Quantitative histology using confocal microscopy: implementation of unbiased stereology procedures.

Direct, two-dimensional counting or measuring of cells as they appear in histological sections is subject to a number of artifacts that can lead to erroneous conclusions about changes in cellular populations. Numerous correction procedures devised to compensate for these artifacts are collectively termed model-based stereology due to their reliance on a model of cell geometry for correction formulas. These corrections are valid only to the degree that the geometric model reflects cellular morphology. In addition, there are requirements for population homogeneity that are often not met in biological material. The development of design-based stereology provides a way to directly count or measure cells in three dimensions, avoiding errors (biases) and the need for assumptions regarding cell size, shape, and orientation to be validated. On this basis, these procedures are described as unbiased stereology. The recent commercial availability of semiautomated stereology systems has substantially reduced the effort and experimenter error (bias) associated with the use of design-based stereology. The optical resolution of confocal microscopy and the ability to collect registered series of focal planes is ideally suited for the three-dimensional sampling of design-based stereology. Unfortunately, stereological procedures are not available in any confocal microscope software and it is up to the user to implement these procedures. Strategies and illustrations of approaches to implementing stereological procedures on a confocal microscope are presented. Where possible, particular design issues are discussed and solutions suggested. With user requests, future generations of confocal software may integrate collection of confocal images with the implementation of design-based stereology. Copyright 1999 Academic Press.