PROJECT SUMMARY
There is an unmet clinical need for accurate, minimally invasive strategies to diagnose endometriosis, a
debilitating disease which affects 10% of reproductive-aged women and frequently results in chronic pain,
infertility, or even cancer. Diagnosis is often delayed due to seemingly invisible and vague symptoms and the
lack of definitive diagnostic methods except invasive surgery. This project aims to study the uterotubal junction
(UTJ), the proximal, contractile segment of the fallopian tubes. Despite the protective role of the UTJ in retrograde
menstruation, and the fact that it is structurally altered in women with endometriosis, this region is understudied.
I hypothesize that there are structural and functional differences in the UTJs of women with and without
endometriosis, which can be visualized with three dimensional minimally invasive imaging. My goal is to
evaluate and compare these differences using optical coherence tomography (OCT), and to develop a miniature
endoscope to access the UTJ through the uterus. OCT is a novel, non-destructive imaging technique capable of
providing depth-based microstructural information at micron-scale resolution. Previous work has indicated the
ability of OCT to define the organization of smooth muscle and collagen in tissue, differentiate endometriosis
from normal tissue, and inform the functional status of tubal cilia in live mouse studies.
I propose the first comparative study of the structure and function of the UTJ in the setting of endometriosis using
high-resolution, volumetric imaging. Through Specific Aim 1, I will compare functional and morphological
measures of explanted UTJs from women with and without endometriosis on volumetric OCT images. I will
develop novel algorithms to extract quantitative measures, including texture features, the quantity and orientation
of collagen (structure), and ciliary beat frequency (function). In the short term, I aim to provide effective and
accurate diagnostic information which can differentiate individuals with endometriosis from controls, as well as
advance our current understanding of the understudied UTJ. Through Specific Aim 2, I will design, build, and
test a minimally invasive, miniature endoscope capable of providing depth-resolved structural-functional
information to demonstrate that OCT can be made suitable for imaging the UTJ. In the long term, I hope to prove
that a simple, low-cost office-based imaging procedure, using an OCT endoscope, can provide accurate
diagnostic information to identify endometriosis at an early stage. This device could overcome limitations in
current diagnostic methods by providing a means for repetitive surveillance, informing prognostic markers of
endometriosis susceptibility, and improving detection times and accuracy. The proposed research will generate
the preliminary data needed to design a larger in vivo study to prove the diagnostic capability of our endoscope.