Rapid Intraoperative Diagnosis of Gliomas Using Stimulated Raman Histology: A Comparative Analysis of Time-savings and Diagnostic Concordance. (16th November 2020)

• Record Type: Journal Article
• Authors: Di, Long; Eichberg, Daniel G; Jamshidi, Aria; Shah, Ashish H; Luther, Evan; Ivan, Michael E; Komotar, Ricardo J; Gultekin, Sakir
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_874
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Intraoperative neuropathologic consult is an essential tool in the oncologic neurosurgeon's armamentarium. However, current standards of frozen section may be time and energy intensive. Non-linear Raman spectroscopy is an emerging technology that may allow for rapid, simulated intraoperative neuropathologic consult comparable to traditional frozen section. METHODS: Following IRB approval, 82 patients undergoing resection for CNS tumors were enrolled in a blinded, prospective cohort study. Patients that were diagnosed with glioma on frozen, SRH, or permanent section diagnosis underwent subgroup analysis. Time to diagnosis, diagnostic accuracy, and concordance with permanent section was compared between simulated SRH histology images and frozen section. RESULTS: Twenty-one patients diagnosed with glioma were included in this study. Mean time-to-diagnosis (TTD) was statistically significantly shorter for SRH-mediated diagnosis compared to frozen section (13.0 vs 41.9 minutes, p <0.0001). There was no significant difference in diagnostic accuracy between methods (p = 1.00). Diagnostic concordance was not significantly different between SRH and frozen, SRH and permanent, and frozen and permanent section diagnostic methods (Κ = .215, K = .297, K = .369). Finally, in identification of lesional tissue, SRH showed high sensitivity (100%), not significantly different from frozen (95%). Specificity for SRH and frozen were both low at 0%. CONCLUSION: With current and projected shortages of board-certified neuropathologists servicing neurosurgical operating rooms, SRH is a promising adjuvant to traditional frozen section that allows for expedited acquisition and reviewal of neuropathologic data without sacrificing accuracy.