Probe-Based Confocal Laser Endomicroscopy in Gynecologic Surgical Oncology: Intraoperative Insights to Guide Surgical Resection

Background: Ovarian cancer is a leading cause of cancer-related death in women. Cytoreductive surgery is the cornerstone of treatment, but frequently requires extensive surgical procedures.1 Frozen section analysis remains the reference for intraoperative differentiation between malignant and normal tissues; however, complementary real-time optical imaging technologies are being developed to support surgical decision-making through rapid tissue characterization directly at the surgical field.2-5 Probe-based confocal laser endomicroscopy (pCLE) is a novel real-time imaging technique that may help achieve this goal.6-8 PATIENTS AND METHODS: This video demonstrates the pCLE procedure step by step through two surgical cases: a 57-year-old woman affected by recurrent FIGO stage IIIB epithelial ovarian cancer (EOC) and a 40-year-old woman with a confirmed pathogenic BRCA2 mutation underwent laparoscopic bilateral adnexectomy as a prophylactic procedure. The real-time microscopic images were acquired using the GastroFlexTM UHD Confocal MiniprobeTM connected to the Cellvizio® system (Mauna Kea Technologies, France), which provided illumination at a wavelength of 488 nm. Results: In vivo pCLE images and subsequent biopsies were acquired from various anatomical sites after injection of fluorescein. Each endomicroscopic sequence was analyzed by dedicated investigators highly experienced in pCLE imaging and compared with the histology of the corresponding specimen. Normal tissues exhibited uniform stromal fibers, consistent cellular architecture, and regular vascularization. In contrast, malignant nodules were identified by fluorescein leakage, reflecting abnormal vessel permeability and highlighting clusters of neoplastic cells. Conclusions: Preliminary data from our observations indicate a substantial concordance between pCLE findings and histology. pCLE is a promising intraoperative tool for real-time cellular analysis.