Mozambique has one of the highest burdens of cervical cancer in the world. However, access to gynecology and pathology services to diagnose cervical precancer in Mozambique is limited. To enable effective cervical dysplasia detection at the point of care, we developed a rugged multi-modal imaging system to acquire colposcopic and high-resolution images of the cervix and identify regions with greater likelihood of high grade cervical precancer. Representative data collected from patients referred for colposcopy at Mavalane Hospital in Maputo, Mozambique illustrate the ability of the multimodal system to identify high grade cervical precancer at the point of care.
Fiber-optic microendoscopes have shown promise as an imaging tool capable of visualizing molecular contrast agents used to study disease in vivo. The small size and flexibility of fiber-bundle probes make them ideal for in vivo use. However, image contrast can be severely limited when imaging highly scattering tissue. Optical sectioning techniques such as confocal or structured illumination can improve image contrast in microendoscopes by rejecting out-of-focus light generated in highly scattering tissue. However, optical sectioning techniques can reduce imaging speed or require complex opto-mechanical components to be installed on the distal end of the fiber-bundle. Here we present differential structured illumination microendoscopy (DSIMe) capable of performing structured illumination imaging in a fiber-optic microendoscope. Sectioning can be performed at video rates without the need for opto-mechanical components attached to the distal end of the fiber-bundle. Improved axial response of DSIMe is demonstrated using an optical phantom and we show image contrast enhancement in highly scattering mouse tissue imaged ex vivo. We also demonstrate contrast enhancement using DSIMe to image cervical tissue in vivo in patients diagnosed with cervical adenocarcinoma in situ and an improved ability to identify cellular changes associated with neoplasia.
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