For many medical procedures, particularly cancer surgery and screening, it is common for doctors to take a biopsy, cutting out small pieces of tissue to be able to take a closer look at them with a microscope. Now, a new high-speed 3D microscope can see real-time cellular detail in living tissues to guide surgery, speed up tissue analyses, and improve treatments.

The technology developed by a team of scientists at Columbia Engineering (New York, NY, USA) could replace conventional biopsies and histology with real-time imaging within the living body. The high-speed 3D microscope named MediSCAPE is capable of capturing images of tissue structures that could guide surgeons to navigate tumors and their boundaries without needing to remove tissues and wait for pathology results. Another major benefit of the approach is that cutting tissue out, just to figure out what it is, is a hard decision for doctors, especially for precious tissues such as the brain, spinal cord, nerves, the eye, and areas of the face. This means that doctors can miss important areas of disease.

The team has demonstrated the power of MediSCAPE for a wide range of applications, from analysis of pancreatic cancer in a mouse, to non-destructive, rapid evaluation of human transplant organs such as kidneys. The team used fresh samples from human kidneys to prove that MediSCAPE could see telltale signs of kidney disease that matched well to conventional histology images. The team also realized that by imaging tissues while they are alive in the body, they could get even more information than from lifeless excised biopsies. They found that they could actually visualize blood flow through tissues, and see the cellular-level effects of ischemia and reperfusion (cutting off the blood supply to the kidney and then letting it flow back in). Eager to take this technology to the next level with a larger clinical trial, the team is currently working on commercialization and FDA approval. The team hopes that MediSCAPE will make standard histology a thing of the past, putting the power of real-time histology and decision making into the surgeon’s hands.

“Such a technology could give a doctor real-time feedback about what type of tissue they are looking at without the long wait,” explained Elizabeth Hillman, professor of biomedical engineering and radiology at Columbia University and senior author of the study. “This instant answer would let them make informed decisions about how best to cut out a tumor and ensure there is none left behind.”

“Understanding whether tissues are staying healthy and getting good blood supply during surgical procedures is really important,” added Hillman. “We also realized that if we don’t have to remove (and kill) tissues to look at them, we can find many more uses for MediSCAPE, even to answer simple questions such as ‘what tissue is this?’ or to navigate around precious nerves. Both of these applications are really important for robotic and laparoscopic surgeries where surgeons are more limited in their ability to identify and interact with tissues directly.” 

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