Discriminating Performance of Early Uterine and Cervical Artery Pulsatility and Resistivity In Pre-Invasive Cervical Lesions

Özet

Objectives: The aim of the present study was to investigate the diagnostic effectiveness of uterine and cervical vascularity aloneor 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-basedcervical 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. Pathologicaldiagnosis was considered as the gold standard for assessment. Diagnostic efficiency of alone and joint screening of the threeindices 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). Insubsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in the HPV-16 (+) group than in theHPV-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-HPVslightly 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 earlyperiod. In addition, RI of UA and CA differed with regard to the presence of HPV infection, whereas CA-RI differed in high-riskHPV cases.