A Glimpse into the Experience of Intraoperative Squash Smear Cytology of Pediatric Space-Occupying Lesions of the Central Nervous System: A Study from North Indian Tertiary Care Center

Abstract Background: Squash smear cytology (SSC) has an established role in the intraoperative diagnosis (IOD) of space-occupying lesions (SOLs) of the central nervous system (CNS). In the pediatric population, an accurate diagnosis during surgery is crucial for deciding the extent of resection (i.e., gross total, near total, or subtotal resection). Aim: Our study aimed to analyze the spectrum of CNS lesions undergoing intraoperative SSC in our tertiary care institute and to evaluate the diagnostic efficacy of SSC in correctly diagnosing CNS SOLs in the pediatric age group. Materials and Methods: This retrospective study was conducted in a tertiary care center in northern India and comprised a total of 77 cases from the pediatric age group who underwent intraoperative SSC between January 1, 2013, and December 31, 2024. The cytological diagnosis was correlated with the histopathological diagnosis, which was taken as the gold standard. Diagnostic efficacy metrics were calculated. Results: The diagnostic accuracy of SSC was calculated to be 81.42%. The sensitivity, specificity, positive predictive value, and negative predictive value were 75%, 84%, 65.2%, and 89.4%, respectively. Conclusion: The spectrum of CNS lesions in the pediatric age group differs from that in adults. Although the sensitivity and specificity of SSC in pediatric tumors are lower than in adults, it remains an important tool for IOD that guides both the intra- and postoperative management of patients.