IN VIVO MICROSCOPY APPLICATIONS IN PATHOLOGY

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?
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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

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FDA APPROVED
REIMBURSEMENT CODES
CARDIOLOGY
CORONARY ARTERY IMAGING
HARIRI ET AL. ARCH PATHOL LAB MED. 136:1493, 2012
GASTROENTEROLOGY


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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
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

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

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
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
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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