In Vivo Microscopy
Topic Center


Pathologists are key players in the development, validation, and clinical implementation of new microscopic imaging technologies. At the forefront is In Vivo Microscopy, where microscopic images are obtained in vivo, in real- time, during clinical procedures.

In Vivo Microscopy in Detail

In Vivo Microscopy (IVM) is an exciting field where microscopic images are obtained in vivo, in real-time, during clinical procedures. IVM imaging technologies use light and rapidly produce 2D or 3D (tomographic) microscopic images. These images may be obtained using instrumentation compatible with existing standard of care clinical instruments (e.g., that can be inserted into endoscope accessory ports) or as standalone imaging tools. IVM is in clinical use in Gastroenterology, Ophthalmology, Cardiology, Dermatology, and in other clinical disciplines, including Pulmonary Medicine, Urology, Breast, and Neurosurgery.

Confocal fluorescence micorscopic images of metastatic Adenocarcinoma in liver from colon primary, grey scale and false colored images.
(Image courtesy of Savitri Krishnamurthy, MD, FCAP: The University of Texas MD Anderson Cancer Center)
Confocal fluorescence micorscopic images of normal liver, grey scale and false colored images.
(Image courtesy of Savitri Krishnamurthy, MD, FCAP: The University of Texas MD Anderson Cancer Center)

Why Pathologists are Central to IVM

Pathologists are the experts in diagnosing disease through the interpretation of diagnostic microscopic images. With the evolution of IVM technology, their expertise to properly interpret new types of microscopic images establishes a role for pathologists as interventional microscopists.

Benefits of In Vivo Microscopy

  • Guide biopsy site acquisition in real time to obtain targeted and diagnostically significant biopsies, as in pulmonary nodules or breast cancer
  • Perform comprehensive screening for occult microscopic disease, as in capsule screening for Barrett Esophagus
  • Obtain microscopic diagnoses when tissues cannot be easily or safely excised, as in coronary arteries, retinal screening or pulmonary fibrosis
  • Guide and assess the efficacy of therapy, such as in chemotherapy, laser ablation, guided surgical ablation, focused ultrasound, cryotherapy, radiofrequency, and brachytherapy

Ex Vivo Microscopy of IVM in Detail

Ex Vivo Microscopy (EVM) is the use of IVM technologies by pathologists in the ex vivo setting, without damage or destruction to the tissue. EVM imaging systems are small and portable, and can be used in virtually every pathology setting: the surgical suite, the procedure room, the grossing room, the laboratory, and the biobank. EVM creates digital images that can be viewed and interpreted remotely so the pathologist does not need to be physically present for EVM to be useful. Digital EVM images can be sent electronically to remote pathologists for consultation, and also used as digital documentation of biobank and other research tissues.

Benefits of Ex Vivo Microscopy

  • Evaluate small tissue biopsies for adequacy, as in breast, lymph nodes, and lung cancer biopsies.
  • Triage biopsy and other tissues for molecular and genomic studies, as in lung cancer
  • Guide the selection of tissue for frozen and permanent sections for diagnostic material
  • Guide tissue collection for Biobanking and other research purposes

IVM and EVM Resources

IVM Webinars

The IVM webinar series provides education about various applications of IVM/EVM. View the webinars section to find more details about these events and to access previous webinars.

April 19, 2018

11:00 am CDT

Microscopy with UV-Surface Excitation (MUSE) for Fast, Non-Destructive, Slide-Free Pathology

Speaker: Richard M. Levenson, MD, FCAP

May 23, 2018

11:00 am CDT

Justifying the Introduction of Emerging Technologies into a Pathology Department – How to Develop a Business Plan

Speaker: Wendy Wells, MD, MBBS, FCAP

July 10, 2018

11:00 am CDT

Incorporation Of In Vivo Microscopy (IVM) Into Pathology Practice

Speaker: Hany Osman, MD

April 25, 2017

11:00 am CDT

Confocal Microscopy for Pigmented Lesions

Speaker: Babar Rao, MD

May 30, 2017

11:00 am CDT

Creating a Successful Pathology-engineering Collaboration

Speaker: Nicholas P. Reder, MD, MPH

Sep 20, 2017

11:00 am CDT

Confocal Microscopy of Non Melanocytic Lesions

Speaker: Babar K. Rao, MD, FCAP

Oct 3, 2017

11:00 am CDT

Light-sheet Microscopy for 3D Pathology

Speakers: Nicholas P. Reder, MD, MPH; Lawrence True, MD

Nov 7, 2017

11:00 am CDT

Rapid Examination of Fresh Tissue Using Light-sheet Microscopy

Speaker: Nicholas P. Reder, MD, MPH

Dec 5, 2017

11:00 am CDT

Role of Reflectance Confocal Microscopy in Skin Inflammations

Speaker: Babar K. Rao, MD, FCAP

Get Involved With IVM Projects

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Contact Information

Please direct questions or comments to:

IVM Committee