The significance of power doppler imaging and ultrasound tomography for the early diagnosis of endometrial and ovarian cancer

AIM: To evaluate the possibilities of energy Doppler ultrasonography and ultrasound tomography in the early diagnosis of endometrial cancer and ovarian cancer. To evaluate the intraendometrial blood flow of endometrial polyps and endometrial cancer, as well as the intraovarian blood flow of benign and malignant ovarian tumors using high-tech ultrasound methods Introduction: Early diagnosis of endometrial cancer and ovarian cancer continues to be a complex and relevant problem. The use of energy Doppler ultrasonography and ultrasound tomography allowed not only to visualize small vessels and assess their hemodynamic characteristics, but also to analyze slices less than 1 mm thick and reduce the number of artifacts that complicate the interpretation of the data.
METHODS: The study was a single-center retrospective, selective study conducted at the Russian Scientific Center of Roentgenoradiology. The pelvic ultrasound examinations were performed using the eSaote Pro device with transvaginal and volumetric transvaginal sensors in 2D mode with the use of energy Doppler mapping and ultrasound tomography.The study included 383 patients with a histologically confirmed diagnosis: 141 patients with stage Iа–Ib endometrial cancer, 86 patients with endometrial polyps, 64 patients with localized or relatively localized ovarian cancer without clinical manifestations of ascites or with minimal free fluid volume in the pelvis (stage Iа–IIb), 72 patients with benign ovarian tumors, and 20 patients with ovarian tecomatosis.
RESULTS: The analysis of non-invasive endometrial carcinomas in patients of reproductive age showed an increase in ovarian volume of more than 12 cm3 in the first phase of the menstrual cycle and a multifollicular structure of the ovaries. Summarizing the data of complex ultrasound diagnostics of malignant and benign ovarian tumors, a number of criteria can be identified that suggest a borderline condition or malignant growth:
•   in postmenopause, the structure of non-enlarged ovaries is heterogeneous, iso-hypoechoic, or hypoechoic, with smooth or irregular contours; the presence of blood flow foci with low resistance indices;
•   in the structure of cystic-solid formations, there is a local increase in blood flow in the structure of the solid component and the detection of low-resistance blood flow loci (it should be noted that the structure of the solid component is also iso-hypoechoic);
•   thickening of the pelvic peritoneum without ascites or with the presence of ascites;
•   neovascularization in a malignant process is characterized by multiple shunts.
CONCLUSION: Patients with impaired fat and carbohydrate metabolism, both in the reproductive period and in menopause, are at risk of developing endometrial cancer, especially those with a family history of cancer. The presence of intraendometrial blood flow loci may be a manifestation of both hyperplastic process and endometrial cancer. Ovarian neoplasms containing solid inclusions and parietal solid components in cystic chambers, even with single blood flow loci, are highly likely to be malignant.

1. Ashrafyan L.A., Antonova I.B., Ivashina S.V. et al. Early diagnosis of endometrial and ovarian cancer. Prakticheskaya onkologiya = Practical Oncology 2009;10(2):71–5. (In Russ.).

2. Babaeva N.A., Ashrafyan L.A., Antonova I.B. and others. Clinical and morphological concept of microinvasive endometrial cancer. Onkologiya. Zhurnal im. P.A. Gertsena = Oncology. Journal named after P.A. Herzen 2013;1(1):78–83. (In Russ.).

3. Xu J., Huang Z., Zeng J. et al. Value of contrast-enhanced ultrasound parameters in the evaluation of adnexal masses with ovarian-adnexal reporting and data system ultrasound. Ultrasound Med Biol 2023;49(7):1527–34. DOI: 10.1016/j.ultrasmedbio.2023.02.015

4. Ashrafyan L.A. Standardized diagnosis of endometrial cancer. Dis. ... Dr. med. sciences. Moscow, 1989. (In Russ.).

5. Kaprin A.D., Ashrafyan L.A., Stilidi I.S. Oncogynecology. National leadership. Moscow: GEOTAR-Media, 2019. 384 p. (In Russ.).

6. Nudnov N.V., Ivashina S.V., Aksenova S.P. High-tech radiation methods in the diagnosis of endometrial cancer - multiparametric MRI, ultrasound tomography, 3D angiography, power Dopplerography. Meditsinskaya vizualizatsiya = Medical Visualization 2023;27(2):147–60. (In Russ.). DOI 10.24835/1607-0763-1167

7. Ni J., Han B., Liang J., Wang F. Three-dimensional 3D ultrasound combined with power Doppler for the differential diagnosis of endometrial lesions among infertile women. Int J Gynaecol Obstet 2019;145(2):212–8. DOI: 10.1002/ijgo.12787

8. Alcázar J.L., Gastón B., Navarro B. et al. Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis. J Gynecol Oncol 2017;28(6):e86. DOI: 10.3802/jgo.2017.28.e86

9. Huang Q., Zeng Z. A review on real-time 3D ultrasound imaging technology. Biomed Res Int 2017;2017:6027029. DOI: 10.1155/2017/6027029

10. Gadzhieva L.T., Pronin S.M., Pavlovich S.V. et al. Organ-preserving treatment of atypical hyperplasia and early endometrial cancer in reproductive age, treatment outcomes. Gynecologiya = Gynecology 2023;25(2):177–82. (In Russ.). DOI: 10.26442/20795696.2023.2.202219

11. Uglietti A., Buggio L., Farella M. et al. The risk of malignancy in uterine polyps: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019;237:48–56. DOI: 10.1016/j.ejogrb.2019.04.009

12. Bohman Ya.V. Features of the clinical course of uterine cancer. Modern problems of oncology. Leningrad, 1969. Pp. 70–78. (In Russ.).

13. Robertson D.M. Screening for the early detection of ovarian cancer. Women Health 2009;5(4):347–9. DOI: 10.2217/whe.09.27