Value of three-dimensional power Doppler to predict clinical and histological response to neoadjuvant chemotherapy in locally advanced cervical carcinoma

Abstract

Objective Platinum-based neoadjuvant chemotherapy followed by radical hysterectomy is an alternative therapeutic strategy for locally advanced cervical carcinoma but variables used to predict chemotherapy response are not well defined. We investigated the potential of three-dimensional (3D) power Doppler in predicting response to neoadjuvant chemotherapy. Methods We enrolled 61 eligible patients with locally advanced cervical carcinoma who underwent neoadjuvant chemotherapy followed by surgery or radiation. Before the initial chemotherapy, we measured 3D power Doppler vascular indices, including vascularization index (VI), flow index (FI) and vascularization flow index (VFI), of the whole cervical carcinoma. We also measured two-dimensional (2D) hemodynamic parameters, such as resistance index and pulsatility index, at three random spots inside the tumor. The associations of all parameters with clinical and histological responses to chemotherapy were evaluated through univariable and multiple logistic regression analysis. Results The clinical and histological response rates to chemotherapy were 70.5% and 70.7%, respectively. Univariable logistic regression analysis showed that VI, FI and VFI were significantly higher in clinical responders than in non-responders (P < 0.05), and that FI was significantly higher in histological responders (P = 0.012). Multiple logistic regression analysis showed that FI was the only significant factor associated with both clinical and histological responses. The best FI cut-off values were 35.3 and 37.3 for clinical response and histological response, respectively (with sensitivity 86.0% and 73.2%, and specificity 72.2% and 64.7%). Interestingly, none of the 2D hemodynamic parameters was significantly correlated with either response. Conclusion FI is a potential marker for predicting both clinical and histological responses to chemotherapy in patients with locally advanced cervical carcinoma. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.