Indian Journal of Pathology and Oncology


Accuracy and reliability of Tzanck smear compared to histopathology in ulcerative and nodular lesions of Skin


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Author Details: Govindaraj T., Venkatraman J, Rangaraj

Volume : 4

Issue : 1

Online ISSN : 2394-6792

Print ISSN : 2394-6784

Article First Page : 127

Article End Page : 131


Abstract

Background: Though cytopathology was an excellent diagnostic tool in routine dermatologic practice, studies relating to histopathological and cytological correlation in relation to ulcerative and nodular lesions are few. The objective of our study was to evaluate cytology as a quick non-invasive method for early diagnosis and to know the accuracy and reliability of Tzanck smear in various ulcerative and nodular skin lesions.
Materials and Methods: A total of 55 cases were chosen from dermatology out-patient department, who presented with ulcerative and nodular lesions. Tzanck smear examination and histopathological examination (incisional/ excisional/ punch biopsy) were done in each case. Keeping histopathological diagnosis as the gold standard test, sensitivity and positive predictive values were calculated to determine the accuracy of results.
Results: Out of 55 cases, 49 showed accurate diagnosis in cytological Tzanck smear examination. Majority of ulcerative and nodular lesions presented between 31-40 years and 11- 20 year age group. The sensitivity of cytology in diagnosing inflammatory lesions, benign neoplastic lesions and malignant neoplastic lesions was 91.6%, 83.3% and 88% respectively. Out of 25 cases clinically diagnosed as malignancy, squamous cell carcinoma was diagnosed in 8 cases, Basal cell carcinoma in 6 cases, Malignant melanoma in 7 cases, and one case each is diagnosed as Sebaceous carcinoma, histiocytosis, Mastocytosis and Erythroplasia of Queyrat respectively.
Conclusion: Tzanck smear is a rapid, non-traumatic, cost effective, safe and important diagnostic tool for the early diagnosis of cutaneous ulcerative and nodular lesions. Cytology can be used to differentiate inflammatory lesions from neoplastic, neoplastic as benign or malignant and definitively diagnose several specific malignant cutaneous lesions and aid in further course of treatment modalities.

Keywords:
Tzanck smear, Sensitivity, Ulcerative, Nodular lesions