The feasibility and accuracy of real-time intra-operative confocal tissue diagnosis in brain and spine cancer surgery

Abstract Real-time intra-operative brain tumour tissue analysis can reduce turnaround times and enable repeated sampling, enhancing diagnostic accuracy and guiding resection. We investigated the use of an ultra-fast confocal microscopy scanner (Histolog®, SamanTree Medical SA) for real-time brain tumour tissue diagnosis. This study aims to demonstrate Histolog®'s diagnostic accuracy in a cohort of brain tumour patients. A single-group, observational study included adult patients undergoing brain biopsies or tumour debulking surgery. Multiple, freshly excised tissue samples were stained and imaged within 60 seconds using Histolog® alongside standard diagnostic methods. A Consultant Neuropathologist performed a blinded concordance analysis. Of 47 specimens, 94% produced interpretable images during surgery. Histolog® images enabled 100% real-time tumour cell identification and matched gold standard diagnoses in 68% of cases. Histolog® demonstrates non-inferior diagnostic accuracy compared to current standards, significantly reducing intra-operative diagnosis time. Future studies will explore real-time margin zone analysis and machine learning for automatic diagnosis.