Stimulated Raman histology for rapid and accurate intraoperative diagnosis of CNS tumors: prospective blinded study

2019 ◽  
pp. 1-7
Author(s):  
Daniel G. Eichberg ◽  
Ashish H. Shah ◽  
Long Di ◽  
Alexa M. Semonche ◽  
George Jimsheleishvili ◽  
...  
Keyword(s):  
Frozen Section ◽  
Cns Tumors ◽  
Rapid Acquisition ◽  
Novel Technology ◽  
Permanent Section ◽  
Diagnostic Time ◽  
Blinded Study ◽  
Histological Data ◽  
Histological Images ◽  
Stimulated Raman

OBJECTIVEIn some centers where brain tumor surgery is performed, the opportunity for expert intraoperative neuropathology consultation is lacking. Consequently, surgeons may not have access to the highest quality diagnostic histological data to inform surgical decision-making. Stimulated Raman histology (SRH) is a novel technology that allows for rapid acquisition of diagnostic histological images at the bedside.METHODSThe authors performed a prospective blinded cohort study of 82 consecutive patients undergoing resection of CNS tumors to compare diagnostic time and accuracy of SRH simulation to the gold standard, i.e., frozen and permanent section diagnosis. Diagnostic accuracy was determined by concordance of SRH-simulated intraoperative pathology consultation with a blinded board-certified neuropathologist, with official frozen section and permanent section results.RESULTSOverall, the mean time to diagnosis was 30.5 ± 13.2 minutes faster (p < 0.0001) for SRH simulation than for frozen section, with similar diagnostic correlation: 91.5% (κ = 0.834, p < 0.0001) between SRH simulation and permanent section, and 91.5% between frozen and permanent section (κ = 0.894, p < 0.0001).CONCLUSIONSSRH-simulated intraoperative pathology consultation was significantly faster and equally accurate as frozen section.

Improved correlation of histological data with DCE MRI parameter maps by 3D reconstruction, reslicing and parameterization of the histological images

2005 ◽  
Vol 15 (6) ◽  
pp. 1079-1086 ◽  
Author(s):  
Fabian Kiessling ◽  
Martin Le-Huu ◽  
Tobias Kunert ◽  
Matthias Thorn ◽  
Silvia Vosseler ◽  
...  
Keyword(s):  
3D Reconstruction ◽  
Dce Mri ◽  
Histological Data ◽  
Histological Images

Accuracy of Frozen Section Diagnosis of the Salivary Gland

1987 ◽  
Vol 96 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Douglas R. Gnepp ◽  
Willa Rae Rader ◽  
Stewart F. Cramer ◽  
Linda L. Cook ◽  
James Sciubba
Keyword(s):  
Salivary Gland ◽  
Malignant Tumor ◽  
Benign Tumor ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Frozen Sections ◽  
Acinic Cell ◽  
Frozen Section Examination ◽  
Permanent Section ◽  
Frozen Section Diagnosis

Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non-neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.

scholarly journals Breast Sentinel Lymph Node Frozen Section Practice: An Enterprise Audit as a Guide for Moving Forward

2020 ◽  
Author(s):  
Rebecca Czaja ◽  
Ruizhe Wu ◽  
Julie M. Jorns
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sampling Error ◽  
Frozen Section ◽  
Academic Institution ◽  
Serial Sectioning ◽  
False Negatives ◽  
Permanent Section ◽  
Section Level

Context.— In recent years, there has been a shift to less aggressive surgical management of the axilla in breast cancer. Consequently, sentinel lymph node evaluation by frozen section (FS) has declined. Additionally, there has been an impetus to decrease efforts in identifying small sentinel lymph node metastases. Objectives.— To critically evaluate our enterprise performance in evaluating axillary sentinel lymph node submitted for FS prior to considering changes in processing. Design.— A retrospective review (August 1, 2017–July 31, 2019) was conducted to identify sentinel and nonsentinel lymph nodes from 1 academic institution and 2 community sites. Cases were evaluated for grossing technique and discordance between FS and permanent section (PS) due to sampling and/or interpretive error. Clinicopathologic features were assessed. Results.— Lymph nodes from 426 patients with 432 neoplasms were sent for FS. Serial sectioning at 2-mm intervals was adhered to in 338 of 432 (78.2%). Serial sectioning was significantly lower at the community sites (14 of 60; 23.3%) versus at the academic institution (324 of 372; 87.1%; P &lt; .001). Discordant cases were all false negatives (21 of 432; 4.8%). A total of 7 of 21 false negatives (33.3%) had macrometastatic (&gt;2 mm) disease; of these, 3 were post–neoadjuvant chemotherapy, 3 were neither serially sectioned nor posttherapy, and 1 was a small (0.3-cm) focus. A total of 15 of 16 false negatives due to sampling error were detected on the first permanent section level. Conclusions.— Standard serial sectioning of sentinel lymph node at 2-mm intervals resulted in infrequent false negatives due to macrometastatic disease. A single additional permanent section level is reasonable, given adherence to serial sectioning.

