Current role of Histolog® in real-time histopathologic assessment: a systematic review

Achieving complete tumor removal with negative margins remains a major goal in oncologic surgery. Frozen section analysis is still the most widely used method for intraoperative margin assessment, but it has several limitations, including time consumption, costs, and the need for dedicated pathology support. In this context, Histolog® Scanner has emerged as a fluorescence confocal microscopy device that enables rapid digital evaluation of freshly excised tissue without conventional histological processing. This systematic review aimed to evaluate the current clinical applications of Histolog® Scanner, its diagnostic performance, and its concordance with conventional histopathological assessment. Most included studies focused on breast surgery, followed by dermatologic, prostatic, and head and neck applications. Reported sensitivity ranged from 30% to 100%, specificity from 75% to 100%, and overall diagnostic accuracy reached up to 99% in selected settings. Current evidence supports the feasibility and promising diagnostic performance of Histolog® Scanner in selected oncologic fields. However, the available literature remains limited and heterogeneous and is still insufficient to support replacement of frozen section analysis in routine practice. Further large-scale prospective studies are needed to better define its reproducibility, cost-effectiveness, and potential role across different oncologic settings, particularly in head and neck surgery.