Intraoperative Assessment of Metastatic Genitourinary Cancer to Brain Using Combined Frozen Section, Squash (Crush), and Touch Preparation Cytology at the Queens Medical Center: A 30-Year Retrospective Analysis

Objective: Brain metastasis in genitourinary malignancies is relatively uncommon (incidence 0.16-30%). Experience with their intraoperative assessment is lacking, especially with rapid techniques like squash/crush/touch preps. We aimed to determine their incidence and to assess efficacy of their intraoperative detection.

Methods: Brain lesions assessed intraoperatively from 1/1/96-12/31/25 were sought.

Results: Of 1210 brain lesions, 1079 (89.2%) and 131 (10.8%) were neoplastic and non-neoplastic, respectively. 24 genitourinary metastases included 11 (5.4%) kidney, 9 (4.4%) prostate, 3 (1.5%) bladder, and 1 (0.5%) testicular cancers. Ages ranged from 31-89 with a profound male preponderance (M:F 23:1). Intraoperative assessments correlated with final diagnoses in all but one (4.2%) case showing only necrotic brain tissue. In 2 (8.3%) cases (1 kidney, 1 prostate), brain metastases were the first manifestation of malignancy.

Conclusion: Genitourinary cancers comprised 11.7% of metastases and 2% of all brain lesions encountered at our institution. Combined intraoperative squash/touch preps and frozen section proved highly effective (diagnostic accuracy 95.8%). Because genitourinary cancer may present as brain metastasis, familiarity with their cytodiagnostic features is imperative.