CUSA Aspirates in Brain Tumors: Integrating Findings from a Single-Center Cohort and a 49-Center National Survey to Reassess Clinical Utility.

Abstract

< strong > Objective: < /strong > Cavitron Ultrasonic Surgical Aspirator (CUSA)–derived material is routinely generated during neurosurgical tumor resections but is often regarded as surgical waste. Although previous studies have demonstrated its potential for diagnostic and research applications, its real-world utilization and perceived value in routine neuropathology practice in Türkiye remain unknown. < strong > Material and Methods: < /strong > We conducted a retrospective single-center study evaluating CUSA aspirates received between 2021 and 2026, focusing on diagnostic yield, histologic quality, and suitability for ancillary testing. In parallel, a nationwide cross-sectional survey was also performed to assess submission practices, processing methods, and perceptions regarding the diagnostic and research utility of CUSA-derived material. < strong > Results: < /strong > Among 10 brain tumor cases, diagnostic tumor tissue was identified in 9 CUSA aspirates (90%). All diagnostically positive samples yielded sufficient material for immunohistochemistry. In one high grade diffuse glioma case, the aspirated material alone contained all features required for diagnosis and grading. Non-neoplastic CNS parenchyma was also present in five cases. Survey results demonstrated that CUSA aspirates are not routinely submitted in most centers (63.3%), and when submitted the processing methods vary. Despite limitations, most respondents acknowledged at least partial diagnostic utility. Lack of standardized protocols and limited awareness were identified as the main barriers to broader utilization. < strong > Conclusion: < /strong > CUSA aspirates represent an underutilized resource with significant diagnostic and translational potential. While often overlooked in routine practice, these materials can provide sufficient tissue for histopathologic evaluation and ancillary testing. Bridging the gap between demonstrated utility and current practice will require improved awareness, interdisciplinary coordination, and standardized handling protocols.