Near real-time confocal microscopy of amelanotic tissue: Detection of dysplasia in ex vivo cervical tissue

Rationale and Objectives. The authors performed this study to determine whether images of ex vivo tissue obtained with a near real-time confocal microscope can be used to differentiate between normal and dysplastic tissue. Materials and Methods. Biopsy specimens of colposcopically normal and abnormal cervical tissue were obtained from 19 patients and imaged at various depths with a confocal microscope. Nuclear morphologic features were extracted from the confocal images; in addition, a group of reviewers examined the images and attempted to identify whether the specimen contained high-grade dysplasia. Results of both analyses were compared with the histopathologic findings of the same specimens provided by a board-certified pathologist with expertise in gynecologic pathology. Results. The morphologic feature measurements compared well with the findings at pathologic examination. The use of the nuclear-cytoplasmic ratio to determine the presence of dysplasia resulted in a sensitivity of 100% and a specificity of 91%. The untrained reviewers had an average sensitivity of 95% and an average specificity of 69% in the determination of dysplasia. Conclusion. The results indicate the clinical potential of in vivo confocal imaging in the detection of dysplasia.