Microscopic assessment of lymph node status in gynecological malignancies using full-field optical coherence tomography

Accurate assessment of lymph node (LN) status is critical in cancer management, particularly in gynecological malignancies. However, preoperative identification of pathological LNs remains a significant challenge with current imaging modalities. Full-field optical coherence tomography (FF-OCT) is a non-invasive microscopic technique based on tissue reflectivity and light interference, providing real-time, high-resolution images in < 10 min, with no tissue preparation or alteration required. Our aim was to evaluate the diagnostic accuracy of FF-OCT in identifying LN metastatic foci measuring ≥ 0.2 mm in gynecological cancers, in an intraoperative setting. Comparative analysis of 80 fresh ex vivo LNs with FF-OCT versus gold standard pathology showed high accuracy (97.6%), sensitivity (92.3%), and specificity (98.2%) of FF-OCT. These results support the suitability of FF-OCT integration into clinical practice for real-time assessment of LN status, thereby improving intraoperative decision making while enabling subsequent routine histological analysis.