Article
Integration of Stimulated Raman Histology (SRH) into intraoperative neuropathology in neurosurgery
Einbindung der stimulierten Raman-Histologie in die intraoperative neuropathologische Gewebeuntersuchung in der Neurochirurgie
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Published: | May 25, 2022 |
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Objective: Histopathological assessment is the gold standard in diagnostics and classification of neurooncological entities. Raman-based intraoperative tissue analysis has been reported to be fast and valuable. Here, we report our experience in implementing Stimulated Raman Histology (SRH) in a major neurosurgical center. Furthermore, we compared the neuropathological interpretability of SRH imaging to standard-of-care intraoperative hematoxylin–eosin (H&E)-staining.
Methods: We evaluated the possibility of establishing a dedicated workflow for SRH serving as an intraoperative diagnostic, research and quality control tool in neurosurgery. In total, 429 SRH-images from 108 patients were analysed. A SRH-naive board-certified neuropathologist evaluated image quality by rating the subjective tumor infiltration and providing a diagnosis based on the SRH images in 73 neurooncological cases. The accuracy of these diagnoses was compared to intraoperative H&E-stainings and related to the gold standard of the final integrated neuropathological diagnoses.
Results: The Raman imaging system was rapidly integrated into the surgical workflow of a large neurosurgical center with a steep learning curve. High-quality images could be acquired in a “plug-and-play” manner from the first days onwards. In order to establish a workflow for high-throughput SRH image acquisition and analysis, certain prerequisites were described. The accuracy of SRH-based diagnosis was 87.3%, which was en par (p = 0.783) to the assessment of standard of care H&E-stainings (88.9%) in our study.
Conclusion: Stimulated Raman Histology (SRH) is an innovative label-free and near real-time intraoperative tool for tissue analysis in neurosurgery. It can be easily implemented in the surgical workflow. Neuropathological assessment of SRH imaging is non-inferior to standard-of-care intraoperative fast-frozen H&E-staining. However, further research is required to modify SRH image analysis in order to obtain information about alterations of the genome, methylome, transcriptome and proteome. This may lead to an intraoperative SRH-based prediction of prognosis and therapy response.