CLINICAL-APPLICATION OF INTRATUMORAL BLOOD-FLOW STUDY IN PATIENTS WITH ENDOMETRIAL CARCINOMA

BACKGROUND, The objective of this study was to evaluate the correlatio n between intratumoral blood flow as assessed by color Doppler ultraso und with stage, tumor grade, depth of invasion, and lymph node metasta sis in endometrial carcinoma and determine its clinical usefulness. ME THODS, Sixty-six patients with endometrial carcinoma were enrolled. Al l patients received surgical treatment. Transvaginal color Doppler ult rasound was performed before surgery to detect the arterial blood flow signals within the tumors and the lowest resistance index (RI) was re corded. Formalin fixed, paraffin embedded pathology slides were review ed by a senior pathologist to evaluate the histologic grading, tumor s ize, depth of myometrial invasion, and presence of lymph node metastas is. RESULTS. Intratumoral RI correlated well with surgical staging, hi stologic grading, the depth of myometrial invasion, and the presence o f lymph node metastasis. Significantly lower RI was noted in tumors of advanced stage (> than International Federation of Obstetrics and Gyn ecology [FIGO] Stage I) (0.38 +/- 0.09 vs. 0.54 +/- 0.11; P < 0.001), tumors with higher histologic grade (Grade 3) (0.36 +/- 0.08 vs. 0.53 +/- 0.11; P < 0.001), tumors with deep myometrial invasion (> 50% myom etrial thickness) (0.38 +/- 0.07 vs. 0.54 +/- 0.11; P < 0.001), and tu mors with lymph node metastasis (0.34 +/- 0.07 vs. 0.52 +/- 0.11; P < 0.001) compared with tumors with Stage I, Grade 1/2 histology, no or s uperficial myometrial invasion, and absence of lymph node metastasis, respectively. CONCLUSIONS. Intratumoral blood flow analysis assessed b y color Doppler ultrasound correlates well with surgical stage, tumor grade, myometrial invasion, and lymph node metastasis in patients with endometrial carcinoma. Assessment of tumor angiogenesis using color D oppler ultrasound provides useful information for the preoperative pre diction regarding stage, histologic grade, depth of myometrial invasio n, and presence of lymph node metastasis in patients with endometrial carcinoma. The authors believe routine pelvic lymph node dissection sh ould be performed for those patients whose lowest RI values of intratu moral blood flow are less than or equal to 0.4 because those patients are at very high risk for pelvic lymph node involvement. (C) 1998 Amer ican Cancer Society.