Visual grading system, blood flow index, and tumor marker SCC antigen as prognostic factors in invasive cervical carcinoma

Background: The purpose of this study was to develop a new visual grading system for the vascular ratio, to assess the correlation of the prognostic significance of the visual grading system, tumoral blood flow velocity and squamous cell carcinoma (SCC antigen serum levels in invasive SCC of the cervix. Patients and methods: A total of 117 patients with invasive cervical carcinoma were enrolled for the assessment of vascular grading and tumor flow using transvaginal ultrasound with power Doppler angiography (TV-PDA) before treatment. The modified visual grading system of the vascular ratio (grades 1 to 3) and six blood flow characteristics tumor vessels (pulsatility index, resistance index, peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, vascular index) were measured by TV-PDA. In addition, serum levels of SCC antigen were randomly obtained in 74 patients with invasive cervical SCC (stages Ia to IIIb) before treatment. Results: The modified visual grading system of the vascular ratio significantly correlated with pretreatment SCC antigen serum levels (p<0.05) and intratumoral resistance index values (p<0.05, r2=0.49) from multiple regression analysis in 71 patients with invasive SCC of the cervix. Modified visual grading of the vascular ratio negatively correlated with intratumoral resistance index values (Pearson's correlation coefficient, r=-0.571, p=0.001), but positively correlated with pretreatment serum levels of SCC antigen (r=0.296, p=0.012). In addition, this modified vascularity grading positively correlated with FIGO stage (r=0.336, p = 0.004) by correlation analysis. Conclusion: The modified visual grading system of the vascular ratio is a valuable sonographic marker in assessing invasive cervical carcinoma. The three major advantages of this semi-quantitative analysis are ease of discrimination, immediate results, and avoiding wasting time. This semi-quantitative analysis with pretreatment SCC antigen serum levels are two effective markers for assessing invasive cervical carcinoma.