scholarly journals Integration of geoscience frameworks into digital pathology analysis permits quantification of microarchitectural relationships in histological landscapes

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Timothy J. Kendall ◽  
Catherine M. Duff ◽  
Andrew M. Thomson ◽  
John P. Iredale
Keyword(s):  
Disease Model ◽  
Digital Pathology ◽  
Experimental Models ◽  
Neoplastic Disease ◽  
Multiple Organs ◽  
Trial Protocols ◽  
Histological Data ◽  
Histological Images ◽  
New Feature ◽  
Models Of Disease

Abstract Although gold-standard histological assessment is subjective it remains central to diagnosis and clinical trial protocols and is crucial for the evaluation of any preclinical disease model. Objectivity and reproducibility are enhanced by quantitative analysis of histological images but current methods require application-specific algorithm training and fail to extract understanding from the histological context of observable features. We reinterpret histopathological images as disease landscapes to describe a generalisable framework defining topographic relationships in tissue using geoscience approaches. The framework requires no user-dependent training to operate on all image datasets in a classifier-agnostic manner but is adaptable and scalable, able to quantify occult abnormalities, derive mechanistic insights, and define a new feature class for machine-learning diagnostic classification. We demonstrate application to inflammatory, fibrotic and neoplastic disease in multiple organs, including the detection and quantification of occult lobular enlargement in the liver secondary to hilar obstruction. We anticipate this approach will provide a robust class of histological data for trial stratification or endpoints, provide quantitative endorsement of experimental models of disease, and could be incorporated within advanced approaches to clinical diagnostic pathology.

Virtual brain tumor histopathology and immunohistochemistry with stimulated raman scattering microscopy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13511-e13511
Author(s):  
Spencer B Lewis ◽  
Balaji Pandian ◽  
Todd Hollon ◽  
Yashar Niknafs ◽  
Mia Garrard ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Raman Scattering ◽  
Stimulated Raman Scattering ◽  
Frozen Section ◽  
Ease Of Use ◽  
Laser Source ◽  
Raman Signal ◽  
Wild Type ◽  
Spectral Difference ◽  
Stimulated Raman

e13511 Background: Stimulated Raman scattering (SRS) microscopy is a label-free optical technique which uses the chemical composition of fresh tissue to generate image contrast. Prior work has demonstrated exceptional correlation between SRS images and H&E microscopy for detecting brain tumor infiltration ex vivo. However, SRS has not previously been suitable for a clinical environment. Further, SRS has utilized structural, rather than chemical, diagnostic features. We present the first clinical validation of SRS, as well as our work towards mutation-targeted SRS imaging. Methods: Implementation of SRS with a fiber laser source allowed sufficient stability for clinical deployment. Unprocessed specimens from 200 neurosurgical cases were imaged at the CH2 and CH3 vibrational modes, then processed to mimic the appearance of H&E staining. 30 cases were trialed in a simulated intraoperative consultation to assess concordance between SRS and cryosection microscopy. A multi-layer perceptron (MLP) model was then used to predict brain tumor diagnosis based on quantified image attributes. To explore the potential for chemically specific SRS, isogenic lines of normal human astrocyte were prepared, differing by the presence or absence of the R132H mutation in the isocitrate dehydrogenase 1 (IDH1) gene. IDH1 R132H cells accumulate high concentrations of the oncometabolite 2-hydroxyglutarate and display predictably altered metabolism. 200 Raman spectra were collected from 50 wild type (WT) and 50 R132H cells with the aim of detecting these changes. Each cell line was then submitted for targeted metabolomic analysis. Results: Excellent concordance was observed between SRS and frozen section histology ( κ >0.89). The MLP diagnosed brain tumor subtype with 90% accuracy. A robust spectral difference was observed between wild type and R132H cells, which showed concordance with metabolomic data. Conclusions: The diagnostic capability, ease of use and speed of SRS make it well-suited for integration into the operative workflow. Further, because SRS amplifies the Raman signal with no resonant background, the spectral differences observed may allow rapid differentiation of IDH1 WT and R132H cells with SRS.

