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Contrast Study on Ovarian Tumor Vascularity with Transvaginal Doppler Ultrasonography and Pathologic Immunohistochemistry

Author: QiZuoQin
Tutor: ZhaoYuZhen
School: Hebei Medical University
Course: Medical Imaging and Nuclear Medicine
Keywords: Ovarian neoplasms Transvaginal color Doppler ultrasonography Resistance index Transvaginal three-dimensional color power angiography Vasculary index Microvessel density Immunohistochemistry
CLC: R737.31
Type: Master's thesis
Year: 2005
Downloads: 71
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Abstract

Objection : To study ovarian tumor vascularity withtransvaginal color Doppler ultrasonography（TVCDU）,pulsedwave Doppler （PW） and transvaginal three-dimensional colorpower angiography （ TR3D-CPA ）, the blood supply andhemodynamic parameters were recorded ,tumor vascularityindex （VI）of TR3D-CPA was then quantified in the study .After operation all the slices of tumor tissue specimens werestained immunohistochemistry with anti-34 and anti-31antibody and MVD was calculated. Those indices wereanalysed in benign and malignant ovarian tumors ,appearedtheir specification, The relations between the indices andclinical stages were also done statistically,so as to studyvascular pathology of TVCDU and TR3D-CPA in ovariantumors , evaluate the clinical value by identifying ovariantumors and analyze the relations of tumor blood supply toclinical stages.Methods: Sixty-one ovarian tumors（38 malignant ovariantumors, 5 borderling ovarian tumors, 18 benign ovarian tumors）were examined preoperatively with transvaginal sonography（TVS）.First,the tumors’size, profile, location, inner echo,relationship with surroundings,nodes on peritoneum、omentumor on intestines, hydroperitoneum, status of lymph nodemetastasis beside iliac vessel were recorded with B-modetransabdomal and transvaginal ultrasonography. Second, theblood flows in ovarian tumors were displayed with CDFI andgraded three types（typeⅠto type Ⅲ）. The key of PW was run,the peak systolic velocity （PSV）, end diastolic velocity（EDV） ,resistance index（RI） and vascularity type（VT）, diastolic notch（DN）were recorded. The satisfied images were stored in MO.Third, 3D-CPA of the ovarian tumors vasculrity werereconstructucted in optimal serial CPA condition. The completeand clear images were stored in MO for later quantitativeanalysis. After operation all the slices of tumor tissue specimenswere stained immunohistochemistry with anti-34 and anti-31antibody and MVD was calculated. The malignant ovariantumors were staged according to FIGO,2000 standard.Results:1 In 38 malignant ovarian tumors stage Ⅰwere 4 cases,stageⅡwere 8 cases, stage Ⅲwere 23 cases and stage Ⅳwere 3 cases. There were fewer cases in stage Ⅰand stage Ⅳ,so stage Ⅰand Ⅱ, stage Ⅲand Ⅳwere combined, therewere 12 and 26 cases in two groups.2 TVCDU displaied rich, bright, tortuous and disorderblood vessels in malignant ovarian tumors than in benignovarian tumors. 78.9%（30/38） malignant ovarian tumors were type Ⅲin vascularitytype, there were significiant differences from benign ovariantumors（5.6%, 1 /18）（P<0.05）. Using type Ⅲas a standard,the sensitivity and specificity in detecting malignant ovariantumors were 78.9% and 86.9% respectively. There were nostatistical differences of PSV between benign or borderlingovarian tumors and malignant ones（P>0.05）. RI in benigntumors was higher than that in malignant and borderlingtumors（P<0.05）. Using RI≤0.5 as a cutoff, the sensitivity andspecificity in detecting malignant ovarian tumors were 89.5%and 78.3% respectively. RI in stage Ⅲand Ⅳ（0.39±0.05）was lower than that in stageⅠandⅡ（ 0.45±0.13）（P<0.05）.There were statistical differences in diastolic notch betweenmalignant ovarian tumors （4/38, 10.5%） and benign ovariantumors （14/18, 77.8%）（P<0.05）.3 TR3D-CPA displaied rich, tortuous and disorder bloodvessels in malignant ovarian tumors than in benign ovariantumors. Using type Ⅲas a standard, the sensitivity andspecificity in detecting malignant ovarian tumors were 78.9%and 86.9% respectively.4 VI in 38 malignant ovarian tumors were significiantlyhigher than those in benign tumors（P<0.05）. Using VI≥0.035counts/cm³ as a cutoff, the sensitivity and specificity indetecting malignant ovarian tumors were 84.2% and 70%respectively. VI in stage Ⅲ、Ⅳ（0.086±0.042） counts/cm3 werehigher than that in stageⅠ、Ⅱ（0.056±0.040） counts/cm3（P<0.05）.5 All the slices of tumor specimens were stainedimmunohistochemically with anti-CD31 and anti-CD34monoclonal antibody. The membrane of vessel endothelia cell（VEC） expressed brown. The morphologies and distributions ofpositive vessels varied a lot . More positive vessels were liedon the edge of tumor than inside .The former vessels had largersinus and crossed each other . The degree of contrast with CD34was thicker than that with CD31. There was significantpositive relation between MVDCD34 and MVDCD31（rs=0.518,P<0.01） .6 MVD_CD34 in malignent ovarian tumors were higherthan that in benign ovarian tumors （P<0.05）. MVD_CD34 instage Ⅲand Ⅳ（43.29±12.20） /400 magnification washigher than that in stageⅠandⅡ（ 27.86±9.90） /400magnification（P<0.05）.7 There were significant negative relation between RI andMVD CD34 in malignent ovarian tumors（r_s=-0.412, P<0.01）andthere were significant positive relation between VI and MVDCD34（rs = 0.684,P<0.01）.Conclusions:1 TVCDU was an effective mothed to identify benign andmalignant ovarian tumors, by detecting the indices（PSV, EDV,RI, VT and DN）.2 The higher clinical stage was, the lower RI was,it canbe an important parameter for predicting prognosis.3 TR3D-CPA was an effective mothed to indentify benign

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