Autofluorescence imaging can identify preinvasive or clinically occult lesions in fallopian tube epithelium: a promising step towards screening and early detection.

BACKGROUND: Optical imaging systems are robust, portable, relatively inexpensive, and have proven utility in detecting precancerous lesions in the lung, esophagus, colon, oral cavity and cervix. We describe the use of light-induced endogenous fluorescence (autofluorescence) in identifying preinvasive and occult carcinomas in ex vivo samples of human fallopian tube (FT) epithelium. METHODS: Women undergoing surgery for an i) ovarian mass, ii) a history suggestive of hereditary breast-ovarian cancer, or iii) known serous ovarian cancer following neoadjuvant chemotherapy (NAC) were approached for informed consent. Immediately following surgery, FT's were photographed in reflectance and fluorescence at high resolution. Images included: (1) white-light reflectance of luminal/epithelial surface; (2) narrow-band green reflectance (570 nm) (3) green autofluorescence (405/436 nm excitation); and (4) blue autofluorescence (405 nm excitation). Areas revealing a loss of natural tissue fluorescence or marked increase in tissue microvasculature were recorded and compared to final histopathologic diagnosis (SEE-FIM protocol). RESULTS: Fifty-six cases involving one or both fallopian tubes underwent reflectance and fluorescence visualization. Nine cases were excluded, either secondary to non-ovarian primary pathology (7) or excessive trauma (2) rendering tissue interpretation impossible. Of the 47 cases remaining, there were 11 high grade serous (HGS) and 9 non-serous ovarian carcinomas undergoing primary debulking surgery, 5 serous carcinomas having received NAC, 8 benign ovarian tumors, and 14 women undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). Methodology was feasible, efficient, and reproducible. TIC or carcinoma was identified in 7/11 HGS, 3/5 NAC, and 1/14 RRBSO. Optical images were reviewed to determine test positive or negative based on standardized criteria. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the entire cohort (73%; 83%; 57%; 91%) and in a subgroup that excluded non-serous histology (87.5%; 92%; 78%; 96%). CONCLUSIONS: Abnormal FT lesions can be identified using ex vivo optical imaging technologies. With this platform, we will move towards genomic interrogation of identified lesions, and developing in vivo screening modalities via falloposcopy.

Fiber-optic confocal microscopy using a spatial light modulator.

We present a novel fiber-optic confocal microscope in which the scanning operation is achieved by use of a spatial light modulator (SLM) to sequentially illuminate individual fibers or patterns of multiple fibers. Experimental images are presented, and the optical-sectioning capability of the device is demonstrated. The novel SLM-based system is more optically efficient, achieves higher contrast, and has improved optical-sectioning capabilities compared with those of other proposed instruments for confocal microendoscopy.

Interferometric optical fourier-transform processor for calculation of selected spatial frequencies.

A novel interferometric optical Fourier-transform processor is presented that calculates the complex-valued Fourier transform of an image at preselected points on the spatial-frequency plane. The Fourier spectrum of an arbitrary input image is interfered with that of a reference image in a common-path interferometer. Both the real and the imaginary parts of the complex-valued spectrum are determined. The source and the reference images are easily matched to guarantee good fringe visibility. At least six interferograms are postprocessed to extract the real and the imaginary parts of the Fourier spectrum at preselected points. The proposed hybrid optical-digital technique is computationally appropriate when the number of desired spatial frequencies is small compared with the number of pixels in the image. When the number of desired points is comparable with the number of image pixels, a conventional or pruned two-dimensional fast Fourier transform is more appropriate. The number of digital operations required by the hybrid optical-digital Fourier processor is proportional to the number of desired spatial frequencies rather than the number of pixels in the image. The points may be regularly distributed over the spatial-frequency plane or concentrated in one or several irregularly shaped regions of interest. The interferometric optical Fourier processor is demonstrated in a moving-object trajectory estimation system. The system successfully estimates the trajectory of multiple objects moving over both stationary and white-noise backgrounds. A comparison of performance was made with all-digital computation. With everything else equal, our hybrid optical-digital calculation was more than 3 orders of magnitude faster.

Optical Fourier processor and point-diffraction interferometer for moving-object trajectory estimation.

A hybrid optical-digital signal processing system that estimates the trajectory of moving targets in a two-dimensional field at video frame rates was developed and constructed. The hybrid system is particularly well suited to the trajectory estimation of small, barely discernable, moving objects of unknown position and velocity in high-resolution image sequences. The system uses an optical Fourier processor and a point-diffraction interferometer to calculate the frequency-domain representation of moving objects from which their trajectory is estimated by use of conventional electronic processing techniques. In a series of experiments, target velocities were estimated to within 4% of their actual value and direction was estimated to within 3 deg.

Hospital choice: empirical verification of a proposed taxonomy, contrasting men and women.

This is a summary of an empirical verification of a hospital choice taxonomy. Four focus groups were executed followed by a telephone survey of 400 individuals. The situation studied was one where the persons involved had a choice (no physician influence or emergency), reflecting the present motion to more proactive health care. No major differences in rank order of factors were found for men versus women; men ordered choice factors differently based on primary physician type (MD/DO).

Hospital choice: a summary of the key empirical and hypothetical findings of the 1980s.

The authors review the development of allopathic and osteopathic hospital choice criteria as found in the literature. Several of the findings are based on previously unpublished and uncited work. This comprehensive and up-to-date summary provides a synthesized view of hospital choice and covers the stability of hospital choice factors over time, factors based on type of care, hospital choice influencers, and the special influence of women on hospital choice. Implications for hospital management and marketing executives, and for future research, also are presented.