Stimulated Raman Histology for Rapid Intraoperative Diagnosis of Gliomas.

BACKGROUND Intraoperative pathologic diagnosis traditionally involves frozen section histopathology which may be labor and time intensive. Indeed, a technique that streamlines the acquisition and evaluation of intraoperative histologic data may expedite surgical decision making and shorten operative time. Stimulated Raman histology (SRH) is an emerging technology that allows for more rapid acquisition and interpretation of intraoperative histopathologic data. METHODS A blinded, prospective cohort study was performed for 82 patients undergoing resection for a CNS tumor. Of these, 21 patients were diagnosed with glioma either intraoperatively or post-operatively on permanent section histology and included in this study. Time to diagnosis (TTD) and diagnostic accuracy relative to permanent section (the gold-standard) was compared between SRH-based diagnosis and conventional frozen section histology. Diagnostic concordance with permanent section was also compared between frozen histopathology and SRH diagnosis. RESULTS Diagnostic accuracy was not significantly different between methods (p = 1.00). Diagnostic concordance was not significantly different between methods when comparing 95% C.I's for kappa values (κ = .215; κ = .297; κ = .369). Lastly, mean TTD was significantly shorter with SRH-based diagnosis compared to frozen section (43 vs. 9.7 minutes, p<.0001). SRH was able to identify key features associated with varying glioma types. CONCLUSION SRH allows for rapid intra-operative diagnosis without sacrificing diagnostic accuracy. SRH may serve as a promising adjuvant to conventional histopathology to expedite intra-operative pathology consultation and surgical decision-making.