University of Massachusetts Medical School, Worcester, MA 01605, USA.
Arch Pathol Lab Med. 2011 Oct;135(10):1343-8. doi: 10.5858/arpa.2010-0264-RA.
The advent of new endoscopic optical techniques is likely to change pathologists' role in diagnosis.
To describe how confocal laser endomicroscopy (CLE) works, show its advantages and limitations compared to cytohistologic biopsy, and explore how it may affect the practice of pathology.
Literature review.
Confocal laser endomicroscopy is proving its ability to provide histology-like images of tissues in vivo to help avoid risks and costs of conventional biopsies. Confocal imaging restricts light to 1 plane, emulating a paraffin section, and topical or systemic optical contrast agents allow subcellular resolution. New contrast agents could theoretically permit molecular characterization. In vivo imaging has begun to demonstrate novel, dynamic types of diagnostic features. Decreased histologic biopsies can be anticipated for a few scenarios. Significant limitations of CLE include the inability to create a tissue archive for broad molecular classification, suboptimal contrast agents, small fields of view and shallow penetration, paucity of clinical validation studies, and problems with reimbursement. Confocal laser endomicroscopy exposes new opportunities for pathologists: CLE technologies can be exploited in pathology, and diagnostic criteria expanded based on endoscopists' discoveries. Potential synergy exists between CLE and cytology, allowing the low-magnification diagnostic architectural changes by CLE and cytomorphology to emulate the full diagnostic information in a histologic biopsy while providing an archive of material for molecular or immunohistochemical studies. Confocal laser endomicroscopy will decrease some types of biopsies, but offers an opportunity for pathologists to find new ways to provide value and improve patient care.
新的内镜光学技术的出现可能会改变病理学家在诊断中的角色。
描述共聚焦激光内镜（CLE）的工作原理，展示其与细胞学活检相比的优势和局限性，并探讨其可能对病理实践产生的影响。
文献回顾。
共聚焦激光内镜正在证明其能够提供组织的组织学样图像，从而帮助避免传统活检的风险和成本。共聚焦成像将光线限制在 1 个平面内，模拟石蜡切片，并且局部或全身光学对比剂允许亚细胞分辨率。新的对比剂理论上可以允许分子特征化。体内成像已经开始显示出新型的、动态的诊断特征。对于少数情况，可以预期组织学活检会减少。CLE 的显著局限性包括无法为广泛的分子分类创建组织存档、对比剂不理想、视场和穿透深度小、临床验证研究不足以及报销问题。共聚焦激光内镜为病理学家带来了新的机会：可以在病理学中利用 CLE 技术，并根据内镜医师的发现扩展诊断标准。CLE 与细胞学之间存在潜在的协同作用，允许 CLE 和细胞学形态学进行低倍放大的诊断结构变化，模拟组织学活检中的全部诊断信息，同时为分子或免疫组织化学研究提供材料存档。共聚焦激光内镜将减少某些类型的活检，但为病理学家提供了寻找新方法提供价值和改善患者护理的机会。
