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One of World’s Smallest Microscopes Benefits Patients at Yale
Confocal Laser Endomicroscope (pCLE), one of the world's smallest microscopes.
Confocal microscopes with high resolutions have been used in the past primarily as a research tool. However, the probe-based Confocal Laser Endomicroscope (pCLE), or confocal endomicroscopy, provides a real time view that is 1,000 times magnified. This technology is being used at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven, to improve the diagnosis and treatment of gastrointestinal cancers and other diseases, including those of the colon, bile duct, pancreas, and esophagus.
Dr. Priya Jamidar, Professor of Medicine and Director of Endoscopy at Yale, commented that this is a promising new method for diagnosing gastrointestinal cancers at a premalignant, or earlier stage. “Instead of only being able to obtain a few biopsies from a small area, using the confocal endomicroscopy we can obtain numerous virtual biopsies from a wider area and are therefore less likely to miss areas where there may be cancerous cells.”
The size of the microscope ranges from under 1mm to just under 3mm in size, and can fit through the biopsy channels of many endoscopes. Images generated can help determine if the cells are benign or malignant, or if further resection is necessary. Multiple areas are visually sampled in real-time, providing immediate information that directs biopsies to areas that will be diagnostic.
This technology is also used for monitoring patients with Barrett’s esophagus, a condition where there is an abnormal growth of intestinal-type cells in the lower esophagus. Barrett’s esophagus is a premalignant condition, and esophageal adenocarcinoma can develop as a result of this. The confocal endomicroscopy can be used to monitor for dysplastic changes, much like a Pap Smear does, as cellular changes can be seen before a cancer occurs.
Yale is the only center in the state using the confocal endomicroscopy, and one of the only institutions globally with this technology. It is manufactured by Mauna Kea Technologies' in Paris. Dr. Harry Aslanian, Associate Director of Endoscopy at Yale University, performed the first confocal laser endoscopic visualization of the interior of a pancreatic cyst in the world. Further data is being collected.
“This is a very cutting edge technology and we are still learning how to interpret the different images. It is being evaluated for potential utility in lung and liver cancer as well,” said Dr. Jamidar. “It’s an impressive technology that is much less invasive for our patients because we do not need to keep repeating procedures for additional biopsies.”
Dr. Jamidar said that it is particularly promising for use in the bile duct, where tissue sampling techniques are at best, 50% sensitive. This means that around half of the tumors cannot be diagnosed at the time of examination. Yale has the most experience of any center with the use of the high resolution probe in the bile duct. Using this new technology may improve the diagnostic yield as well as help guide therapy.
There are no guidelines yet as to how often this procedure should be done, but there have been no harmful side effects seen to date. They are still learning about acquiring images and how to interpret them, but Dr. Jamidar sees this technique becoming more utilized in the future.
“I am confident that as we learn more about this technology, we will discover additional applications. It allows us to provide a minimally invasive method that may expedite diagnosis and treatment, which is always a good thing when you are dealing with cancer,” said Dr. Jamidar.