title: Three-dimensional power Doppler ultrasound in cervical carcinoma: monitoring treatment response to radiotherapy.
abstract: OBJECTIVE
  To investigate, using three-dimensional power Doppler ultrasound (3D-PDU), alterations in cervical intratumoral vascularization during and after radiotherapy.
  
  
  METHODS
  Between 2004 and 2009 we enrolled into the study 37 patients with FIGO Stages IB1-IIB cervical carcinoma who were undergoing radiotherapy. Serial 3D-PDU scans were performed during treatment, providing ultrasonographic measurement of tumor size, vascularization index, flow index and vascularization flow index, as well as monthly for 3 months post-treatment and tri-monthly thereafter, until vascularity was undetectable on two consecutive occasions. Physical examination, cervical cytology and serum marker evaluation were performed every 3-6 months for the first 5 years following treatment. Patients evaluated after a 2-year tumor-free interval and those with clinically assessed positive findings at follow-up underwent 3D-PDU to detect possible local disease.
  
  
  RESULTS
  A total of 329 3D-PDU scans were performed in the 37 women. Cervical tumors and intratumoral vascularization disappeared within 3 months following radiotherapy, except in one patient with persistent disease. Nine patients had disease relapse, in four of whom the recurrence was local. In three of these four, there was recurrence of tumor and vascularization after a complete response. At follow-up, 3D-PDU detected local disease with 75.0% sensitivity and 98.5% specificity, while serum markers detected local disease among 34 patients with squamous cell carcinoma with 20.0% sensitivity and 77.3% specificity.
  
  
  CONCLUSIONS
  Compared with serum markers in cervical squamous cell carcinoma, 3D-PDU has higher sensitivity and specificity for detecting local recurrence or persistence in cervical carcinoma. Thus, 3D-PDU combined with clinical assessment may be a new and safe method for monitoring radiotherapy treatment response and detecting local recurrence.
authors: Department of Obstetrics & Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Y-F
authors: YF
authors: Huang
authors: Y-M
authors: YM
authors: Cheng
authors: Y-P
authors: YP
authors: Wu
authors: H H W
authors: HH
authors: Chen
authors: K-F
authors: KF
authors: Hsu
authors: Y-H
authors: YH
authors: Wu
authors: C-Y
authors: CY
authors: Chou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D002584:Cervix Uteri / Q000098:blood supply / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009389:Neovascularization, Pathologic; D010808:Physical Examination; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D047368:Tumor Burden; D018615:Ultrasonography, Doppler, Color; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D014621:Vagina / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers