Confocal laser endomicroscopy is gaining attention as a potential alternative to traditional tissue biopsies in gastroenterology, offering real-time, cellular-level imaging during endoscopic procedures.
The technology uses a laser that scans the tissue surface, capturing images that resemble pathology slides but without the need to physically remove samples. These “optical biopsies” can provide instantaneous feedback, compared with the three- to five-day wait for pathology review following conventional biopsies.
In a 2022 Scientific Reports study Michigan Medicine researchers found that CLE, combined with artificial intelligence, could distinguish cancerous from noncancerous tissue in real time, possibly improving both diagnostic efficiency and accuracy.
“Confocal endomicroscopy allows us to take histology-like images during the endoscopy instead of sending samples away and waiting days for results,” Tom Wang, MD, PhD, coauthor of the study and director of the National Institutes of Health National Centers for Biomedical Imaging and Bioengineering at the University of Michigan in Ann Arbor, told Becker’s.
Dr. Wang described CLE as a tool that could reduce unnecessary biopsies and give physicians more flexibility during procedures.
“It’s really useful because the doctor can decide right there if more biopsies are needed, and from the right area,” he said. “It gives much more flexibility and information for both the physician and the patient.”
Dr. Wang also noted that his team is pairing CLE images with AI models to help interpret results in real time, though he acknowledged the process can still be challenging without input from a pathologist.
Beyond efficiency, CLE could also broaden access to cancer diagnostics in low-resource or underserved areas, where pathology services are limited.
“There are many patients in the U.S. and globally who don’t have access because there just aren’t enough pathologists,” Dr. Wang said. “If we can make the devices cheap and even disposable, then people in underserved or remote areas could have access to this life-saving technology.”
Still, Dr. Wang noted that CLE faces adoption challenges.
“One challenge is acceptance,” he said. “Pathology has been around for hundreds of years. But once people see what artificial intelligence can do with these images, I think acceptance will grow.”
Looking ahead, he expects the technology to become cheaper and more widely available as device innovations advance.
Dr. Wang added his team is developing miniature MEMS scanners to replace costly fiber bundles, with the goal of producing affordable, disposable devices. He envisions the technology being deployed in mobile units that could deliver imaging directly to community centers and other underserved settings where patients typically lack access to screening.
“There’s still a long way to go,” Dr. Wang said. “Our goal is to keep advancing this technology to make healthcare more accessible and ultimately save lives and improve patient outcomes.”
