Incremental angiogenesis assessed by color doppler ultrasound in the tumorigenesis of ovarian neoplasms

Abstract

Background. The crucial role of angiogenesis in tumor behavior has been studied extensively in vitro. The authors assessed the in vivo angiogenesis in ovarian neoplasms by color Doppler ultrasound and waveform analysis. Methods. The intratumor artery resistance index (RI) of 222 ovarian neoplasms referred for color Doppler ultrasound evaluation was measured, and the corresponding histopathologic diagnosis was recorded. Results. Satisfactory intratumor artery waveforms were obtained at an average of 1.12 sites in 44.7% (68 of 152) of benign tumors and at 6.28 sites in 97.1% (68 of 70) of the malignant group. Great heterogeneity in RI values existed. The RI of the intratumor artery in the benign group during the follicular phase (mean, 0.678) was significantly higher (P <0.001) than that of the lteal phase (mean, 0.414), epithelial ovarian carcinoma (n = 34; mean, 0.402), malignant germ cell tumor (n = 6; mean, 0.413), malignancy metastasized to the ovary (n = 18; mean, 0.357), and other rare malignancies (n = 4; mean, 0.435). The RI of primary ovarian malignancy (n = 41; mean, 0.411) was significantly higher than that of malignancy metastasized to the ovary (P <0.05). The RI values of epithelium‐originated neoplasms showed a significant incremental decrease from benign tumors (n = 48; mean, 0.695) toward borderline malignancy (n = 6; mean, 0.535; P <0.01), early‐stage ovarian carcinoma(n = 10; mean, 0.485; P <0.01), and, finally, to advanced‐stage ovarian malignancies (n = 29; mean, 0.398; P <0.05). Conclusions. Angiogenesis is a common phenomenon in malignant ovarian neoplasms, but the intensity of neovascularization may depend on individual tumor characteristics. The authors documented the incremental decrease of the resistance index in ovarian neoplasms, which may reflect the increase in angiogenesis intensity as an indication of malignant potential. Cancer 1994; 73:1251–6.

The preoperative diagnosis of borderline ovarian tumors: a review of current literature

“…In addition, up to 17% of BOTs appear as unilocular smooth anechoic cysts without endophytic papillary growth [17,[35][36][37]39] resulting in low sensitivity of ultrasonography in the diagnosis of BOT. Some authors observed a gradual decrease in the mean value of resistance index (RI) and pulsatility index (PI) from benign tumors, via BOT, to invasive ovarian malignancies [40][41][42]. Other authors reported significant differences in PI and RI values between BOT and benign tumors, while no difference was observed between BOT and malignant tumors [13,26,34,35,39].…”

Accuracy of Ultrasonography With Color Doppler in Ovarian Tumor

“…21,23,26,28Y30 Six studies were nonblinded and prospective with a small population, but included sufficient experimental details, proper diagnostic tests and diagnostic reference standards. 20,21,23,26,28,30 Of the 12 included studies, 6 had high 20,21,23,26,28,30 methodological quality, satisfying 55% or higher of the criteria for study quality and with an Oxford Evidence level of 2B. 11 However, 6 studies 19,22,24,25,27,29 were classified as level 3B because details of the patients, including age, were not reported and because they met lower than 50% of the quality criteria.…”

Color Doppler Ultrasonographic Flow Parameters in the Differentiation of Benign and Malignant Causes of Omental Thickening

“…4 The intensity of neovascularization may depend on individual tumor characteristics. Wu et al 25 documented an incremental decrease of the RI in ovarian neoplasms, which might reflect the increase in angiogenesis intensity as an indication of malignant potential. Because of deficient smooth muscle layer in the media of tumor vessels and presence of arteriovenous shunting, the vessels in malignant tumors have low impedance that leads to high diastolic flow and low systolic-diastolic difference (lower RI).…”