Hyperplastic processes in the endometrium, including malignant ones, are an actual problem of modern gynecology. The classical principles of their diagnostics based on ultrasound imaging and histological confirmation of the research material obtained by scraping of the uterine cavity walls are not subject to revision. In women of reproductive age receiving conservative treatment, there is a need for regular monitoring of the endometrium. For this purpose, it is necessary to search for a method that is not inferior in informativeness to histological examination, but less invasive. Multimodal optical coherence tomography is a potentially promising technology for such tasks.
OBJECTIVE
To assess the polarization properties and elasticity properties of endometrial tissue ex vivo in the normal state, in hyperplastic and neoplastic changes by multimodal optical coherence tomography to develop criteria for their differential diagnosis.
MATERIAL AND METHODS
The ex vivo samples of the removed uterus body tissue were studied in patients without endometrial pathology and in patients with endometrial hyperplasia and adenocarcinoma. The studies were carried out with the help of spectral multimodal optical coherence tomography — a system of domestic production — and included the use of classical structural optical coherence tomography, cross-polarization optical coherence tomography to assess the state of the connective tissue component and optical coherence elastography to determine the elasticity properties of individual morphological tissue components. The results obtained by multimodal optical coherence tomography were verified by standard histological examination.
RESULTS
The multimodal optical coherence tomography images of the studied tissue samples revealed obvious differences between the compared groups and clear correlations with the histological picture. The norm is characterized by a homogeneous distribution of low values of elastic modulus (~200 kPa) on optical coherence elastography images in the projection of the atrophic layer of the endometrium. Endometrial hyperplasia is characterized by a decrease in signal intensity in the cross-polarization channel due to a pronounced proliferation of glandular structures of the endometrium and a decrease in elastic modulus values to ~100 kPa. Endometrial adenocarcinoma is distinguished by heterogeneous distribution of high values of elastic modulus (more than 500 kPa) from tumor glandular structures and the same distribution of average values of elastic modulus (~300 kPa) from stromal fibers on optical coherence elastography images.
CONCLUSION
The results of the pilot study demonstrated the potential effectiveness of the multimodal optical coherence tomography method for studying the endometrial structure at the level close to the histological one. Further collection of material and subsequent quantitative analysis of the study data using multimodal optical coherence tomography will allow to establish criteria for differential diagnostics of various pathological conditions of the endometrium.
