Application of confocal laser microscopy and its feasibility in routine diagnosis of surgical biopsy specimens.
Authors: Jeong Yea Ji, Fontes Gabrielle S, Selmic Laura E, Premanandan Christopher
Journal: Veterinary pathology
Summary
# Handheld confocal laser endomicroscopy: Real-time histological assessment for surgical specimens Rapid, intraoperative tumour characterisation remains challenging in veterinary practice, yet handheld confocal laser endomicroscopy (CLE) offers the potential to bridge the gap between immediate surgical decision-making and definitive histopathology. Researchers evaluated whether pathologists with minimal training could use a portable CLE device (Optiscan ViewnVivo) to accurately diagnose surgical biopsies in real time by comparing confocal images against conventional histology in 18 cases (15 canine, 1 feline, 1 equine). Diagnostic accuracy varied by task: participants successfully identified abnormal tissue in 88% of cases (15/17), differentiated neoplasia from inflammation in 71% (12/17), and characterised neoplastic cellular morphology in 62% (8/13), with performance improving significantly when clinical history and signalment were available (P = 3.07E-07 to 0.005). For equine practitioners, this technology offers feasibility for chairside assessment of skin tumours, soft tissue masses and surgical margins, potentially reducing the turnaround time for critical treatment decisions—though the relatively modest accuracy rates for cellular characterisation suggest CLE should presently supplement rather than replace conventional histopathology, with particular value in confirming tissue abnormality and guiding intraoperative decisions about margin adequacy.
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Practical Takeaways
- •CLE could enable faster intraoperative surgical margin assessment in equine cases, potentially reducing need for multiple biopsies and repeat surgeries.
- •The technology requires only minimal training for pathologists to reach useful diagnostic accuracy, making it feasible for integration into routine diagnostic workflows.
- •Always provide clinical history and signalment data when requesting pathology assessment, as this significantly improves diagnostic accuracy with this imaging modality.
Key Findings
- •Confocal laser endomicroscopy (CLE) successfully captured detailed cellular morphology and tissue microarchitecture across 17 surgical biopsy and autopsy specimens with minimal operator training required.
- •Diagnostic accuracy for distinguishing abnormal tissue was 88% (15/17 cases), for differentiating neoplasia from inflammation was 71% (12/17 cases), and for identifying specific neoplastic cellular morphology was 62% (8/13 cases).
- •Clinical history provision significantly improved diagnostic accuracy across all assessments (P-value range: 3.07E-07 to 0.005), demonstrating the value of contextual information.
- •CLE images correlated well with standard histology, enabling rapid preliminary diagnosis and margin assessment ex vivo without requiring extensive training.