In Vivo and Ex Vivo Microscopy: Moving Toward the Integration of Optical Imaging Technologies Into Pathology Practice

Abstract

The traditional surgical pathology assessment requires tissue to be removed from the patient, then processed, sectioned, stained, and interpreted by a pathologist using a light microscope. Today, an array of alternate optical imaging technologies allow tissue to be viewed at high resolution, in real time, without the need for processing, fixation, freezing, or staining. Optical imaging can be done in living patients without tissue removal, termed in vivo microscopy, or also in freshly excised tissue, termed ex vivo microscopy. Both in vivo and ex vivo microscopy have tremendous potential for clinical impact in a wide variety of applications. However, in order for these technologies to enter mainstream clinical care, an expert will be required to assess and interpret the imaging data. The optical images generated from these imaging techniques are often similar to the light microscopic images that pathologists already have expertise in interpreting. Other clinical specialists do not have this same expertise in microscopy, therefore, pathologists are a logical choice to step into the developing role of microscopic imaging expert. Here, we review the emerging technologies of in vivo and ex vivo microscopy in terms of the technical aspects and potential clinical applications. We also discuss why pathologists are essential to the successful clinical adoption of such technologies and the educational resources available to help them step into this emerging role.

Comparison of Real-Time Fluorescence Confocal Digital Microscopy With Hematoxylin-Eosin–Stained Sections of Core-Needle Biopsy Specimens

“…Optical imaging modalities are emerging as the next generation of digital microscopy tools, with implications for pathology practice. 16,17 We chose the commercially available investigational prototype of an FCM platform for real-time bedside imaging of IR-guided CNBs. This FCM device has been extensively tested for evaluating skin specimens obtained from Mohs surgery for diagnosis and margin assessment of basal cell carcinoma.…”

Ex vivo full‐field cellular‐resolution optical coherence tomography of basal cell carcinomas: A pilot study of quality and feasibility of images and diagnostic accuracy in subtypes

“…12 The interpretation of either ex vivo FFOCT or FCM images requires a certain learning curve. Numerous training and educational opportunities are now available, 14 These results seem greatly promising for traditional low-resolution OCT given that images are interpreted by one or two experienced assessors. However, the high accuracy rate in these studies were not repeated in the high-resolution OCT images we obtained.…”

“…12 The interpretation of either ex vivo FFOCT or FCM images requires a certain learning curve. Numerous training and educational opportunities are now available, 14 and we expect that high-quality FFOCT images can shorten the learning curve. Wahrlich et al validated a scoring system (Berlin Score) for OCT diagnosis of BCC.…”

Three decades of listeriology through the prism of technological advances

“…Application of multimodal imaging to track infection in patients will be a major challenge. Exciting advances in other fields such as biomaterial imaging (Gil et al, ) and in vivo microscopy in living patients (Wells et al, ) could fuel developments in infection imaging. All these techniques have specific limitations specified in reviews cited in this article and should be used in combination to obtain the most reliable results.…”