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In vivo laser-based imaging of the human fallopian tube for future cancer detection

机译:人体输卵管的基于体内激光的成像技术,用于将来的癌症检测

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Inherited mutations in BRCA1 and BRCA2 lead to 20-50% lifetime risk of ovarian, tubal, or peritoneal carcinoma. Clinical recommendations for women with these genetic mutations include the prophylactic removal of ovaries and fallopian tubes by age 40 after child-bearing. Recent findings suggest that many presumed ovarian or peritoneal carcinomas arise in fallopian tube epithelium. Although survival rate is >90% when ovarian cancer is detected early (Stage_Ⅰ), 70% of women have advanced disease (Stage_Ⅲ/Ⅳ) at presentation when survival is less than 30%. Over the years, effective early detection of ovarian cancer has remained elusive, possibly because screening techniques have mistakenly focused on the ovary as origin of ovarian carcinoma. Unlike ovaries, the fallopian tubes are amenable to direct visual imaging without invasive surgery, using access through the cervix. To develop future screening protocols, we investigated using our 1.2-mm diameter, forward-viewing, scanning fiber endoscope (SFE) to image luminal surfaces of the fallopian tube before laparoscopic surgical removal. Three anesthetized human subjects participated in our protocol development which eventually led to 70-80% of the length of fallopian tubes being imaged in scanning reflectance, using red (632nm), green (532nm), and blue (442nm) laser light. A hysteroscope with saline uterine distention was used to locate the tubal ostia. To facilitate passage of the SFE through the interstitial portion of the fallopian tube, an introducer catheter was inserted 1-cm through each ostia. During insertion, saline was flushed to reduce friction and provide clearer viewing. This is likely the first high-resolution intraluminal visualization of fallopian tubes.
机译:BRCA1和BRCA2的遗传突变导致卵巢癌,输卵管癌或腹膜癌的终生风险为20-50%。对于具有这些基因突变的女性,临床建议包括在生育40岁后预防性切除卵巢和输卵管。最近的发现表明,许多推测的卵巢癌或腹膜癌出现在输卵管上皮细胞中。尽管早期发现卵巢癌(Stage_Ⅰ)的存活率> 90%,但是当生存率低于30%时,有70%的女性表现出晚期疾病(Stage_Ⅲ/Ⅳ)。多年来,卵巢癌的早期有效检测仍然难以捉摸,这可能是因为筛查技术错误地将卵巢癌作为卵巢癌的起源。与卵巢不同,输卵管可以通过子宫颈直接进入视觉影像,而无需进行侵入性手术。为了制定未来的筛查方案,我们使用直径1.2毫米的前视扫描纤维内窥镜(SFE)对腹腔镜手术切除前的输卵管腔表面进行了成像。三名麻醉过的人类受试者参与了我们的方案开发,最终导致使用红色(632nm),绿色(532nm)和蓝色(442nm)激光在扫描反射率下对输卵管的长度进行成像,占其长度的70-80%。使用宫腔扩张盐水的子宫镜定位输卵管口。为了促进SFE通过输卵管的间质部分,将导尿管插入每个小孔1 cm。在插入过程中,冲洗盐水以减少摩擦并提供更清晰的视野。这可能是输卵管的首次高分辨率腔内可视化。

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