Endomicroscopy is born—do we still need the pathologist?

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Endomicroscopy is born—do we still need the pathologist? Ralf Kiesslich, MD, PhD, Markus F. Neurath, MD Gastrointestinal Endoscopy Volume 66, Issue 1, Pages 150-153 (July 2007) DOI: 10.1016/j.gie.2006.12.031 Copyright © 2007 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 In vivo diagnosis of Barrett's esophagus and Barrett's associated neoplasia by confocal laser endomicroscopy. A, Fluorescein-based endomicroscopy of columnar-lined lower esophagus: lumen of a single Barrett gland can be readily identified (yellow arrow). Dark, roundish areas within single epithelial cells represent goblet cells (red arrow), which are pathognomonic for Barrett's epithelium. B, Irregular cell and vascular architecture is characteristic for Barrett's associated neoplasia. Fluorescein leakage displaying a bright contrast between cells in the lamina propria is due to the fragility of neoplastic vessels. Dysmorph Barrett glands with disruption of the basement membrane can be identified. Gastrointestinal Endoscopy 2007 66, 150-153DOI: (10.1016/j.gie.2006.12.031) Copyright © 2007 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 In vivo diagnosis of colorectal adenoma and cancer by confocal laser endomicroscopy. A, Acriflavine-aided endomicroscopy of a rectal polyp showing typical tubular arranged crypt architecture. The lumen of single glands can be identified (yellow arrow). Enlarged and irregular nuclei can be seen (blue arrow), with compression of mucin within goblet cells indicating tubular adenoma. Final histology revealed tubular adenoma with high-grade dysplasia. B, Irregular cell architecture is visible under the surface of a sigmoid mass. Many capillaries can be identified due to the bright contrast produced by fluorescein-guided endomicroscopy. Malignant irregular cells are displayed as black cells due to the pH interaction of fluorescein. Final histology showed a poorly differentiated adenocarcinoma. Gastrointestinal Endoscopy 2007 66, 150-153DOI: (10.1016/j.gie.2006.12.031) Copyright © 2007 American Society for Gastrointestinal Endoscopy Terms and Conditions