A new approach to the practice of surgical pathology for brain tumor patients could make a powerful combination: more accurate, safer and more efficient operations.
About Brain Tumor
Brain tumors are the abnormal growth of brain cells that may be benign or metastatic. Brain tumors account for about 2.4% of all the tumor diagnosesandare most challenging due to their critically delicate location.
Brain tumors are the abnormal growth of brain cells that may be benign or metastatic. Brain tumors account for about 2.4% of all the tumor diagnosesandare most challenging due to their critically delicate location.
‘Stimulated Raman histology improved speed and diagnostic efficiency, in an operating room. This could change the pace and structure of an operation.’
Neurosurgeons and pathologists at Michigan Medicine are the first to
execute stimulated Raman histology, a method that improves speed and
diagnostic efficiency, in an operating room. They detail the advance in a
new Nature Biomedical Engineering paper.
The researchers imaged tissue from 101 neurosurgical patients using conventional methods and the new method. Both techniques, they found, produced accurate results but the new method was much faster.
That, if applied widely, could change the pace and structure of an operation.
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"Our technique may disrupt the intraoperative diagnosis process in a great way, reducing it from a 30-minute process to about three minutes," Orringer says. "Initially, we developed this technology as a means of helping surgeons detect microscopic tumor, but we found the technology was capable of much more than guiding surgery."
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Stimulated Raman scattering microscopy, the technology behind SRH, was developed in 2008, but the hazardous lasers it involved made it unsuitable for use in an operating room. A clinical version has now been developed and tested in the operating room for more than a year at U-M, with the fiber-laser-based microscope mounted right onto a clinical cart that plugs into the wall.
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SRH uses virtual coloring to highlight the cellular and architectural features of brain tumors, with a result resembling traditional staining. The pathologist is then able to differentiate the tumor tissue from normal brain as usual.
"It's very similar to what we currently do in our intraoperative diagnosis, with the exception that the tissue is fresh, has not been processed or stained," says senior author Sandra Camelo-Piragua, assistant professor of pathology at the U-M Medical School.
In the Nature Biomedical Engineering study, neuropathologists were given 30 specimen samples, processed via SRH or traditional methods. They were told the same information about each patient's medical history and the location of the tumor and asked to make a diagnosis.
Those pathologists, the U-M researchers found, were equally likely to make a correct diagnosis whether they used SRH or conventional slides.
"SRH imaging will ensure that appropriate and good quality tissue is collected to reach our ultimate goal: accurate diagnosis," Camelo-Piragua says.
Artificial intelligence
As Orringer and his team continue to improve this imaging technology, they're also teaching a computer how to use SRH images to make diagnoses.
They built and validated a machine learning process that was able to predict brain tumor subtype with 90 percent accuracy in a subset of 30 patient samples.
"The more we feed the computer, the more accurate its diagnoses will become," Orringer says.
Connecting hospitals
Using SRH might also improve the workflow for facilities without access to expert neuropathologists. Orringer notes that smaller hospitals may be able to partner with larger systems that do have access, since there are fewer than 800 board-certified neuropathologists compared to the approximately 1,400 U.S. institutions performing brain surgery.
"Bringing the SRH to smaller hospitals would extend their capabilities because the images can be interpreted remotely," he says. Sample preparation is minimal and the SRH could quickly deliver virtual histologic sections to aid diagnosis remotely.
The next step is a large-scale clinical trial, with an eventual goal of showing equivalence between SRH technique for making diagnoses, Orringer says. The prototype system is currently intended for research use only.
Source-Eurekalert
