Endogenous fluorescence of hemosiderin in endometriosis to improve clinical detection

Andrew Cabe, Arnold D. Estrada, Taylor Hoyt, Xiao Yang, Scott Jenney, Philip T. Valente, Bryan Cox, Jessica McLaughlin, Randal D. Robinson, Thomas E. Milner, Marc D. Feldman
In: Translational Medicine Communications · 2019 · vol. 4(1) · doi:10.1186/s41231-019-0038-3 · W2949961197
article OA: hybrid CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Combined OCT and TPM imaging utilizing hemosiderin fluorescence and gland identification improved endometriosis detection sensitivity to 93% and specificity to 100% compared to clinical visual diagnosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This prospective ex vivo study enrolled 41 women undergoing laparoscopy for clinically suspected endometriosis; peritoneal biopsies were classified by surgeons as “yes,” “maybe,” or “no,” then 120 biopsies (from 27 women) underwent histology as the blinded gold standard. The researchers used co-registered optical imaging—optical coherence tomography (OCT) to identify gland-associated features and two-photon microscopy (TPM) to detect endogenous hemosiderin fluorescence—and calculated sensitivity, specificity, PPV, and NPV for imaging and clinical impression. Histology confirmed glands, stroma, and hemosiderin in 49%, 72%, and 86% of endometriosis samples, with clinical suspicion showing 98% sensitivity but only 53% specificity, while OCT-TPM showed 93% sensitivity, 100% specificity, 100% PPV, and 93% NPV; a key caveat is that performance was assessed on excised biopsies imaged within 24 hours and may not capture real-time intraoperative conditions. This paper is centrally about endometriosis — it tests OCT-TPM identification of gland structures and hemosiderin fluorescence to improve detection during surgical evaluation.

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Abstract

Endometriosis impacts 6–10% of all reproductive- age women. Studies have shown the more effectively endometriosis is removed, the better the patient outcomes for pain reduction and fertility (2, 3). Hemosiderin, glands, and stroma are the histologic markers of endometriosis; optical coherence tomography (OCT) can identify glands and hemosiderin has a known endogenous fluorescence than can be detected by two-photon microscopy (TPM). The hypothesis was that the identification of optical properties of endometriosis using OCT and TPM combined would improve a surgeon’s ability to diagnose and treat by improving endometriosis detection compared to current standards of visual diagnosis. Forty-one women with clinically suspected endometriosis undergoing laparoscopy were consented. Women were enrolled at two clinical sites: University of Texas Health Science Center, San Antonio and Methodist Healthcare System, San Antonio. The surgeon made a clinical diagnosis of suspected endometriosis as 1) yes present 2) maybe present, and 3) not present (controls) from the peritoneum without suspected disease. One-hundred-twenty biopsies were collected from 27 women with visually suspected endometriosis. All three patient biopsy classes were excised and underwent histologic examination as the gold-standard diagnosis for endometriosis. The samples were imaged ex-vivo for optical markers of endometriosis; OCT for endometrial glands and TPM for hemosiderin. Histologic markers were co-registered with optical properties. Biopsies were embedded in agar to maintain orientation during imaging and histological processing. TPM used the endogenous fluorescence of hemosiderin as a marker. OCT used glands as a marker. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated. The main-outcome-measure was the statistical comparison of clinical impression, imaging results, and histologic truth. Glands, stroma and hemosiderin were present in 49, 72 and 86% of endometriosis samples confirmed by histology. Clinical suspicion of endometriosis had 98% sensitivity, 53% specificity, 68% PPV, and 96% NPV. In 31 samples of endometriosis maybe being present, 39% were histologically confirmed. Eighty-eight samples were analyzed using OCT-TPM. OCT-TPM had 93% sensitivity, 100% specificity, 100% PPV, and 93% NPV. OCT-TPM is useful in identifying endometriosis’ presence or absence. Evaluation of suspected endometriosis by OCT-TPM improves surgeons’ abilities to diagnose and treat endometriosis.

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endometriosis

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