Clinical application of intratumoral blood flow study in patients with endometrial carcinoma

• Published in: Cancer Vol. 82; no. 10; pp. 1881 - 1886
• Main Authors: Cheng, Wen‐Fang, Chen, Tzer‐Ming, Chen, Chi‐An, Wu, Chih‐Cheng, Huang, Kuang‐Ta, Hsieh, Chang‐Yao, Hsieh, Fon‐Jou
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.05.1998; Wiley-Liss
• Subjects: Adult; Aged; Biological and medical sciences; Cervix Uteri; Doppler ultrasound; endometrial carcinoma; Endometrial Neoplasms - blood supply; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; intratumoral blood flow; Linear Models; lymph node; Lymphatic Metastasis; Medical sciences; metastasis; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Preoperative Care - methods; Regional Blood Flow; Tumors; Ultrasonography, Doppler, Color; Sonography; Doppler ultrasound study; Histological grading; Human; Carcinoma; Lymph node; Malignant lymphadenopathy; Malignant hemopathy; Tumorous infiltration; Malignant tumor; Metastasis; Depth; Female genital diseases; Pathology; Clinical stage; Histopathology; Uterine diseases; Hemodynamics; Endometrium
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980515)82:10<1881::AID-CNCR10>3.0.CO;2-P

BACKGROUND The objective of this study was to evaluate the correlation between intratumoral blood flow as assessed by color Doppler ultrasound with stage, tumor grade, depth of invasion, and lymph node metastasis in endometrial carcinoma and determine its clinical usefulness. METHODS Sixty‐six patients with endometrial carcinoma were enrolled. All patients received surgical treatment. Transvaginal color Doppler ultrasound was performed before surgery to detect the arterial blood flow signals within the tumors and the lowest resistance index (RI) was recorded. Formalin fixed, paraffin embedded pathology slides were reviewed by a senior pathologist to evaluate the histologic grading, tumor size, depth of myometrial invasion, and presence of lymph node metastasis. RESULTS Intratumoral RI correlated well with surgical staging, histologic grading, the depth of myometrial invasion, and the presence of lymph node metastasis. Significantly lower RI was noted in tumors of advanced stage (> than International Federation of Obstetrics and Gynecology [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% myometrial thickness) (0.38 ± 0.07 vs. 0.54 ± 0.11; P < 0.001), and tumors 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 superficial myometrial invasion, and absence of lymph node metastasis, respectively. CONCLUSIONS Intratumoral blood flow analysis assessed by 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 Doppler ultrasound provides useful information for the preoperative prediction regarding stage, histologic grade, depth of myometrial invasion, and presence of lymph node metastasis in patients with endometrial carcinoma. The authors believe routine pelvic lymph node dissection should be performed for those patients whose lowest RI values of intratumoral blood flow are ≤ 0.4 because those patients are at very high risk for pelvic lymph node involvement. Cancer 1998;82:1881‐6. © 1998 American Cancer Society. Intratumoral blood flow using color Doppler ultrasound can predict pelvic lymph node metastasis in patients with endometrial carcinoma.