Optical biopsy: the surgical perspective

Several new intraoperative imaging techniques, often described under the generic term "optical biopsy", have been developed over the last twenty years. The term optical biopsy in fact covers two distinct approaches. The first is endomicroscopy, which provides the surgeon with histologic images comparable to those obtained by the pathologist in the laboratory. The second is image-guided surgery, which includes a variety of techniques, from fluorescence to sentinel node biopsy and real-time image fusion (enhanced reality). The diagnostic value of intraoperative histology, and the reproducibility of these methods outside the expert centers where they were initially developed, remains to be determined. In particular, it remains to be seen whether they can avoid the need for conventional biopsy The main issue will probably be to decide who is qualified to read these images: a surgeon with training in pathology, or a pathologist who examines images transmitted to the lab or directly in the operating room? Pathologic diagnosis may require several readings of the same slides, additional biopsy sections, or even additional staining procedures. The ability to examine living tissue in situ is a very attractive prospect and will probably represent a major step forward in diagnosis and treatment evaluation. It is difficult to know which of the many candidate techniques will finally be adopted, but the future seems to lie in a combination of image-guided surgery and endomicroscopy.