The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix

Objective To investigate the pathological significance of intra-tumoural bl ood flow signals detected by colour Doppler ultrasound and their associatio n with angiogenesis in cervical carcinoma. Design A prospective cross-sectional study. Setting University hospital. Population One hundred and four women with Stage IB-IIA cervical carcinoma. Methods All women underwent radical hysterectomy and pelvic lymph node diss ection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra-tumoural resistance index were defined as tumour with d etectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochem ically. The women's clinical and pathologic data were recorded. Results There were 60 tumours (58%) exhibiting detectable intra-tumoural bl ood flow signals. Tumours with detectable blood flow were larger, had deepe r cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compa red with those without detectable blood flow. Cervical cancers with deep ce rvical stromal invasion, parametrial invasion, and pelvic lymph node metast asis had higher microvessel density than those with superficial stromal inv asion, no parametrial invasion, or no lymph node metastasis. Microvessel de nsity correlated well with lymph node metastases and parametrial invasion b y multiple regression analysis, while intra-tumoural blood signals only sho wed correlation with parametrial invasion. In the prediction of pelvic lymp h node metastases and parametrial invasion, colour flow Doppler had a sensi tivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0.91 and specificity of 0.57 in predicting parametrial invasion. Conclusions The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogene sis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra-tumoural blood flow signals mi ght be used as a screening test in predicting parametrial invasion and pelv ic lymph node metastases. These findings may be helpful in planning treatme nt for women with Stage I and II cervical carcinoma.