Optical coherence tomography enables optical biopsy of endometrial tissue for early cancer detection.

Endometrial cancer is the most common malignancy of the female reproductive tract, yet diagnosis relies on invasive tissue sampling with risk of false negatives. We report an initial investigation of catheter-based 3D optical coherence tomography (OCT) integrated with functional, structural, and radiomic feature analysis for noninvasive endometrial assessment in ex vivo specimens. A custom 3.1-mm OCT catheter acquired volumetric images from 57 intact uterine specimens spanning normal endometrium, benign conditions, high-risk endometrial intraepithelial neoplasia, and endometrial cancer. Functional, structural, and radiomic features were extracted from OCT intensity and scattering images. Statistically significant features were selected to construct a cosine similarity matrix and a cosine-similarity network graph. Cosine-similarity visualization demonstrated exploratory sensitivity and specificity of 94% and 87%, while a cross-validated Logistic Regression Classifier yielded sensitivity and specificity of 91% and 83%. These findings support catheter-based 3D OCT as a promising noninvasive optical biopsy approach to improve detection of endometrial cancer.