In a dimly lit lab in St. Louis, Sanskar Thakur clicked through a series of 3D images—each a cross-section of uterine tissue captured in under three seconds—revealing a future where endometrial cancer could be caught earlier, more accurately, and without a single scalpel. At Washington University in St. Louis, a team led by Quing Zhu has pioneered a noninvasive optical biopsy using optical coherence tomography (OCT) and machine learning, offering new hope for the more than 69,000 Americans diagnosed with endometrial cancer each year. Unlike today’s standard biopsy, which is invasive, painful, and carries a 10% false-negative rate, this new method scans the entire endometrial cavity in just seconds, detecting subtle tissue changes invisible to the naked eye. With cases rising by up to 3% annually, early detection is no longer just beneficial—it’s essential.
The technology hinges on a custom catheter probe developed in Zhu’s lab, capable of capturing high-resolution 3D OCT images up to 1–2 millimeters deep. In 2025, the team tested the system on 57 post-hysterectomy uteri, 34 of which contained high-risk precancerous lesions or early-stage cancers. Working closely with clinicians Lindsay Kuroki and Ian Hagemann from WashU Medicine, the researchers were able to correlate OCT findings with actual pathology, revealing clear differences in tissue microstructure across normal, benign, precancerous, and cancerous states. The real breakthrough came when doctoral student Yixiao Lin and Thakur built a machine learning model trained on 26 imaging features to classify tissues. The result? An exploratory sensitivity of 94% and specificity of 87%—outperforming current biopsy methods in early detection potential.
"Current endometrial biopsy practice has an estimated false-negative rate of about 10%... With our three-dimensional OCT imaging system combined with machine learning, we can image the entire endometrial cavity in 2 to 3 seconds and may have the potential to achieve higher sensitivity than random biopsy sampling," said Zhu, the Edwin H. Murty Professor of Engineering. For David Mutch, a leading gynecologic oncologist and principal investigator of the Route 66 Endometrial Cancer SPORE grant, the implications are profound: "There is currently no reliable screening for endometrial cancer. This technology... should allow us to better screen for this cancer and at a minimum catch it much earlier in its development."
The study, published in npj Imaging, marks the first catheter-based 3D OCT approach to integrate structural, functional, and radiomic features for endometrial assessment. Now, the team is preparing for the next phase: testing the catheter in live patients. If successful, this optical biopsy could transform routine gynecological care, replacing guesswork with precision. For millions of women, especially those at high risk due to genetics or obesity, this could mean the difference between late-stage treatment and early, curable intervention. In the quiet hum of a St. Louis lab, a revolution in women’s health is unfolding—one flash of light at a time.