Fluorescence In Vivo Endomicroscopy


Figure 11: Methods to recognize and discriminate useful regions of FIVE images show that even images that are interpreted as “nondiagnostic” by experienced human raters may, in fact, have some predictive value (A). Often what is or is not useful in an image may be subtle, however, patterns can be rapidly detected after computational system training on a database of images. (B) This rationale is further refined to identify regions or “neurons” within the image that are assessed by algorithms using deep convolutional neural networks that are the most informative, and may yield an important and rapid histological interpretation. Such automated computational image recognition systems will become increasingly crucial to sort useful from non-useful images in clinical confocal endomicroscopic imaging because of the high number of images produced over the course of intraoperative images (about 1 per second). Used with permission from Barrow Neurological Institute, Phoenix, Arizona.


A Joint Future for FIVE and Histopathology Despite its high resolution and ability to replace classi-


cal histology, FIVE covers a limited field-of-view, and pan- endomicroscopy of the whole organ is not feasible. Hence, use of FIVE requires a combined approach of macroscopic visualization with targeted FIVE imaging instead of random sampling. In previous studies of chronic ulcerative colitis, FIVE was combined with chromoendoscopy and white light endoscopy [23,62]. It showed that the number of biopsies necessary in a conventional colonoscopy group was 42.2, whereas using the combined approach of chromoendoscopy


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and FIVE only 3.9 biopsies per patient were sufficient. In expert hands, this technique has resulted in the use of endo- microscopy to plan, guide, and survey therapy. FIVE may not replace conventional histopathology, but it serves as an aid to target fewer, smarter biopsies with higher diagnostic yield than large numbers of random untargeted biopsies. Future perspectives. FIVE provides a cutting-edge tool for


real-time histological information in both the basic and clinical sciences. It is translational in its approach as it permits func- tional imaging, significantly changing our understanding of many diseases. Molecular imaging applications allow detection


www.microscopy-today.com • 2021 May


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