Stimulated Raman histology for rapid and accurate intraoperative diagnosis of CNS tumors: prospective blinded study

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  • 1 Departments of Neurological Surgery and
  • 2 Pathology, University of Miami Miller School of Medicine; and
  • 3 Sylvester Comprehensive Cancer Center, Miami, Florida
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OBJECTIVE

In some centers where brain tumor surgery is performed, the opportunity for expert intraoperative neuropathology consultation is lacking. Consequently, surgeons may not have access to the highest quality diagnostic histological data to inform surgical decision-making. Stimulated Raman histology (SRH) is a novel technology that allows for rapid acquisition of diagnostic histological images at the bedside.

METHODS

The authors performed a prospective blinded cohort study of 82 consecutive patients undergoing resection of CNS tumors to compare diagnostic time and accuracy of SRH simulation to the gold standard, i.e., frozen and permanent section diagnosis. Diagnostic accuracy was determined by concordance of SRH-simulated intraoperative pathology consultation with a blinded board-certified neuropathologist, with official frozen section and permanent section results.

RESULTS

Overall, the mean time to diagnosis was 30.5 ± 13.2 minutes faster (p < 0.0001) for SRH simulation than for frozen section, with similar diagnostic correlation: 91.5% (κ = 0.834, p < 0.0001) between SRH simulation and permanent section, and 91.5% between frozen and permanent section (κ = 0.894, p < 0.0001).

CONCLUSIONS

SRH-simulated intraoperative pathology consultation was significantly faster and equally accurate as frozen section.

ABBREVIATIONS CI = confidence interval; HGG = high-grade glioma; LGG = low-grade glioma; NPV = negative predictive value; PPV = positive predictive value; SRH = stimulated Raman histology; TTD = time to diagnosis.

Supplementary Materials

    • Supplementary Tables 1–6 (PDF 412 KB)

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Contributor Notes

Correspondence Daniel G. Eichberg: University of Miami Miller School of Medicine, Miami, FL. deichberg35@gmail.com.

INCLUDE WHEN CITING Published online December 6, 2019; DOI: 10.3171/2019.9.JNS192075.

Disclosures The NIO Imaging System was provided by Invenio Imaging. Dr. Levi reports receiving grant support from the NIH/NINDS and the Department of Defense, and teaching honoraria from the AANS and Medtronic. Dr. Ivan reports being a consultant to and receiving research funding from Medtronic and the NX Development Corporation.

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