The Applications Of Three-dimensional Power Doppler Sonography In The Diagnosis And Treatment Of Cervical Cancer

PART ONEObjective To characterize intratumoral vascularization in early stage cervical cancer by three-dimensional(3D) power Doppler ultrasoundMethods Thirty patients with early-stage cervical cancer (cervical cancer group), twenty patients with CIN(CIN group) and twenty-five normal control(control group) were studied by transvaginal 3D power Doppler ultrasound. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) within the tumor or normal cervix were recorded and used for analysis. Vascular blood flow indices of cervical cancer were compared with those of CIN and normal control. The tumor volume of the cervical cancer was determined. The relationship between parameters and cervical tumor volume were analyzed.Results The mean VI, FI and VFI of cervical cancer group were (4.99±3.09)%, (41.34±4.56) and (2.12±1.49), respectively. While those in CIN group were (1.88±0.56)%, (39.16±3.22) and (1.25±0.57) respectively. And those in control group were (0.78±0.21)%, (38.11±2.72) and (0.48±0.21) respectively. VI, FI and VFI in cervical cancer group were significantly higher than those in CIN group and control group. VI and VFI in CIN group were also significantly higher than those in control group. The mean tumor volume of cervical cancer group measured by 3D-PDUS was (42.58±27.82) ml. The tumor volume was positively correlated with FI (r=0.464, P= 0.02), but not with VI or VFI.Conclusion 3D power Doppler ultrasound provides a useful tool to investigate intratumoral vascularization and volume of cervical cancer. PART TWOObjective To evaluate the potential role of 3D power Doppler ultrasound in predicting response to transarterial chemoembolization in cervical cancer.Methods Twenty-six women with cervical cancer treated by TACE followed by surgery were enrolled. Clinical characteristics and pathologic data were recorded. 3D power Doppler ultrasound was performed before and after TACE. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) within the tumor were recorded and used for analysis. All patients were clinically evaluated by physical examination and 3D power Doppler ultrasound after TACE. Their response to TACE was evaluated.Results Twenty(76.9%) patients including two complete response and eighteen partial response showed a response (responders) to TACE and six(23.1%) patients were stable or had progressive disease (nonresponders) after TACE. The tumor volume, VI, FI and VFI of the responders before TACE were (40.3±23.2)ml, (5.4±3.5)%, (40.9±4.3) and (2.3±1.6) respectively. The tumor volume, VI, FI and VFI of the nonresponders before TACE were (30.2±20.8)ml, (11.3±4.2)%, (44.0±3.9) and (5.1±2.2) respectively. VI and VFI of the nonresponders before TACE were significantly higher than those of the responders. No differences were found in tumor volume and FI. When the cutoff point for predicting nonresponders to TACE was set at a VI value of 6.6%, the sensitivity was 83.3% and the specificity 65%. When the cutoff point for predicting nonresponders to TACE was set at a VFI value of 2.77, the sensitivity was 83.3%and the specificity 65%.Conclusion The power Doppler vascularity index can predict the response to TACE in cervical cancer, and might be useful for the evaluation of response to TACE in cancer patients in the future.