Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2021 Jun;150:e135-e143. doi: 10.1016/j.wneu.2021.02.122. Epub 2021 Mar 5.
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.
A blinded, prospective cohort study was performed for 82 patients undergoing resection for a central nervous system tumor. Of these, 21 patients were diagnosed with glioma either intraoperatively or postoperatively on permanent section histology and included in this study. Time to diagnosis (TTD) and diagnostic accuracy relative to permanent section (the gold standard) were compared between SRH-based diagnosis and conventional frozen section histology. Diagnostic concordance with permanent section was also compared between frozen histopathology and SRH diagnosis.
Diagnostic accuracy was not significantly different between methods (P = 1.00). Diagnostic concordance was not significantly different between methods when comparing 95% confidence intervals for kappa values (κ = 0.215; κ = 0.297; κ = 0.369). Lastly, mean TTD was significantly shorter with SRH-based diagnosis compared with frozen section (43 vs. 9.7 minutes, P < 0.0001). SRH was able to identify key features associated with varying glioma types.
SRH allows for rapid intraoperative diagnosis without sacrificing diagnostic accuracy. SRH may serve as a promising adjuvant to conventional histopathology to expedite intraoperative pathology consultation and surgical decision-making.
术中病理诊断传统上涉及冰冻切片组织病理学检查，这可能既耗费劳力又耗费时间。实际上，一种简化术中组织学数据获取和评估的技术可以加快手术决策并缩短手术时间。受激拉曼组织学（SRH）是一种新兴技术，可实现更快速地获取和解释术中组织病理学数据。
对 82 例因中枢神经系统肿瘤接受切除术的患者进行了一项盲法、前瞻性队列研究。其中，21 例患者在术中或术后根据永久切片组织学诊断为胶质瘤，并包括在本研究中。对基于 SRH 的诊断与常规冰冻切片组织学的诊断时间（TTD）和相对于永久切片（金标准）的诊断准确性进行了比较。还比较了冰冻组织病理学与 SRH 诊断之间的诊断一致性。
两种方法的诊断准确性没有显著差异（P=1.00）。当比较 Kappa 值的 95%置信区间时，两种方法的诊断一致性没有显著差异（κ=0.215；κ=0.297；κ=0.369）。最后，与冰冻切片相比，基于 SRH 的诊断的平均 TTD 明显缩短（43 与 9.7 分钟，P<0.0001）。SRH 能够识别与不同胶质瘤类型相关的关键特征。
SRH 可以在不牺牲诊断准确性的情况下实现快速术中诊断。SRH 可以作为常规组织病理学的一种有前途的辅助手段，以加快术中病理咨询和手术决策。
