Introduction This study observed and described the morphological characteristics of the endometrium of the resected uterus using confocal laser endomicroscopy. This included normal endometrium, non-atypical endometrial hyperplasia, endometrial hyperplasia without atypia, and endometrial carcinoma, thereby laying a foundation for finding the precise localization and resection of endometrial lesions, given the feasibility of confocal laser endomicroscopy-assisted hysteroscopy.

Methods This prospective study included 74 patients who underwent hysterectomy. We used confocal laser endomicroscopy to observe the endometrium of resected uteruses and described the characteristics of endometrium in different states by comparing histopathological findings (primary objects). The secondary objects of observation were the myometrium, endocervical canal, and surface of the external os of the cervix.

Results A total of 74 patients : 19 with EC , 3 with atypical endometrial hyperplasia,22 with benign diseases, 20 with CC, and 7 with OC and borderline tumor. The dynamic images of the endometrium were observed and recorded using pCLE. Considering histopathology as the gold standard, the diagnostic concordance rate of pCLE was 97.3% in patients with EC and precancerous lesions and 100% in EC.

Conclusion/Implications Confocal laser endomicroscopy provides real-time high-resolution images of the normal endometrium and endometrial lesions. Compared with histopathology, confocal laser endomicroscopy has high diagnostic accuracy and may become an auxiliary examination tool for hysteroscopy, as it is useful for early identification of endometrial lesions, real-time diagnosis of tumor, and detection of tumor boundaries for complete tumor resection. These findings can lay a foundation for the feasible use of fertility-sparing local excision of tumor lesions by hysteroscopy.