Advanced Salpingoscope for Minimally-Invasive Imaging of the Fallopian Tubes

输卵管藏浆液性输卵管上皮内癌（STIC），假定的前体高- 恶性浆液性卵巢癌是这种疾病最致命的形式，死亡率为70%。早期发现 STIC可以挽救生命，并防止成千上万的不必要的预防性输卵管卵巢切除术。 不幸的是，早期输卵管疾病是无法通过传统的全身成像检测 技术和非侵入性的卵巢癌筛查方法是无效的。输卵管 可以在腹腔镜检查期间使用高分辨率技术 (OCT)和多光子显微镜（MPM）。调查人员已经清楚地表明，这些能力 技术，以区分正常与病变组织，并已证明腹腔镜成像 女人的系统。然而，腹腔镜检查所需的全身麻醉使其用作诊断或 监测技术不吸引人，即使在高风险的妇女。 我们建议在办公室环境中实现输卵管的高灵敏度，高分辨率成像。我们 输卵管镜将在局部麻醉下通过阴道插入直肠子宫袋， 微创进入远端输卵管，并且还能够对卵巢和外部进行成像， 子宫壁用于导航的白色光、大视场成像将与灵敏的OCT相结合， MPM成像用于肿瘤的早期检测。转向和活检能力将进一步提高实用性， 这个系统的可用性。拟议的具体目标是： 具体目标1：开发多用途近红外激光器。一种新颖、紧凑、坚固、飞秒 将开发中心波长为1300 nm的基于光纤的激光器，它将作为 OCT和MPM子系统的理想光源，在基于光纤的内窥镜中功能强大 医疗办公室环境中的系统。 具体目标2：开发先进的经阴道输卵管镜。直径3 mm，可操纵，高 将开发一种具有能力的输卵管镜，它将包括一个用于导航的白色光成像通道， OCT/MPM通道用于高分辨率调查可疑区域的组织微观结构和功能， 用于组织取样的活检通道和能够使器官漂浮或施加染料的冲洗端口。 具体目标3。评估输卵管镜的操作和诊断能力。的 将用离体人体组织评估输卵管镜的机械和操作性能， 在绵羊模型中的体内，以及最后在有限的初步研究中的女性体内。 在短期内，我们将为成千上万的卵巢癌高危妇女提供治疗， 有机会发现早期疾病，延迟或避免改变生命（可能缩短）的预防措施 输卵管卵巢切除术输卵管镜也可用于其他盆腔疾病的成像。

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.