Confocal endomicroscopy: a novel imaging technique for in vivo histology of cervical intraepithelial neoplasia.

Optical imaging technologies, such as reflectance and fluorescence spectroscopy, have shown the potential to provide enhanced detection of changes in the uterine cervix at clinical examination. This review focuses on fluorescence confocal endomicroscopy that enables in vivo microscopic imaging of the cervical epithelium in histological detail in real time. The microscopic imaging technique may permit 'see-and-treat' workflows in colposcopy through high-resolution fluorescence imaging of cellular and subcellular detail from the surface and subepithelial layers of the cervical mucosa. The device may be used in conjunction with a conventional colposcope. Preliminary data from clinical studies suggest that the device can be used to visualize features of the cervical epithelium including the squamo-columnar junction, dermal papillae and endocervical glands. Moreover, the technique has the ability to detect and grade precancerous changes of the cervical epithelium in conditions, such as cervical intraepithelial neoplasia, where prediction using colposcopy may be problematic. The early detection and diagnosis of gynecological abnormalities through the collection of 'optical' biopsies or targeted mucosal excisional biopsies have the potential to improve patient management through early therapeutic intervention and 'see-and-treat' strategies.