Doppler ultrasound predicts spread of endometrial cancer

Doppler sonography and 3D power Doppler angiography can distinguish between endometrial cancer and hyperplasia, according to researchers in Spain. The standard measurement of endometrial thickness alone, however, did not significantly differentiate between the two conditions.

Dr. Luis T. Mercé at International Ruber Hospital in Madrid and colleagues at other hospitals in Madrid and Guadalajara published their research in the October 2007 issue of the Journal of Ultrasound in Medicine. They set out to understand better how 3D power Doppler ultrasound compares with the standard method of evaluating symptoms of endometrial cancer: ultrasound measurement of endometrial thickness.

The researchers studied 84 women with uterine bleeding. All underwent biopsies, and from these 29 received a diagnosis of endometrial hyperplasia, and 55 were diagnosed with endometrial carcinoma. All 84 patients received transvaginal 3D sonography and power Doppler angiography exams prior to surgery.

The exams measured endometrial thickness, endometrial volume, vascularization index, flow index, the vascularization-flow index, and intratumoral resistive index.

The researchers found that patients with endometrial carcinoma had significantly higher endometrial volume, vascularization index, flow index, and vascularization-flow index, along with a significantly lower intratumoral resistive index. They discovered they could predict endometrial carcinoma using a cutoff of 2.07 on the vascularization-flow index with a sensitivity of 76.5% and specificity of 80.8%.

All the 3D power Doppler measurements were significantly higher when the cancer had spread to more than 50% of the myometrium. The endometrial vascularization index, in particular, was significantly higher when tumors were at a stage higher than 1. The intratumoral resistive index was significantly lower in those patients with a high histologic grade, myometrial infiltraion of more than 50%, and lymph node metastases. Endometrial thickness, however, had no significant correlation to either condition.

The researchers concluded that 3D power Doppler indices, vascularization index, and intratumoral resistive index are better measurements than endometrial thickness for differentiating between hyperplasia and endometrial carcinoma. They found that intratumoral blood flow, as measured by pulsed Doppler ultrasound and power Doppler angiography, can predict how far endometrial carcinoma has infiltrated into other organs.