IN VIVO MICROSCOPY APPLICATIONS IN PATHOLOGY MARIA SHEVCHUK, MD FCAP MANU JAIN, MD FCAP SUSHMITA MUKHERJEE, PhD WEILL CORNELL MEDICAL COLLEGE NEW YORK WHY SHOULD A PATHOLOGIST CARE ABOUT IVM? WHY SHOULD I CARE ABOUT THE PATHOLOGIST?   In Vivo Microscopy is another version of histopathology, and pathologists are the experts in analyzing/diagnosing human tissues. It is in the patients’ interest that pathologists interpret these images. TECHNOLOGIES CONFOCAL MICROSCOPY OPTICAL COHERENCE TOMOGRAPHY (OCT) ff-OCT OPTICAL FREQUENCY DOMAIN IMAGING MULTIPHOTON MICROSCOPY (MPM) IN VIVO MICROSCOPY CURRENT APPLICATIONS   FDA APPROVED REIMBURSEMENT CODES CARDIOLOGY CORONARY ARTERY IMAGING HARIRI ET AL. ARCH PATHOL LAB MED. 136:1493, 2012 GASTROENTEROLOGY    GUIDE TO OBTAINING THE MOST CLINICALLY SIGNIFICANT BIOPSIES FOLLOW THERAPY SCREENING TUBULAR ORGANS: ESOPHAGUS, COLON BARRETT’S ESOPHAGUS EX VIVO APPLICATIONS OF IN VIVO MICROSCOPY LUNG, BENIGN MILD INTERSTITIAL FIBROSIS LUNG ADENOCARCINOMA LUNG SQUAMOUS CELL CARCINOMA GASTROINTESTINAL TRACT C0LON CONFOCAL MICROSCOPY OF NL. COLON MPM OF MILDLY INFLAMED COLON BARRETT’S ESOPHAGUS TESTIS BIOPSIES DONE FOR FERTILITY BLADDER CIS BLADDER PAPILLARY UROTHELIAL CARCINOMA PROSTATE ADENOCARCINOMA PERIPROSTATIC TISSUES KIDNEY BENIGN RENAL PARENCHYMA KIDNEY RENAL CELL CARCINOMA Low Grade Clear cell RCC High Grade Clear cell RCC Chromophobe RCC KIDNEY PAPILLARY CARCINOMA EX VIVO APPLICATIONS OF IVM    INITIALLY MIGHT NOT BE USED FOR PRIMARY DIAGNOSIS MIGHT REPLACE FROZEN SECTIONS IN SOME INSTANCES APPLICATIONS: INTRAPROCEDURAL IN PATHOLOGY GROSS ROOM 1. INTRA-OPERATIVE ASSESSMENT    HELP TO IDENTIFY THE MOST SINGNIFICANT AREA FOR FROZEN SECTION MAY REPLACE FROZEN SECTION MOST HELPFUL IN FATTY TISSUES THAT DO NOT FREEZE INTRA-OPERATIVE ASSESSMENT  MARGIN ASSESSMENT DURING CANCER RESECTIONS MAY REPLACE FROZEN SECTIONS IN SOME INSTANCES “FAT DOES NOT FREEZE” Modern Pathology, March 2014, vol. 27, p.464 2. INTRAPROCEDURAL ADEQUACY EVALUATION SIMILAR TO ADEQUACY EVALUATION OF NEEDLE ASPIRATION BY CYTOPATHOLOGY NEEDLE BIOPSY ADEQUACY REAL-TIME EVALUATION 3. TISSUE SELECTION FOR MOLECULAR AND GENETIC TESTING TUMOR OR TISSUE OF INTEREST MUST INVOLVE 50-60% OF TISSUE SUBMITTED. IMAGING OF BIOBANKED TISSUES PERMANENT DIGITAL RECORD 4. SPECIMEN GROSSING AID BREAST MARGIN ASSESSMENT POSSIBLE FUTURE APPLICATIONS    ADDITIONAL INFORMATION ABOUT THE CHEMICAL NATURE OF TISSUES, ESPECIALLY AS PERTAINING TO THE BIOLOGY OF CARCINOGENESIS (MOLECULAR IVM). EVALUATION OF VASCULAR STRUCTURES AND BLOOD FLOW. USED AS AN ADDITIONAL “SPECIAL STAIN”. DEPARTMENT OF PHARMACOLOGY AND OF MOLECULAR BIOPLOGY UNIVERSITY OF WISCONSIN December 2006 CONCLUSIONS PREDICTIONS  EX VIVO MICROSCOPY 1. WILL BECOME PART OF THE PRACTICE OF PATHOLOGY. 2. WILL BE USED FOR INTRA-OPERATIVE EVALUATION, IN SOME CASES REPLCING FROZEN SECTIONS 3. WILL BE USED TO EVALUATE ADEQUACY OF NEEDLE AND OTHER BIOPSIES. (MAY REPLACE FROZEN SECTIONS IN SOME CASES.) 4. WILL BE USED IN THE GROSS ROOM TO ENHANCE MOST MEANINGFUL SECTIONING OF SPECIMENS. 5. WILL BE USED IN TISSUE SELECTION FOR MOLECULAR/GENOMIC/PROTEIOMIC STUDIES AND IN BIOBANKING. CONCLUSIONS 1. PATHOLOGISTS CAN USE IVM TECHNOLOGIES FOR EX VIVO APPLICATIONS NOW. 2. PATHOLOGISTS ARE AN INTEGRAL PART OF THE DEVELOPMENT OF THESE TECHNOLOGIES THANK YOU