Cervical tumor characterization by transvaginal color flow Doppler ultrasound

The aim of the study was to investigate the blood flow characteristics of benign cervical lesions and invasive cervical tumors and to determine if invasive cervical tumors can be predicted by transvaginal sonography (TVS) and color flow Doppler (CFD). The study design incorporated an open prospective collection of data from patients attending the Women's Cancer Center, University of Minnesota and the Sydney Women's Cancer Center. Inclusion criteria included patients with known benign or malignant cervical pathology. The study group of 66 patients comprised 32 patients with invasive cervical cancer and 34 patients with benign cervical lesions. Benign cervixes were significantly more likely to have absent or normal flow whereas malignant lesions were significantly more likely to have abnormal or increased flow (P < 0.0001). No differences in the uterine or intratumor systolic, diastolic, or mean velocity were found between the two groups. A reduction in the uterine artery pulsatility index (PI) and resistance index (RI) from 1.84 to 1.55 and 0.73 to 0.71, respectively, and also in the intracervical PI from 1.5 to 1.1, in the benign compared to invasive group was found, none of which reached statistical significance. However the intracervical RI was statistically lower (0.62) in malignant tumors compared to patients with benign lesions (0.71) (P = 0.03). The effect of menopause on blood flow characteristics was variable and overall not significant. While the uterine artery systolic velocity was significantly higher in premenopausal women, no such effect was found for the diastolic or mean velocity or the PI and RI. In postmenopausal women, the intratumor PI and RI were higher compared to premenopausal women. In conclusion, transvaginal CFD analysis of the uterine arterial or intratumor bed does not appear to be beneficial in attempting to distinguish benign from malignant cervical tumors.