The Value of Monitoring Frozen Section–Permanent Section Correlation Data Over Time

2006 ◽  
Vol 130 (3) ◽  
pp. 337-342
Author(s):  
Stephen S. Raab ◽  
Joseph A. Tworek ◽  
Rhona Souers ◽  
Richard J. Zarbo
Keyword(s):  
Frozen Section ◽  
Linear Modeling ◽  
Improvement Program ◽  
Continuous Quality ◽  
Permanent Section ◽  
The Mean ◽  
Long Term Monitoring ◽  
Term Monitoring ◽  
Over Time

Abstract Context.—The effectiveness of the long-term monitoring of errors detected by frozen section–permanent section correlation is unknown. Objective.—To determine factors important in laboratory improvement in frozen section–permanent section discordant and deferral rates by participation in a multi-institutional continuous quality improvement program. Design.—Participants in the College of American Pathologists Q-Tracks program self-reported the number of anatomic pathology frozen–permanent section discordant and deferred cases in their laboratories by prospectively performing secondary review of intraoperative consultations. Laboratories participated in the program for 1 to 5 years and reported their data every quarter. We calculated mean and median discordant and deferred case frequencies and used mixed linear modeling to determine if length of participation in the program was associated with improved performance. Participants.—One hundred seventy-four laboratories self-reported data. Main Outcome Measures.—Mean frozen–permanent section discordant and deferred diagnostic frequencies and changes in these frequencies over time were measured. Results.—The mean and median frozen–permanent section discordant frequencies were 1.36% and 0.70%, respectively. The mean and median deferred diagnostic frequencies were 2.35% and 1.20%, respectively. Longer participation in the Q-Tracks program was significantly associated (P = .04) with lower discordant frequencies; 4- or 5-year participation showed a decrease in discordant frequency of 0.99%, whereas 1-year participation showed a decrease in discordant frequency of 0.84%. Longer participation in the Q-Tracks monitor was associated with lower microscopic sampling frequencies for discordant diagnoses (P = .04). Increased length of participation in the Q-Tracks program was significantly associated (P = .04) with lower deferred diagnostic frequencies. Conclusions.—Long-term monitoring of frozen–permanent section correlation is associated with sustained improvement in performance.

Treatment of Cutaneous Melanoma of the Face by Mohs Micrographic Surgery

2003 ◽  
Vol 7 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Tasha N. Bienert ◽  
Martin J. Trotter ◽  
John P. Arlette
Keyword(s):  
Malignant Melanoma ◽  
Frozen Section ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Melanoma In Situ ◽  
Permanent Section ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
The Face

Background: The treatment of cutaneous malignant melanoma of the face presents a challenge to ensure eradication of disease with maximum preservation of tissue. Mohs micrographic surgery provides a means for histologically controlled removal of malignant melanoma. Objective: This study evaluates the efficacy of Mohs micrographic surgery, at a single institution, for the treatment of facial melanoma and assesses the accuracy of margin control by frozen section techniques. Methods: Ninety-seven patients with biopsy-confirmed melanoma in situ or invasive melanoma of the face were treated by Mohs micrographic surgery over a 6-year period. In 25 patients, tissue margins defined as negative for melanoma at the time of frozen section were re-evaluated on permanent section histology of formalin-fixed, paraffin-embedded tissue. Results: Ninety-two of 97 patients had followup information available (8–72 months; mean 33 months). There were no cases of local recurrence. Eighty-nine of the 92 patients were alive and well with no evidence of disease. One patient died of metastatic melanoma. In situ or invasive melanoma was not identified on permanent sections of 117 tissue margins which had been interpreted as negative on frozen section. Conclusion: Mohs micrographic surgery appears to be an effective treatment for facial melanomas. Our study showed complete correlation between frozen section tissue margins and permanent section controls.

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