Identification of vascular hotspots and analysis of micro‐vessel flow velocity waveforms in high‐grade squamous intraepithelial lesions of the cervix
Abstract
Objectives
To assess hotspot micro‐vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV‐PDU) and explore associations with high‐grade squamous intraepithelial lesions (HSIL, cervical intraepithelial neoplasia [CIN] II and III).
Methods
In all, 62 patients with confirmed HPV‐HSIL (14 CIN II, 48 CIN III) and 65 age‐ and parity‐matched women with neither HPV infection nor CIN were compared. Seven parameters by TV‐PDU were used to assess vascular classification and micro‐vessel flow velocity, including vascular grading (class I, II, III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end‐diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED).
Results
HSIL was primarily associated with vascular class I (75.8%), followed by class II (14.5%) and class III (9.7%). PI, RI, and VI in HSIL were significantly lower than the control group (P < 0.0001). Mean PI, RI, and VI values decreased progressively from the normal cervix to CIN II–III. At a PI cutoff of 1.03, sensitivity was 88.7%, specificity was 83.8%, and area under the curve (AUC) was 95.0. At an RI cutoff of 0.68, sensitivity was 96.8%, specificity 61.5%, and AUC 84.0. At a VI cutoff of 2.84, sensitivity was 85.5%, specificity 78.5%, and AUC 85.0.
Conclusion
Based on different patterns of hotspot vascular classification and micro‐vessel flow velocity waveforms, particularly PI between HSIL and the normal cervix, TV‐PDU may offer a potential role for aiding the planning for patients with suspicious HSIL. Further studies are needed to validate the findings.