Hsieh C Y, Wu C C, Chen T M, Chen C A, Chen C L, Wang J F, Chang C F, Hsieh F J
Department of Obstetrics and Gynecology, National Taiwan University, College of Medicine, Taipei.
Cancer. 1995 May 15;75(10):2518-22. doi: 10.1002/1097-0142(19950515)75:10<2518::aid-cncr2820751018>3.0.co;2-a.
Much evidence has suggested that vascular density reflects the clinical behavior of cancer. In this study, the intratumoral blood flow in cervical carcinomas was assessed by transvaginal color Doppler ultrasound, and its clinical significance was evaluated.
Sixty-five patients with Stage Ib-IIb cervical carcinoma exhibiting visible cervical tumor by transvaginal ultrasound were enrolled. All patients were scheduled for radical hysterectomy and pelvic lymph node dissection. Transvaginal color Doppler ultrasound was performed before surgery to search for blood flow signals from the tumor and the main uterine artery. The corresponding arterial resistance index (RI) was calculated. Clinical and pathologic data were recorded. A cytokinetic study was performed by propidium iodide staining and flow cytometry. The human papillomavirus (HPV) status was assessed by polymerase chain reaction.
Intratumoral blood flow was detected by color Doppler ultrasound in 46.2% (30/65) of the tumors. Patients with detectable intratumoral blood flow exhibited significantly more pelvic lymph node metastasis (10/30 vs. 2/35, P = 0.005), a higher percentage of cancer cells in the S- + G2M-phase (30.02 +/- 18.54% vs. 19.35 +/- 11.21%, P < 0.005), and a higher prevalence of HPV infection (30/30 vs. 25/35, P = 0.001) when compared with those without intratumoral blood flow. No significant difference was observed concerning the patient's age, tumor size, clinical staging, histologic type, and DNA ploidy status between these two groups. Regression analysis of the intratumoral RI value on the S- + G2M-phase fraction showed linear regression (n = 30, r2 = 0.501, P < 0.01). The RI values of the main uterine artery showed no significant difference between these two groups.
The intratumoral blood flow by transvaginal color Doppler ultrasound correlated well with a higher proliferation index, higher incidence of HPV infection, and pelvic lymph node metastasis in cervical carcinoma.
大量证据表明血管密度反映癌症的临床行为。在本研究中，通过经阴道彩色多普勒超声评估宫颈癌的瘤内血流情况，并对其临床意义进行评估。
纳入65例经阴道超声显示宫颈可见肿瘤的Ib-IIb期宫颈癌患者。所有患者均计划行根治性子宫切除术及盆腔淋巴结清扫术。术前进行经阴道彩色多普勒超声检查，以寻找肿瘤及子宫主要动脉的血流信号。计算相应的动脉阻力指数（RI）。记录临床和病理数据。通过碘化丙啶染色和流式细胞术进行细胞动力学研究。通过聚合酶链反应评估人乳头瘤病毒（HPV）状态。
彩色多普勒超声检测到46.2%（30/65）的肿瘤存在瘤内血流。与无瘤内血流的患者相比，有瘤内血流检测结果的患者盆腔淋巴结转移明显更多（10/30对2/35，P = 0.005），处于S期 + G2M期的癌细胞百分比更高（30.02±18.54%对19.35±11.21%，P < 0.005），HPV感染患病率更高（30/30对25/35，P = 0.001）。两组患者在年龄、肿瘤大小、临床分期、组织学类型和DNA倍体状态方面未观察到显著差异。瘤内RI值与S期 + G2M期分数的回归分析显示呈线性回归（n = 30，r2 = 0.501，P < 0.01）。两组之间子宫主要动脉的RI值无显著差异。
经阴道彩色多普勒超声检测到的瘤内血流与宫颈癌较高的增殖指数、较高的HPV感染发生率及盆腔淋巴结转移密切相关。
