Stimulated Raman Histology a Promising Adjunct, Alternative to Frozen Section in Sinonasal and Skull Base Tumor Diagnosis

by Linda Kossoff •

How accurate is intraoperative stimulated Raman histology (SRH) technology in producing images in a novel range of sinonasal and skull base tumors compared to formalin-fixed paraffin-embedded (FFPE) and hematoxylin and eosin (H&E)?

BOTTOM LINE

Stimulated Raman histology can rapidly produce images similar to FFPE H&E in sinonasal and skull base tumors and may be an adjunct or alternative to standard frozen sampling (FS).

BACKGROUND: Margin assessment and diagnosis of tumors in sinonasal and skull base surgery is challenging due to these tumors’ multiple histological subtypes. There is, therefore, a need for improved histology methods. SRH is an emerging technology using laser spectroscopy and color-matching algorithms to enable rapid intraoperative acquisition of histological images.

STUDY DESIGN: Cohort study.

SETTING: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.

SYNOPSIS: Researchers sought to describe the novel application of SRH across a broader spectrum of skull base pathologies than previously described. Their cohort included 12 patients (median age 62 years, 66.7% female) undergoing sinonasal or skull base surgery using an SRH system and taking place at a single academic cancer center from June 2020 to September 2021. In total, 67 SRH images from seven tumor types were assessed. The tumor was identified in 100% of lesional specimens, with characteristic diagnostic features readily appreciable on SRH. Diagnosis using SRH was faster than FS (4.3 minutes versus 44.5 minutes). In matched sample sites, the diagnoses for both methods matched 93.8% of the time. Overall, similar concordance between SRH and FS was seen in sensitivity, specificity, precision, and overall accuracy. However, researchers noted that certain diagnostic features that can be assessed on FS may not be readily apparent in SRH images, such as the features of a mitotic figure versus apoptotic cell, and that designating tissue as malignant versus benign might be a more realistic application for SRH. Study limitations included the small sample size.

CITATION: Fitzgerald CWR, Dogan S, Bou-Nassif R, et al. Stimulated Raman histology for rapid intra-operative diagnosis of sinonasal and skull base tumors. Laryngoscope. 2022;132:2142-2147.