Assessment of cervical vascularization density in patients with locally advanced squamous cell cervical carcinoma evaluated in colour Doppler and power Doppler functions

Abstract

Purpose The aim of the prospective study was to assess changes during treatment and prognostic significance of cervical vascularization density in patients with cervical squamous cell carcinoma (SCC) staged II B and III B and to find relationship of cervical vascularization density with tumour diameter, grading, staging and age of patients. Methods The study group included 50 patients who underwent transvaginal Doppler ultrasonography prior to chemoradiotherapy, after external beam radiation therapy (EBRT) and 6 weeks after HDR brachytherapy. The colour Doppler (CD) vascularity index (CDVI) and the power Doppler (PD) vascularity index (PDVI) in cervical tumour were examined. Results CDVI and PDVI values decreased significantly during radiotherapy (0.13 (95% CI 0.09–0.16); 0.09 (95% CI 0.07–0.11) and 0.05 (95% CI 0.03–0.06) for CDVI (p < 0.001) and 0.26 (95% CI 0.22–0.31); 0.18 (95% CI 0.14–0.22) and 0.08 (95% CI 0.06–0.11) for PDVI (p < 0.001)). No statistically significant associations of CDVI and PDVI with tumour diameter, grading, staging and age of patients were found. The higher (above median) CDVI values before EBRT were associated with better OS (p = 0.041). The higher (above median) PDVI values before EBRT were associated with superior DFS (p = 0.011) and OS (p < 0.001). DFS and OS did not differ significantly regarding CDVI and PDVI values after EBRT and after the treatment. Conclusions In the study group, cervical vascularization density evaluated in CD and PD functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy. The prognosis for our patients with CDVI and PDVI before the treatment above the median value was better than compared to patients with these parameters below the median value.

Quantitative analysis of superb microvascular imaging for monitoring tumor response to chemoradiotherapy in locally advanced cervical cancer

“…Changes of vascularization are potential non-invasive markers for tumor response forecast to CRT in patients with cervical cancer ( 30 ). According to previous studies, using transvaginal color Doppler US (TVCD), 3-dimensional power Doppler angiography (3D-PDA) and CEUS to evaluate tumor vascularity correlates with some tumor features and could provide a means for predicting clinical response to CRT in patients with LACC ( 18 , 19 , 28 , 31 ). Moreover, it is demonstrated that strain elastography was useful as an early predictor of respond and long-term outcomes after CCRT for patients with cervical cancer ( 13 ).…”

“…Color or power Doppler US plays an indispensable role in assessing tumor angiogenesis and predicting the efficacy of CRT in cervical cancer ( 18 , 19 ). Unfortunately, color or power Doppler US is limited by a wall filter to truly distinguish between low-flow components and clutter motion artifacts, which makes the fine vessels of cervical lesions potentially undetectable.…”