Use of Stimulated Raman Histology for Rapid Intraoperative Diagnosis in Sinonasal Malignancy

Introduction: Accurate histological diagnosis is integral to surgical treatment. Intra-operative histology is traditionally obtained using fresh frozen section analysis. Stimulated Raman histology (SRH) is an emerging technology which permits rapid acquisition of diagnostic histological images during surgery using spectroscopy technologies. The utility of this nondestructive analysis of tissue has been demonstrated in intracranial and skull base pathologies, but not previously in sinonasal malignancy. We describe a case report of utilization of this technology during resection of a sinonasal malignancy.

Methods: The Invenio NIO Imaging system (Invenio Imaging) was employed with a technician and surgeon available in the operating room for specimen interpretation. This was discrete from the utilization of traditional frozen section pathology and the specimen assessed was reviewed on final section by our pathology department. A 73-year-old female patient underwent endoscopic transpterygoid resection of a nasopharyngeal adenoid cystic carcinoma. SRH was compared with fresh frozen analysis in terms of time to result and accuracy compared with final histology.

Results: SRH was successfully employed during the endoscopic sinonasal procedure. Intra-operative histological analysis using SRH was completed in 4 minutes 26 seconds. Fresh frozen pathology results were obtained in 44 minutes after being passed off the field. Both SRH and fresh frozen analysis were concordant with the final histology result of adenoid cystic carcinoma. Representative images can be seen in Figs. 1 and 2.

Conclusion: SRH is a novel technology which can provide rapid, accurate intraoperative pathological results in sinonasal surgery. This has the potential to dramatically decrease intraoperative time and allow for the near “real-time” assessment of margins. We present the successful integration of a SRH to a single case of sinonasal malignancy. Prospective evaluation of the technique is required.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021