Volumetric sonographic depiction of the fallopian tube lumen for the early detection of tubal abnormalities: A work in progress

Abstract

Objectives: The fallopian tube (FT) has emerged as an important imaging target in the detection of early ovarian cancer, which has remained an evasive challenge in the field of medicine. Recent understanding of ovarian cancer has identified the distal FT as the site of early tumorigenesis. Evaluation of the FT poses challenges due to the small size and variable anatomic position. This study outlines image acquisition and analysis techniques for volumetric depiction of the FT lumen. Methods: Women with BRCA+ ​mutations undergoing risk reduction salpingo-ophorectomy were imaged using contrast-enhanced 3D transvaginal ultrasound (n ​= ​7). Sono-salpingography was conducted with intraluminal contrast instilled through the cervix for improved imaging of the FT lumen. Three-dimensional volumetric data was collected for qualitative and quantitative image analysis. Pathologic correlation was conducted using the Sectioning and Extensively Examining the Fimbriated End Protocol (SEE-FIM). Results: Study subjects underwent 3D imaging with trans-cervical FT lumen contrast enhancement at the time of our interim reporting. None of the subjects in our initial study had serous tubal intraepithelial carcinoma (STIC) lesions, however one had acute inflammation of the FT. The 3D quantitative image analysis demonstrated areas of luminal irregularity corresponding to the regions of inflammation on pathology. Conclusions: Our study shows promise in the detailed evaluation of the FT lumen for the detection of luminal abnormalities. We continue to optimize image acquisition and analysis techniques for the detection of STIC lesions as we enroll additional patients.

Keywords

• Transvaginal contrast-enhanced ultrasound
• 3D transvaginal ultrasound
• Serous tubal intraepithelial carcinoma (STIC)
• Sectioning and extensively examining the fimbriated end protocol (SEE-FIM)