Confocal Microscopy from VivaScope

In this publication, the authors report the suitability of Ex Vivo confocal microscopy, the VivaScope® 2500M-G4, for real-time evaluation of histological samples and micro-fragments of solid laryngeal lesions. It is well known that incisional biopsies (single or multiple) do not have an accuracy comparable to a definitive histologic diagnosis because the biopsies cannot represent the entire lesion. Moreover, this kind of biopsy can later cause undue damage and fibrosis of the multilayer structure of the vocal cord. In this study, the innovative VivaScope® 2500 technology allowed rapid examination of 8 histological samples from 8 patients of laryngeal lesions. The resulting VivaScope® images were evaluated and compared to their corresponding paraffin H&E images. The VivaScope workflow to obtain subcellular resolution images of the specimens, took less than 5 minutes. From these images the pathologists were able to evaluate the adequacy of the samples, dysplasia grade, the presence of inflammatory outbreaks, and the surgical margin statuses. The processing of the sample did not alter the specimen for subsequent ancillary analysis. The final histopathological evaluation of the laryngeal samples showed a high level of agreement on diagnosis between the Vivascope evaluation and the definitive histological examination in assessing the presence or absence of carcinoma and/or dysplasia (k= 0.95). The VivaScope® technology offers the possibility of quickly analyzing the unfixed fresh tissue, leading to considerable saving of time. Therefore, this can enable a “real-time” histological diagnosis of the laryngeal lesion and its margins, allowing the surgeon to extend the resection, if necessary, during the same day procedure. This innovative approach could avoid revision surgeries and the general anesthesia associated risks, and also the sacrifice of healthy tissue. The novel workflow offers the following advantages: • Easy and fast sample preparation and image acquisition (within 5 min), without assistance of a well-trained technician • No laboratory required • Establish the adequacy of the sample and avoiding loss of healthy tissue • Diagnosis of the dysplasia grade as well as inflammatory outbreaks • Safe surgical resection margins on the same day of the procedure • Remote pathological evaluation with 24/7 availability, in real time The VivaScope technology could also offer the possibility of conducting a “remote diagnosis” by sharing digital images for counseling with pathologists remotely and also provide the opportunity to build a library of digital images. This digital sharing can also be used to obtain a quick pathological consultation in a hospital where a pathology unit is unavailable, thus allowing for adequate evaluation through remote analysis. Relevant links Link: L. De Benedetto, et al. Journal of Personalized Medicine 2023

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VivaScope GmbH from Munich is celebrating its 20th anniversary in Europe this year. The company, which specialises in the development and manufacture of high-quality confocal microscopes, has enjoyed impressive success over the past two decades.