Cervical tumor characterization by transvaginal color flow Doppler ultrasound

Abstract

The aim of the study was to investigate the blood flow characteristics of benign cervical lesions and invasive cervical tumors and to determine if invasive cervical tumors can be predicted by transvaginal sonography (TVS) and color flow Doppler (CFD). The study design incorporated an open prospective collection of data from patients attending the Women's Cancer Center, University of Minnesota and the Sydney Women's Cancer Center. Inclusion criteria included patients with known benign or malignant cervical pathology. The study group of 66 patients comprised 32 patients with invasive cervical cancer and 34 patients with benign cervical lesions. Benign cervixes were significantly more likely to have absent or normal flow whereas malignant lesions were significantly more likely to have abnormal or increased flow (P < 0.0001). No differences in the uterine or intratumor systolic, diastolic, or mean velocity were found between the two groups. A reduction in the uterine artery pulsatility index (PI) and resistance index (RI) from 1.84 to 1.55 and 0.73 to 0.71, respectively, and also in the intracervical PI from 1.5 to 1.1, in the benign compared to invasive group was found, none of which reached statistical significance. However the intracervical RI was statistically lower (0.62) in malignant tumors compared to patients with benign lesions (0.71) (P = 0.03). The effect of menopause on blood flow characteristics was variable and overall not significant. While the uterine artery systolic velocity was significantly higher in premenopausal women, no such effect was found for the diastolic or mean velocity or the PI and RI. In postmenopausal women, the intratumor PI and RI were higher compared to premenopausal women. In conclusion, transvaginal CFD analysis of the uterine arterial or intratumor bed does not appear to be beneficial in attempting to distinguish benign from malignant cervical tumors.

Doppler Ultrasound Flow Evaluation of the Uterine Arteries Significantly Correlates with Tumor Size in Cervical Cancer Patients

“…13 Nevertheless, if our data are confirmed by prospective studies, evaluation of the uterine artery could be particularly useful in the follow-up of patients with cervical cancer during chemotherapy and/or radiotherapy, particularly as it has recently been demonstrated that bevacizumab, an antiangiogenic antibody, increases specific disease-free and overall survival in the advanced stages of gynecological neoplasms 20,21 including cervical cancer. 22 Furthermore, a pioneering study hypothesized and assumed that tumor size is strictly correlated to prognosis, 5 and knowledge of Doppler flow characteristics could be useful in monitoring patients, and could offer speculative advantages in predicting patients who will respond better to treatment.…”

“…However, only a few studies have been published to date, and their results were contradictory. [11][12][13][14][15][16][17][18] Our hypothesis was that the blood flow characteristics in the uterine arteries may be influenced by local expansion of the cervical cancer, increased by neoangiogenesis tumor-linked.…”

Intratumoral blood flow in cervical cancer as assessed by transvaginal color doppler ultrasonography: Correlation with tumor characteristics

“…However, this was challenged by Carter and colleagues (14) . None of these authors correlated intratumoral blood flow with tumor features.…”

Color Doppler velocimetry and three‐dimensional color power angiography of cervical carcinoma

“…The role of color Doppler parameters in the discrimination of benign from malignant ovarian neoplasms4–6, and in the analysis of vascularization in endometrial cancer7–9, has been extensively studied. Few data have been published on cervical tumors10–13, although some studies have tried to define the correlation between Doppler parameters and the pathological characteristics of cervical cancer14–17.…”