Discriminating Performance of Early Uterine and Cervical Artery Pulsatility and Resistivity In Pre-Invasive Cervical Lesions
Ozan Doğan1, Çiğdem Pulatoğlu2, Alper Başbuğ3, Aşkı Ellibeş Kaya3, Murat Yassa41Department of Obstetrics and Gynecology, Health Sciences University, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey2Department of Obstetrics and Gynecology, Bayburt Government Hospital, Bayburt, Turkey.
3Department of Obstetrics and Gynecology, Duzce University Hospital, Duzce, Turkey.
4Department of Obstetrics and Gynecology, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
Objectives: The aim of the present study was to investigate the diagnostic effectiveness of uterine and cervical vascularity alone or in combination with human papillomavirus (HPV) DNA testing and with cytology.
Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high-risk types was viewed as positive. Pulsatility (PI) and resistance (RI) indices of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was considered as the gold standard for assessment. Diagnostic efficiency of alone and joint screening of the three indices for discriminating cervical intraepithelial neoplasia (CIN-I) or above from below was assessed.
Results: UA-RI and CA-RI were significantly lower in the HPV (+) group than in the controls (p=0.02 and p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in the HPV-16 (+) group than in the HPV-18 (+) group (p=0.04). High-risk HPV (Hr-HPV) testing had the highest sensitivity compared with Doppler and cytology (76.5%, 64.7%, and 58.5%, respectively). Combining CA-RI with cytology or Hr-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining UA-PI with Hr-HPV slightly increased the positive predictivity when compared with testing Hr-HPV alone (36.1% vs. 33.3%).
Conclusion: The potential of the Doppler indices of UA and CA was doubtful in discriminating CIN-I or above lesions in the early period. In addition, RI of UA and CA differed with regard to the presence of HPV infection, whereas CA-RI differed in high-risk HPV cases.
Preinvaziv servikal lezyonlarda erken uterin ve servikal arter pulsatilite ve rezistivitesinin ayırt edici performansı
Ozan Doğan1, Çiğdem Pulatoğlu2, Alper Başbuğ3, Aşkı Ellibeş Kaya3, Murat Yassa41Department of Obstetrics and Gynecology, Health Sciences University, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey2Department of Obstetrics and Gynecology, Bayburt Government Hospital, Bayburt, Turkey
3Department of Obstetrics and Gynecology, Duzce University Hospital, Duzce, Turkey.
4Department of Obstetrics and Gynecology, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
Objective: It was aimed to investigate the diagnostic effectiveness of the uterine and cervical vascularity alone or by combining with Human Papillomavirus (HPV) DNA testing and with cytology.
Materials and Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high‑risk types was viewed as positive. Pulsatiliy (PI) and resistance (RI) indexes of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was taken as the golden standard for assessment. Diagnostic efficiency of alone and joint screening of the three indexes for discriminating CIN-I or above from below was assessed.
Results: UA-RI and also CA-RI was significantly lower in HPV(+) group when compared to controls (p=0.02, p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in HPV-16(+) group when compared to HPV-18(+) (p=0.04). Hr-HPV testing had the highest sensitivity compared to Doppler and cytology (76.5%, 64.7% and 58.5%, respectively). Combining CA-RI with cytology or HR-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining the UA-PI with Hr-HPV slightly increased the positive predictivity when compared to testing Hr-HPV alone (36.1% vs. 33.3%).
Conclusions: Potential of the Doppler indices of uterine and cervical arteries was doubtful in discriminating CIN-I or above lesions in early period. Besides, RI of uterine and cervical arteries differed regarding to the presence of HPV infection while cervical artery RI differed in also high-risk HPV cases.
Manuscript Language: English