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Arch Pathol Lab Med. 2019 Mar;143(3):288-298. doi: 10.5858/arpa.2018-0298-RA. Epub 2018 Dec 10.

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

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From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston.


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.


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