
3 Department of Pathology, “Agia Sofia” Children's Hospital, Athens, Greece
4 Laboratory of Biology, University of Ioannina School of Medicine, Ioannina, Greece
5 Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece

Click here for correspondence address and email

Date of Web Publication8-Mar-2019

How to cite this article:
Alexiou GA, Vartholomatos G, Stefanaki K, Markopoulos GS, Kyritsis AP. Intraoperative flow cytometry for diagnosis of central nervous system lesions. J Cytol 2019;36:134-5

How to cite this URL:
Alexiou GA, Vartholomatos G, Stefanaki K, Markopoulos GS, Kyritsis AP. Intraoperative flow cytometry for diagnosis of central nervous system lesions. J Cytol [serial online] 2019 [cited 2022 Dec 8];36:134-5. Available from:

We read with great interest the article of Jindal et al. on the value of intraoperative squash cytology as a diagnostic aid to pediatric central nervous system (CNS) lesions. The authors studied intraoperative squash smears of CNS lesions from 150 pediatric patients and compared their findings to histopathological diagnosis. The results showed a 94.67% diagnostic accuracy of squash smear technique when compared with histological diagnosis. The most common tumor was medulloblastoma, followed by pilocyctic astrocytoma and ependymoma. The authors concluded that smear cytology can be used as an accurate tool for intraoperative CNS consultations.[1]

Intraoperative squash cytology is a valuable technique for brain tumor characterization, with implications for assessing the intraoperative extent of resection, however, several diagnostic difficulties exist such as estimation of cellularity and presence of necrosis.[2] Furthermore, several clinical details and imaging findings are necessary for correct diagnosis.[1] We are currently working on the implementation of cell cycle analysis using flow cytometry during brain tumor surgery for defining the tumor grade of malignancy and boundaries in both adults and pediatric brain tumors.[3],[4],[5] Cell cycle analysis by quantitation of DNA content was one of the first applications of flow cytometry, however, sample preparation required substantial time that hindered intraoperative use.[1] The development of a rapid cell-cycle analysis protocol (6 min) by our group permitted its intraoperative use.[1] In a series of 68 pediatric tumor samples, G0/G1 phase and mitosis fraction had 100% sensitivity and specificity for differentiation of malignant from normal brain tissue.[2] All neoplastic lesions had higher than 2% mitosis fraction and lower than 89% G0/G1 phase fraction compared to normal tissue. Apart from that, low grade tumors could be differentiated from high-grade tumors based on G0/G1 fraction. When the S-phase fraction was more than 10% or the mitosis fraction more than 13%, the tumor was always high grade. A correlation between S-phase fraction and Ki-67 index was found in medulloblastomas and anaplastic ependymomas.[4] Furthermore, cell cycle analysis by PI staining of CD56+ (gated) cells by flow cytometry could accurately differentiate neoplastic from non-neoplastic tissue, and S-phase fraction could be used to separate high-grade from low-grade tumors.[5]

Flow cytometry requires a small amount of sample and can rapidly analyze a large population of cells. Additional advantages of flow cytometry lie in its reproducibility and accuracy which are operator independent. Based on the results, so far intraoperative use of cell cycle analysis may provide rapid results to the assessment of pediatric brain tumor malignancy and to guide brain tumor surgery for complete tumor excision.[3],[4],[5] Further studies with a large number of patients are obviously needed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Jindal A, Kaur K, Mathur K, Kumari V, Diwan H. Intraoperative squash smear cytology in CNS lesions: A study of 150 pediatric cases. J Cytol 2017;34:217-20.  Back to cited text no. 1
[PUBMED]  [Full text]  
Sharma S, Deb P. Intraoperative neurocytology of primary central nervous system neoplasia: A simplified and practical diagnostic approach. J Cytol 2011;28:147-58.  Back to cited text no. 2
[PUBMED]  [Full text]  
Alexiou GA, Vartholomatos G, Goussia A, Batistatou A, Tsamis K, Voulgaris S, et al. Fast cell cycle analysis for intraoperative characterization of brain tumor margins and malignancy. J Clin Neurosci 2015;22:129-32.  Back to cited text no. 3
Alexiou GA, Vartholomatos G, Stefanaki K, Lykoudis EG, Patereli A, Tseka G, et al. The role of fast cell cycle analysis in pediatric brain tumors. Pediatr Neurosurg 2015;50:257-63.  Back to cited text no. 4
Vartholomatos G, Alexiou GA, Stefanaki K, Lykoudis EG, Tseka G, Tzoufi M, et al. The value of cell cycle analysis by propidium-iodine staining of CD56+cells in pediatric brain tumors. Clin Neurol Neurosurg 2015;133:70-4.  Back to cited text no. 5

Correspondence Address:
Prof. George A Alexiou
Neurosurgical Institute, University of Ioannina School of Medicine, PO BOx 103, Neohoropoulo, Ioannina 45500
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JOC.JOC_45_18

Rights and Permissions

This article has been cited by
1 Detection of cancer cells and tumor margins during colorectal cancer surgery by intraoperative flow cytometry
Vaia K. Georvasili, Georgios S. Markopoulos, Anna Batistatou, Michael Mitsis, Thomas Messinis, Georgios D. Lianos, George Alexiou, George Vartholomatos, Christina D. Bali
International Journal of Surgery. 2022; 104: 106717
[Pubmed] | [DOI]
2 Intraoperative Flow Cytometry for the Characterization of Gynecological Malignancies
Zoi Anastasiadi, Stefania Mantziou, Christos Akrivis, Minas Paschopoulos, Eufemia Balasi, Georgios D. Lianos, George A. Alexiou, Michail Mitsis, George Vartholomatos, Georgios S. Markopoulos
Biology. 2022; 11(9): 1339
[Pubmed] | [DOI]
3 Accurate Characterization of Bladder Cancer Cells with Intraoperative Flow Cytometry
Athanasios Paliouras, Georgios S. Markopoulos, Stavros Tsampalas, Stefania Mantziou, Ioannis Giannakis, Dimitrios Baltogiannis, Georgios K. Glantzounis, George A. Alexiou, Evangelia Lampri, Nikolaos Sofikitis, George Vartholomatos
Cancers. 2022; 14(21): 5440
[Pubmed] | [DOI]
4 The Past, Present and Future of Flow Cytometry in Central Nervous System Malignancies
Evrysthenis Vartholomatos, George Vartholomatos, George A. Alexiou, Georgios S. Markopoulos
Methods and Protocols. 2021; 4(1): 11
[Pubmed] | [DOI]
5 Touch Imprint Intraoperative Flow Cytometry as a Complementary Tool for Detailed Assessment of Resection Margins and Tumor Biology in Liver Surgery for Primary and Metastatic Liver Neoplasms
Georgios S. Markopoulos, Georgios K. Glantzounis, Anna C. Goussia, Georgios D. Lianos, Anastasia Karampa, George A. Alexiou, George Vartholomatos
Methods and Protocols. 2021; 4(3): 66
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded81    
    Comments [Add]    
    Cited by others 5    

Recommend this journal