Ovarian cancer remains the deadliest gynecologic cancer, largely because it is rarely found early. Symptoms are often vague, and existing screening approaches—such as blood tests and transvaginal ultrasound—can miss the disease at stages when treatment is most effective. In recent years, research has reshaped understanding of how many aggressive ovarian cancers begin, pointing not to the ovary itself, but to the fallopian tubes. That shift has created a need for tools that can safely examine these narrow structures for early changes linked to cancer.
In a study published in Biophotonics Discovery , researchers describe a redesigned endoscope built to image the inside of the fallopian tubes and collect cells at the same time. The device, known as a Cell‑Acquiring Fallopian Endoscope, or CAFE, is small enough to navigate the tight, winding tube while capturing optical signals and cellular samples associated with early disease. Tested in intact human tissue, the system demonstrates how combined imaging and cell collection could support future strategies for earlier ovarian cancer detection.
Most ovarian cancers are classified as high‑grade serous carcinomas. A growing body of evidence shows that many of these cancers originate as precursor lesions in the fallopian tubes. These early lesions can persist for years before cancer spreads, offering a potential window for detection.
As these abnormal cells develop, they alter their surrounding environment. Changes in metabolism, tissue structure, and blood supply can affect how tissue reflects and emits light, particularly under fluorescence imaging. At the same time, the cells themselves are molecularly distinct, making them identifiable through cytology or other analytical methods if enough cells can be collected.
Taken together, these findings suggest that a device capable of both imaging fallopian tube tissue and gathering cells could play a role in detecting disease before it reaches an advanced stage.
The fallopian tubes present a challenging environment for medical imaging. Their inner diameter can be less than a millimeter, and their walls are flexible and folded. Earlier falloposcopes provided limited resolution, restricted access, or imaging alone without the ability to collect cells.
The new CAFE system represents a complete redesign informed by clinician feedback. The endoscope measures less than one millimeter in diameter and is flexible enough to follow the natural curves of the tube. A lighter handle improves control during use, while a guidewire-compatible design helps clinicians navigate the narrow lumen.
Optically, the device combines white‑light imaging for navigation with blue‑light reflectance and fluorescence imaging to probe tissue properties. A higher‑density fiber bundle and a custom close‑focus lens allow the system to form sharp images at very short distances, where the tube wall lies close to the endoscope tip.
The endoscope also includes a working channel for cell collection. Instead of scraping tissue with an exposed wire, the redesigned system uses a smooth, “scoop”-style collection method that gathers epithelial cells directly into the endoscope tip, reducing the risk of tissue injury.
To evaluate performance, the research team tested the device in intact fallopian tubes removed during surgery from three patients. The experiments were carried out at New York Presbyterian Queens Hospital by a multidisciplinary team, and all tissue samples were confirmed to be benign.
The endoscope successfully entered the fallopian tubes and produced images at multiple locations along their length. White‑light images revealed structural features and small blood vessels, while blue‑light imaging captured both reflectance and natural fluorescence signals. Fluorescence images showed strong signal levels even with short exposure times, indicating that the system is sensitive enough to detect subtle optical differences.
Rather than relying on raw image brightness, the researchers analyzed ratios between reflectance and fluorescence signals, as well as color channel ratios in white‑light images. These measurements were generally consistent between the left and right tubes of the same patient, suggesting that the signals reflect real tissue properties rather than imaging artifacts.
In addition to imaging, the endoscope consistently collected large numbers of epithelial cells—ranging from tens of thousands to hundreds of thousands per sampling attempt. This quantity is sufficient for many cytological and molecular analyses used to study early cancer-related changes.
Safety testing showed that the device met electrical and laser exposure standards, and sterilization did not degrade performance. Follow‑up tissue analysis found no visible damage from imaging or cell collection, supporting the feasibility of using the device in future studies.
The researchers emphasize that this work represents an early step. The current study focused on benign tissue, with the goal of demonstrating that the device can safely navigate the fallopian tubes, collect images, and gather cells. Future studies will examine tissue with precursor lesions, cancer, and other conditions to determine whether imaging and cell-based measurements can reliably distinguish healthy from abnormal tissue.
If successful, the approach could be especially relevant for individuals at high risk of ovarian cancer, such as those with inherited BRCA1 or BRCA2 mutations. These patients are often advised to undergo preventive removal of the ovaries and fallopian tubes. A minimally invasive method to monitor for early changes could, in principle, offer an alternative way to assess risk over time.
By bringing imaging and cell collection together in a single, submillimeter device, the redesigned CAFE system offers a new way to study where ovarian cancer begins—and how it might be found earlier than ever before.
For details, see the original Gold Open Access article by D. Gálvez et al., “ Improved endoscope for imaging and cell collection in the fallopian tubes, " Biophoton. Discovery 3(2), 025001 (2026), doi: 10.1117/1.BIOS.3.2.025001
Biophotonics Discovery
Cells
Improved endoscope for imaging and cell collection in the fallopian tubes
17-Mar-2026