Advanced imaging refers to direct microscopic imaging of tissue, without the need for traditional hematoxylin-eosin (H&E) microscopy, including microscope slides or whole-slide images. A detailed example is presented of optical coherence tomography (OCT), an imaging technique based on reflected light. Experience and example images are discussed in the larger context of the evolving relationship of surgical pathology to clinical patient care providers. Although these techniques are diagnostically promising, it is unlikely that they will directly supplant H&E histopathology. It is likely that OCT and related technologies will provide narrow, targeted diagnosis in a variety of in vivo (patient) and ex vivo (specimen) applications.