Evaluation of Potential Imaging Targets for Positron Emission Tomography (PET) in the Microenvironment of Endometriosis

Project descpription:

Endometriosis affects approximately 10% of fertile women, causing significant pain and infertility, yet non-invasive diagnostic tools remain inadequate. […] This project aims to address these challenges by developing a novel diagnostic approach using Positron Emission Tomography (PET). PET offers higher resolution and sensitivity for detecting and characterizing tissues. Recent research has shown that endometriotic lesions are rich in relaxed fibronectin (Fn), particularly in the stroma and areas of reactive fibrosis. Preliminary studies have successfully stained Fn in endometriotic tissues, suggesting it could serve as a promising target for PET imaging. The project proposes a detailed analysis of several extracellular matrix proteins, including relaxed fibronectin, fibroblast activation protein (FAP), matrix metalloproteinases, and integrins, using immunohistochemistry. These markers will be correlated with MRI and ultrasound findings, as well as intraoperative observations and histopathology results. The goal is to identify an optimal target for PET imaging that can differentiate active, painful endometriotic tissue from scar tissue, thereby improving preoperative lesion localization and surgical planning. This approach could potentially allow for earlier, more accurate diagnosis, better patient management, and improved pain relief after surgery.

Preliminary results: 

Endometriosis is the presence of endometrial tissue outside of the endometrium and myometrium, consisting of endometrial glands and/or stroma. It often causes chronic pain, infertility, and reduced quality of life due to chronic inflammation surrounding theendometrial tissue. Reliable non-invasive diagnostic methods remain limited, and definitive diagnosis still requires surgery. This leads to significant delays and makes optimal treatment planning more difficult.
The aim of this project is to identify molecular targets within endometriotic tissue that could enable more accurate, non-invasive detection using advanced imaging techniques such as positron emission tomography (PET).
In a prospective single-center study, tissue samples from 20 patients were collected during surgery and systematically correlated with preoperative MRI and ultrasound findings. Immunohistochemical staining for several promising molecular markers,including relaxed fibronectin, fibroblast activation protein, integrins, matrix metalloproteinases and tenascin-C has been successfully completed. Endometriotic lesions will be identified and annotated, providing the basis for correlating imaging findings with histopathological and molecular results.
The ongoing analysis aims to identify the most suitable imaging targets, with the long-term goal of improving early detection, enabling more precise treatment planning, andadvancing non-invasive diagnosis for patients with endometriosis.

About Bastian Schulz:

Dr. med. Bastian Schulz, has been working as an assistant physician at the Institute of Legal Medicine in Zurich since 2020. In 2023, he completed a research year in radiology at Kantonsspital Baden, during which he published three papers and one case report as first author and contributed to a industrial whitepaper. Since June 2024, he has been in a rotational year in pathology at Kantonsspital Baden. Alongside his work in pathology, he is involved in the Endometriosis Project, a multidisciplinary collaboration between the departments of radiology, nuclear medicine, and gynecology at Kantonsspital Baden, in partnership with PSI and ETH Zürich.

About Nicole Mikos:

Nicole Mikos is a physician in specialist training in forensic medicine at the University of Zurich. She studied human medicine at Johannes Gutenberg University Mainz and completed clinical rotations in surgery and pathology as part of her postgraduate training. She is part of an interdisciplinary team involving ETH Zurich, Paul Scherrer Institute, and collaborators in pathology, radiology, and nuclear medicine, working on the evaluation of potential imaging targets for Positron Emission Tomography in the microenvironment of Endometriosis.