Fluorescence confocal endomicroscopy of the cervix: pilot study on the potential and limitations for clinical implementation

Abstract

Abstract. Current diagnostic capabilities and limitations of fluorescence endomicroscopy in the cervix are assessed by qualitative and quantitative image analysis. Four cervical tissue types are investigated: normal columnar epithelium, normal and precancerous squamous epithelium, and stromal tissue. This study focuses on the perceived variability within and the subtle differences between the four tissue groups in the context of endomicroscopic in vivo pathology. Conclusions are drawn on the general ability to distinguish and diagnose tissue types, on the need for imaging depth control to enhance differentiation, and on the possible risks for diagnostic misinterpretations.

In vivo optical cellular diagnosis for uterine cervical or vaginal intraepithelial neoplasia using flexible gastrointestinal endocytoscopy - a prospective pilot study-

“…J Tan et al reported that the sensitivity for detection of CIN was 97%. However, low inter-observer agreement reported by Schlosser C et al is problematic for a clinical setting [17,18]. Endocytoscopy provides sharp images that re ect the size, chromatin concentration and density of the nucleus similar to histopathology, and it enables diagnosis of CIN in vivo.…”

Dual-mode endomicroscopy for detection of epithelial dysplasia in the mouth: a descriptive pilot study

“…The limited permeation of the dye into the surface 2 to 3 cell layers (i.e., ≈30 μm) limits FE contrast to the tissue surface. 11 While very strong and prolonged illumination of stained cells may cause cellular photo damage, 16 AH has a reported long history of safe clinical usage as an antiseptic compound. AH molecules fluoresce with a spectrum centered at about λ ¼ 500 nm.…”

“…Owing to the same imaging field of view for both modalities, the separation between severe dysplasia and all other data points is achieved with very high certainty, as nuclear density serves as an established imaging feature to confirm severely dysplastic lesions. 11 This removes some of the localization uncertainty often encountered for other imaging devices when coregistering images to histopathology.…”

“…The presented qualitative and quantitative imaging results are in agreement with our recent findings in the cervix, where we used DOM and FE independently. 5,11 Sections 4 and 5 discuss the significance and limits of our work and conclude on our results, respectively.…”

“…[6][7][8][9][10] This dye contrast helps to reveal severe dysplasia through the analysis of nuclear size and density in the surface layers of the epithelium. [11][12][13][14] However, FE is mostly unable to detect moderate dysplasia where structural alterations are limited to deeper cell layers. Therefore, we combine FE with DOM, which images and quantifies light backscattering from different tissue depths through a structured illumination approach.…”