Lichen sclerosus (LS) is a chronic inflammatory skin condition that predominantly affects anogenital skin in women. Despite its significant impact, the true prevalence of vulvar LS remains uncertain due to underdiagnosis and underreporting [1]. Studies estimate LS affects up to 3% of postmenopausal women, with an increasing incidence, though it also occurs in premenopausal women and children [2]. This condition is often underserved, and delays in diagnosis can severely impact patients' quality of life, leading to irreversible scarring, vulvar architectural distortion, genitourinary complications, and chronic pain syndromes [3]. Currently, there is limited understanding of LS pathogenesis and no FDA-approved treatments, with lifelong management being the standard approach. Skin biopsies are the gold standard for diagnosing LS; however, they are invasive, particularly in the sensitive vulvar region, and time-consuming. Additionally, approximately 5% of women with LS develop vulvar squamous cell carcinoma (SCC), and nearly half of all vulvar cancers are associated with LS [4]. This necessitates frequent monitoring and repeated biopsies to evaluate SCC development in longstanding LS lesions. To address the limitations of current diagnostic and monitoring methods, there is an urgent need for noninvasive, high-sensitivity, real-time imaging techniques. OCT has the potential to provide the best combination of benefits because of its high-resolution (1- 15 μm), its real-time cross-sectional imaging with a penetration depth of 1-2 mm, and its safe, non-invasive operation. Furthermore, our group has developed Doppler OCT/OCTA to visualize vascular networks and angiogenesis [5-9]. This study proposes the development of a 1.7-μm optical coherence tomography angiography (OCTA) technique to enable noninvasive diagnosis and monitoring of vulvar LS lesions. This approach aims to provide a sensitive, real-time imaging modality that can improve diagnostic accuracy, reduce patient burden, and facilitate early detection of malignant transformations in LS.

Lichen sclerosus (LS) is a chronic inflammatory skin condition that has a predilection for the anogenital skin in women. The true prevalence of vulvar LS is unknown, underdiagnosed, and underreported [1]. Studies have estimated LS affects up to 3% of postmenopausal women, with a rising incidence [2]. The disease also affects premenopausal women and children. Overall, this is an underserved condition and the related delay in diagnosis can have a profound burden on patients’ quality of life and health outcomes, leading to irreversible scarring, infection, vulvar architectural distortion, genitourinary complications, itch, and pain syndromes [3]. There is a limited understanding of disease pathogenesis and no FDA-approved treatment options, with current guidelines recommending lifelong treatment. In the context of Vulvar Lichen Sclerosus, Skin biopsies are considered the standard method for detecting LS. However, they have certain drawbacks, as they are invasive, particularly in the sensitive vulvar area, and can be time-consuming. Approximately 5% of women with LS eventually develop vulvar squamous cell carcinoma (SCC), and half of all vulvar cancers arise in the presence of LS [4]. Therefore, patients need frequent monitoring, often requiring additional biopsies to assess the development of SCC or its precursors in longstanding LS lesions. Given the challenges associated with diagnosing VLS and monitoring SCC development in the context of an inflammatory skin condition, there is a high demand for noninvasive, high-sensitivity, real-time imaging techniques that can be performed in vivo. Hence, our study involves the design and development of a 1.7-μm optical coherence tomography angiography (OCTA) technique for diagnosing and monitoring of VLS lesions.

Optical coherence tomography (OCT) is a non-invasive diagnostic method that offers real-time visualization of the layered architecture of the skin in vivo. The 1.7-micron OCT system has been applied in cardiology, gynecology and dermatology, demonstrating an improved penetration depth in contrast to conventional 1.3-micron OCT. To further extend the capability, we developed a 1.7-micron OCT/OCT angiography (OCTA) system that allows for visualization of both morphology and microvasculature in the deeper layers of the skin. Using this imaging system, we imaged human skin with different benign lesions and described the corresponding features of both structure and vasculature. The significantly improved imaging depth and additional functional information suggest that the 1.7-micron OCTA system has great potential to advance both dermatological clinical and research settings for characterization of benign and cancerous skin lesions.

Objective

Develop a multi-functional imaging system that combines 1.7 µm optical coherence tomography/angiography (OCT/OCTA) to accurately interrogate Hereditary Hemorrhagic Telangiectasia (HHT) skin lesions.

Methods

The study involved imaging HHT skin lesions on five subjects including lips, hands, and chest. We assessed the attributes of both HHT lesions and the healthy vasculature around them in these individuals, employing quantifiable measures such as vascular density and diameter. Additionally, we performed scans on an HHT patient who had undergone anti-angiogenic therapy, allowing us to observe changes in vasculature before and after treatment.

Results

The results from this pilot study demonstrate the feasibility of evaluating the HHT lesion using this novel methodology and suggest the potential of OCTA to non-invasively track HHT lesions over time. The average percentage change in density between HHT patients' lesions and control was 37%. The percentage increase in vessel diameter between lesion and control vessels in HHT patients was 23.21%.

Conclusion

In this study, we demonstrated that OCTA, as a functional extension of OCT, can non-invasively scan HHT lesions in vivo. We scanned five subjects with HHT lesions in various areas (lip, ear, finger, and palm) and quantified vascular density and diameter in both the lesions and adjacent healthy tissue. This non-invasive method will permit a more comprehensive examination of HHT lesions.

Significance

This method of non-invasive imaging could offer new insights into the physiology, management, and therapeutics of HHT-associated lesion development and bleeding.

Obstructive sleep apnea (OSA) is a common upper airway disorder with severe long-term health impacts. There is a critical need for methods that provide quantitative information on dynamic airway collapse during sleep; information not available from sleep studies or conventional Imaging (e.g., CT). We present an alternative minimally invasive approach that combines drug-induced sleep endoscopy (DISE) with optical coherence tomography (OCT) and deep learning. These studies generate a massive volume of data, hence automated methods are needed using deep learning/convolutional neural networks (CNNs) to segment images. This strategy enhances the identification of critical regions prone to collapse, providing a robust tool to optimize treatment for OSA.