Study On The Disease Of Endometrium With Three Dimensional Color Power Doppler In Women With Postmenopausal Bleeding

ObjectiveMalignant tumors are highly dependent on vascularization for their growth and spread. Three-dimensional(3D) power Doppler ultrasound is a non-invasive technology that evaluates the blood flow of pelvoc organs. Three-dimensional power Doppler ultrasound is a relatively new technique that allows tumor vascularization assessment,both quantitatively by means of 3D-PDU-derived vascular indices and qualitatively by depicting three-dimensionally the tumor vascular network.The aim of the present study was to assess whether differences exist in vascularization as assessed by 3D-CPA between benign and malignant endometrial conditions in women with postmenopausal bleeding;and to find the correlation between tumor angiogenesis assessed by 3D-power Doppler ultrasound and MVD in endometrial cancer.Materials and MethodsFrom June 2009 to March 2010,an analysis was performed of 77 women with postmenopausal bleeding at Shengjing Hospital,China Medical University.All patients were assessed by 3D-CPA before endometrial biopsy in 1-3days.All the endometrial carcinoma patients were staged clinically according to the staging system of the International Federation of Gynecology and Obstetrics(FIGO)。The equipment used in the study was Philips iu22 Expert with an multifrequency (3-9MHz) endovaginal protocol.First,each patient underwent systematic gray-scale examination of uterus and ovaries with special emphasis on the cervix.Following B-mode evaluation,the two-dimensional power Doppler gate was activated to assess vascularization.Resistance Index(RI),pulsatility index (PI) and Peak Systolic Velocity (PSV,cm/s) were recorded automatically.And then the three-dimensional power Doppler mode was switched on.Then the QLAB program was used to achieve vascularization index(VI).All clinicopathologic data were obtained.All the cervical tissue samples were obtained after operation.MVD of the tissue samples was assessed by immunohistochemical method(SP method).The statistical data were analyzed using the Statistical Package for the Social Sci-ences(SPSS)15.0.Comparisons were performed by Dunnett-t-test, Independent Samples T Test and Pearson correlation analysis.P value<0.05 was considered to be significant.Results1.Significant differences between means for benign and malignant endometrial conditions were found for following parameters:PSV,PI,RI,VI.The PSV,PI,RI,VI in endometrial carcinoma was significantly lower than that in benign endometrial condition.On the basis of the analysis of ROC curve,it shows the cut off values of PI,RI and VI respectively are 0.48,0.45,15.00/cm3.2.There was a sigmificant positive correlation between MVD and VI (r=0.717). There were no significant correlation in PSV,PI,RI and MVD.3.the relationship of clincopathologocal characteristics and 3D-CPA parameters or MVD in endometrial carcinoma:(1) Significantly differences of VI and MVD values were noted in Stage II tumors compare with Stage I tumor and in stage late compare with Stage II tumor.(2) There were no significant differences in all values regard to histologic grades.(3) Significant differences between means for endometrial cancer with lymph node metastasis and tumors without lymph node metastasis were found for following parameters:RI,VI and MVD.Conclusions1.3D-CPA had important reference value in diagnosis and differential diagnosis of endometrium lesions.2. There was a significant positive correlation between MVD and VI.Thus, MVD and VI could be used as useful in vivo indicators of tumor angiogenesis in endometrial carcinoma,and observe the biological behavior of tumors and prediction of the prognosis of patients with endometrial cancer.