Advanced Salpingoscope for Minimally-Invasive Imaging of the Fallopian Tubes

点击翻译按钮获取中文摘要

The fallopian tubes harbor serous tubal intraepithelial carcinoma (STIC), the putative precursor to high- grade serous ovarian carcinoma, the deadliest form of this disease with a 70% mortality rate. Early detection of STIC could save lives as well as prevent thousands of unnecessary prophylactic salpingo-oophorectomies. Unfortunately, early disease of the fallopian tubes is undetectable via conventional whole-body imaging technologies, and noninvasive methods of screening for ovarian cancer are not effective. The fallopian tubes can be visualized during laparoscopy using high resolution techniques such as optical coherence tomography (OCT) and multiphoton microscopy (MPM). The investigators have clearly shown the ability of these techniques to differentiate normal from diseased tissues and have demonstrated laparoscopic imaging systems in women. However, the general anesthesia needed for laparoscopy makes its use as a diagnostic or surveillance technique unattractive, even in high risk women. We propose to enable high-sensitivity, high-resolution imaging of the fallopian tube in an office setting. Our salpingoscope will be inserted under local anesthesia through the vagina into the rectouterine pouch, providing minimally-invasive access to the distal fallopian tube and also enabling imaging of the ovaries and exterior uterine wall. White light, large field-of-view imaging for navigation will be combined with sensitive OCT and MPM imaging for early detection of neoplasia. Steering and biopsy capability will further enhance the utility and usability of this system. The proposed specific aims are: Specific Aim 1: Develop a multipurpose near-infrared laser. A novel, compact, robust, femtosecond fiber-based laser operating at a center wavelength of 1300 nm will be developed, which will function as an ideal source for both the OCT and MPM subsystems, and be highly functional in a fiber-based endoscopic system in a medical office environment. Specific Aim 2: Develop an advanced transvaginal salpingoscope. A 3 mm diameter, steerable, high capability salpingoscope will be developed which will include a white light imaging channel for navigation, an OCT/MPM channel for high resolution investigation of tissue microstructure and function in suspicious regions, a biopsy channel for tissue sampling and an irrigation port to enable organ floatation or apply dye. Specific Aim 3. Evaluate the operational and diagnostic capability of the salpingoscope. The mechanical and operational performance of the salpingoscope will be assessed with ex vivo human tissues, in vivo in a sheep model, and finally in vivo in women in a limited pilot study. In the near term, we will provide the of hundreds of thousands of women at high risk for ovarian cancer an opportunity to detect early disease and delay or avoid the life-altering (and possibly shortening) prophylactic salpingo-oophorectomy. The salpingoscope may also find broad utility for imaging of other pelvic disorders.