Comment on "Modified full-field optical coherence tomography: A novel tool for rapid histology of fresh tissues".

Optical coherence tomography (OCT) is one of several three-dimensional microscopy techniques that may revolutionize pathology practice.[1] These techniques essentially create histology-like images without glass microscope slides. This type of imaging can even be performed in vivo,[2] and represents a tremendous opportunity for pathology as a medical specialty. Not only can we pathologists revolutionize our workflow to drastically decrease turn-around time; we can also begin to project our substantial microscopic diagnostic expertise into realms that were previously off limits (i.e., in vivo diagnostics).

Mukherjee et al.[1] present an excellent report of their experience with a novel “full-field” OCT-based imaging platform. They demonstrate high quality images that resemble low-to-medium magnification histopathology photomicrographs. This is extremely exciting, and one can imagine potential applications for such images: enhanced specimen grossing; reduced need for frozen sections during intraoperative consultation; perhaps even sign-out of specific surgical pathology tests such as postpartum tubal ligation specimens. This last may seem controversial, but existing OCT images may already be of high enough quality to permit assessment for the presence of complete cross sections of fallopian tube tissue.[3]

It is likely that image quality will continue to increase, perhaps to the extent that it may rival what is possible with traditional microscopy (i.e., “routine” diagnostic work). Maturation of 3D histopathology may push OCT and related techniques far beyond glass-based methods, especially with computer-assisted diagnostic tools.[4] It is very possible that diagnostic-quality in vivo images may even make traditional biopsy obsolete, especially in certain situations (i.e., surveillance of Barrett's esophagus). Mukherjee's experience is also interesting because they are reporting on a system that it is commercially available, designed for use with histopathology specimens, and produces DICOM-compatible images that by definition can be incorporated into existing image management infrastructure such as radiology PACS systems.

The rise of three-dimensional microscopic imaging modalities represents a fabulous opportunity for Pathology, but it also may foreshadow the end of traditional microscope-based practice. The stakes are very high, and we may have to compete with other specialties for “turf”. We should do so vigorously, leveraging our strong advantages related to existing microscopic morphology expertise, our culture of providing definitive diagnosis (vs. “impressions”), and possibly even cost. If we do not seize this opportunity we may be left in a passive role as these technologies develop around us, perhaps even rendering our old microscopic techniques obsolete. Mukherjee et al have provided us with a tantalizing glimpse of the future, and it is bright.