Port Blair, Mar 05: In a milestone achievement, a team of orthopedic surgeons and cytopathologists from Andaman &Nicobar Islands Institute of Medical Sciences performed the Islands’ first ‘Intraoperative cytology’ at GB Pant Hospital, Port Blair.
The procedure was performed on a 30year old woman, with a bone tumor in the upper end of tibia – a bone in the leg.
While the patient was on operation table, the orthopedic team led by Dr. Amit Ray, Professor Head of Department of Orthopedicsand his teamobtained a small piece of tissue from the tumor and sent over to the cytopathologists team led byDr. Archana Deshpande, Professor and Head of Department of Pathology, for analysis. A preliminary report was released within 20 minutes and based on the findings of the report, Orthopedic Surgeons successfully completed the surgery.
The role of intraoperative diagnosis is well established in the medical field particularly in the field of cancer surgery. In this method, while the patient is on the operation table, a sample is collected from the tumor and examined by the Pathologist, meanwhile the operating surgeon waits for the opinion of the Pathologist. A preliminary report is provided to the surgeon as swiftly as possible, following which the surgeon completes the surgery based on the findings of the report. The most important indication of this procedure is to establish or confirm a diagnosis rapidly so that the surgeons can perform a more definitive surgery or modify the surgical procedure if need be. Traditionally histopathologicalintraoperative diagnosis in made with the help of ‘frozen sections’, which requires very expensive equipments and trained technical staff. However this facility too will be made available soon at ANIIMS.
Since facility for frozen sections is not available at present at GB Pant Hospital, the Pathologists decided to use an alternative method, which though technically simple, is far more difficult to interpret by the Pathologist. However, within the limited resources available, this method was used and the diagnosis was made.In this patient the intraoperative differential diagnosis was between Giant cell tumour and tuberculosis. The treatments of both differ widely and a misdiagnosis could have been detrimental. Once the tissue was processed in the cytology lab and a diagnosis given, a definitive treatment of the tumour was done, in the form of tumour ablation with phenol followed by reconstruction of the proximal tibia. The diagnosis was subsequently confirmed by the standard method of histopathology. The patient is doing well post operatively.
The availability of this procedure will be hereafter extended to all other surgical disciplines within ANIIMS/GB Pant Hospital.
This was made possible due to the encouragement and support of the Director of ANIIMS, Dr. R.P.Choubey.
