Tiresias: The Laser's Edge

“Pathology after surgery is as useful to the surgeon and the patient as an autopsy is to a deceased patient."

Tiresias

My friends,

Self-referential self-quoting is not in Tiresias’s metier. Nevertheless, if something is worth saying it is worth repeating, and repeating again. Optiscan Confocal Laser Endomicroscopy (CLE) is a disruptive innovation which will transform pathology and diagnosis and treatment of cancer. CLE enables Real-time histopathology. CLE enables 3-dimensional microscopic imaging in real time. It will transform cancer screening in the clinic. It will make frozen section biopsy in the operation room obsolete. It will make prolonged outpatient ambulatory surgical excision with repeated frozen section biopsies obsolete and enable much more rapid and more accurate surgical excision possible. It will revolutionise cancer surgery in that it will finally enable to surgeon to see every last malignant cell present in the operative field and at depth, beyond the surface of the field. And this is just the technology available now. Additional developments, which are inevitable, include developments if different laser wavelengths and different power will improve resolution and depth of visualization. Increasing the power of the laser will enable the imaging laser, at the flick of a switch, become a therapeutic laser and instant vaporize the malignant cells in the field. Machine learning/AI and image enhancement will transform what we already have now so that the applications and the possibilities are so enormous that even Tiresias sees them “as if through a glass darkly”.

You see my friends, gross pathology hasn’t changed for hundreds of years, and histopathology has hardly changed in 150 years. It still involves examining pieces of tissue taken either at the time of operation of from the excised specimen, soaking it in preservatives and dyes developed in the 19^th century, fixing it in a block of paraffin wax, slicing it up with a fine salami slicer, gluing the slices onto a glass slide and then looking under a light microscope, sitting at a desk, a week or two later. Yes, there are a few additional stains, but the principles, the work-flow, and the time it takes, are unchanged. Frozen section biopsy is unchanged in the last 120 years. It is hardly more accurate or more useful than when first developed in the freezing Minnesota winter, at the Mayo Clinic about 120 years ago. With CLE and the developments which Tiresias sees, and with appropriate new in-vivo molecular level stains being developed right now around the world, all this will change. All of this will be in real time. It will be 3-dimensional. It will be digitalised and networked so it is available anywhere in the world. It will finally remove the glass slide and the bench microscope. It will do to pathology what digitisation has done to radiology.

Tiresias remembers struggling with reems of film, having to be mounted on massive fluorescently illuminated screens covered in banks and banks of old and recent films of a single patient. The digitalisation of microimaging of radiology put an end to all of this. There was so much photographic film being used in radiology that digitalisation of radiology actually significantly affected the world demand for silver and the price of silver. Tiresias can access any X-ray, any CT scan, any Ultrasound scan, any MRI scan, any nuclear or PET scan, from anywhere in the world, or even as they are done in the operating theatre, live. What digitalization has done for macro-imaging, Optiscan will do for micro-imaging. Pathology at present suffers from radiology envy and Optiscan’s promise is to change all that.