Testa A C, Ferrandina G, Distefano M, Fruscella E, Mansueto D, Basso D, Salutari V, Scambia G
Department of Gynecology/Obstetrics, Catholic University of the Sacred Heart, Rome, Italy.
Ultrasound Obstet Gynecol. 2004 Sep;24(4):445-52. doi: 10.1002/uog.1703.
To investigate the blood flow within invasive cervical carcinoma by transvaginal two-dimensional (2D) color spectral Doppler and three-dimensional (3D) color power angiography and to correlate these parameters with the clinicopathological characteristics.
Seventy-four patients with invasive cervical carcinoma were enrolled for the analysis. Squamous cell carcinoma serum antigen levels (SCC) were obtained for all the patients. Sections of all malignant tissues were analyzed for tumor expression of cyclooxygenase-2 (COX-2). All patients underwent color and spectral Doppler examination and 44 patients had 3D color power angiography. Color spectral Doppler parameters (color score, lowest resistance index (RI), highest peak systolic velocity (PSV)) and 3D color power angiography indices (relative color, average color, flow measure) of FIGO I/II cervical cancers were compared with those obtained in a control group of 24 patients with a normal uterine cervix. Pulsed Doppler parameters and the 3D vascular indices were compared with clinicopathological parameters, SCC serum antigen levels and tumor COX-2 expression.
At color Doppler analysis 72 patients (97%) showed intralesional detectable vessels. Color spectral Doppler and 3D-derived parameters were significantly different in FIGO I/II cervical cancers compared with those in women with a normal cervix. A significantly higher color score (P = 0.0008), lower RI (P = 0.032) and higher PSV (P = 0.004) were associated with a tumor diameter > or =4 cm compared with smaller tumors. The highest PSV was significantly higher in patients with FIGO stage III/IV compared with FIGO stage I/II (P = 0.0069). There was a direct correlation between PSV and SCC (r = +0.44, P = 0.003). The median relative color was significantly higher in patients with a higher color score (P = 0.0006). No statistically significant correlations were found between 3D color power angiography parameters and the clinicopathological characteristics or between the 3D vascular parameters and biological factors.
Alterations of 3D ultrasound-derived vascular indices were found in patients with cervical cancer compared with those with a normal cervix. Moreover, some vascular indices proved to be associated with tumor size. The assessment of a possible clinical role of 2D and 3D ultrasound-derived vascular indices in cervical cancer deserves further investigation.
通过经阴道二维（2D）彩色频谱多普勒和三维（3D）彩色能量血管造影研究浸润性宫颈癌的血流情况，并将这些参数与临床病理特征进行关联分析。
纳入74例浸润性宫颈癌患者进行分析。获取所有患者的鳞状细胞癌血清抗原水平（SCC）。对所有恶性组织切片进行环氧合酶-2（COX-2）肿瘤表达分析。所有患者均接受彩色和频谱多普勒检查，44例患者进行了3D彩色能量血管造影。将国际妇产科联盟（FIGO）I/II期宫颈癌的彩色频谱多普勒参数（彩色评分、最低阻力指数（RI）、最高收缩期峰值速度（PSV））和3D彩色能量血管造影指标（相对色彩、平均色彩、血流测量值）与24例正常宫颈患者的对照组所获得的参数进行比较。将脉冲多普勒参数和3D血管指标与临床病理参数、SCC血清抗原水平及肿瘤COX-2表达进行比较。
在彩色多普勒分析中，72例患者（97%）显示病灶内可检测到血管。FIGO I/II期宫颈癌的彩色频谱多普勒和3D衍生参数与正常宫颈女性相比有显著差异。与较小肿瘤相比，肿瘤直径≥4 cm时，彩色评分显著更高（P = 0.0008），RI更低（P = 0.032），PSV更高（P = 0.004）。FIGO III/IV期患者的最高PSV显著高于FIGO I/II期患者（P = 0.0069）。PSV与SCC之间存在直接相关性（r = +0.44，P = 0.003）。彩色评分较高的患者，其相对色彩中位数显著更高（P = 0.0006）。在3D彩色能量血管造影参数与临床病理特征之间，以及3D血管参数与生物学因素之间未发现统计学上的显著相关性。
与正常宫颈患者相比，宫颈癌患者的3D超声衍生血管指标存在改变。此外，一些血管指标被证明与肿瘤大小有关。2D和3D超声衍生血管指标在宫颈癌中可能的临床作用评估值得进一步研究。
