Archives of Gynecology and Obstetrics

, Volume 298, Issue 3, pp 617–622 | Cite as

3D vocal power Doppler sonography for the estimation of tumor volume and vascularization in stage IB1 cervical cancer

  • George Daskalakis
  • Diamantis Diamantopoulos
  • Mariana Theodora
  • Anysia SemertzidouEmail author
  • Kaliopi Pappa
  • Panagiotis Antsaklis
  • Mihail Sindos
  • Alexandros Rodolakis
  • Konstantinos Kalmantis
Gynecologic Oncology



To evaluate the tumor’s volume and intratumoral vascularization with 3D vocal power Doppler ultrasound in patients with stage 1B1 cervical cancer.


This was a prospective study on patients with cervical cancer and stage 1B1 disease, which took place between 2012 and 2015. All women had an initial 2D ultrasound examination for the estimation of the tumor volume. Following this, 3D volumes of the cervix were acquired and were further analyzed using the Virtual Organ Computer Aided Analysis (VOCAL) program. In the selected volume, the vascular pattern (linear or complex vascularization) was also examined. The ultrasonographic findings were compared to the histological ones following surgery.


Twenty-seven patients were included. The average cervical tumor volume measured by the 2D ultrasound and 3D VOCAL-PD were 3.14 and 3.08 cm3, respectively. Both 2D and 3D VOCAL-PD overestimated the tumor staging. Further analysis showed a statistically significant superiority of 2D ultrasound over 3D VOCAL-PD for tumors equal or smaller than 2.5 cm3 with linear vascularity (p < 0.001), while for tumors of larger volume with complex vascularization, a statistically significant superiority of 3D VOCAL-PD was confirmed (p < 0.001).


3-D VOCAL-PD is extremely accurate and superior to 2D ultrasound for the estimation of tumor volume and vascularization when it is more than 2.5 cm3 and has a complex vascularization in patients with stage 1B1 cervical cancer.


3-dimensional ultrasound Vocal Power Doppler Tumor volume Cervical cancer 


Author contributions

GD—Project development, data collection. DD—Data analysis. MT—Data analysis. AS—Data analysis, manuscript writing/editing. KP—Manuscript writing/editing. PA—Manuscript writing/editing. MS—Manuscript writing/editing. AR—Manuscript writing/editing. KK—Project development, supervision.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    American Cancer Society (2016) Cervical cancer: what are the key statistics about cervical cancer. Last medical review 19 Sep 2014, last revised: 29 Jan 2016
  2. 2.
    Pecorelli S, Odicino F (2003) Cervical cancer staging. Cancer J 9(5):390–394CrossRefPubMedGoogle Scholar
  3. 3.
    Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S (2000) FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 70(2):209–262CrossRefPubMedGoogle Scholar
  4. 4.
    Follen Michele, Levenback Charles F, Iyer Revathy B, Grigsby Perry W, Boss Erik A, Delpassand Ebrahim S, Fornage Bruno D, Fishman Elliot K (2003) Imaging in cervical cancer. Cancer 98(9 Suppl):2028–2038CrossRefPubMedGoogle Scholar
  5. 5.
    Choi BI, Kim TK, Han JK, Chung JW, Park JH, Han MC (1996) Power versus conventional color Doppler sonography: comparison in the depiction of vasculature in liver tumors. Radiology 200(1):55–58CrossRefPubMedGoogle Scholar
  6. 6.
    Hosoki T, Mitomo M, Chor S, Miyahara N, Ohtani M, Morimoto K (1997) Visualization of tumor vessels in hepatocellular carcinoma. Power Doppler compared with color Doppler and angiography. Acta Radiol 38(3):422–427PubMedGoogle Scholar
  7. 7.
    Fleischer AC, Wojcicki WE, Donnelly EF, Pickens DR, Thirsk G, Thurman GB, Hellerqvist CG (1999) Quantified color Doppler sonography of tumor vascularity in an animal model. J Ultrasound Med 18(8):547–551CrossRefPubMedGoogle Scholar
  8. 8.
    Cendrowski K, Sawicki W, Spiewankiewiez B, Stelmachów J (2003) The importance of fine needle aspiration biopsy and sonographic evaluation of parametria in cervical cancer. Eur J Gynaecol Oncol 24(5):413–416PubMedGoogle Scholar
  9. 9.
    Pairleitner H, Steiner H, Hasenoehrl G, Staudach A (1999) Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol 14(2):139–143CrossRefPubMedGoogle Scholar
  10. 10.
    Creasman WT (1995) New gynecologic cancer staging. Gynecol Oncol 58(2):157–158CrossRefPubMedGoogle Scholar
  11. 11.
    Raine-Fenning N, Campbell B, Collier J, Brincat M, Johnson I (2002) The reproducibility of endometrial volume acquisition and measurement with the VOCAL-imaging program. Ultrasound Obstet Gynecol 19(1):69–75CrossRefPubMedGoogle Scholar
  12. 12.
    Testa AC, Ferrandina G, Distefano M, Fruscella E, Mansueto D, Basso D, Salutari V, Scambia G (2004) Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma. Ultrasound Obstet Gynecol 24(4):445–452CrossRefPubMedGoogle Scholar
  13. 13.
    Fischerova D, Cibula D, Stenhova H, Vondrichova H, Calda P, Zikan M, Freitag P, Slama J, Dundr P, Belacek J (2008) Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int J Gynecol Cancer 18(4):766–772CrossRefPubMedGoogle Scholar
  14. 14.
    Epstein E, Testa A, Gaurilcikas A, Di Legge A, Ameye L, Atstupenaite V, Valentini AL, Gui B, Wallengren NO, Pudaric S, Cizauskas A, Måsbäck A, Zannoni GF, Kannisto P, Zikan M, Pinkavova I, Burgetova A, Dundr P, Nemejcova K, Cibula D, Fischerova D (2013) Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound—a European multicenter trial. Gynecol Oncol 128(3):449–453CrossRefPubMedGoogle Scholar
  15. 15.
    Mayr NA, Yuh WT, Taoka T, Wang JZ, Wu DH, Montebello JF, Meeks SL, Paulino AC, Magnotta VA, Adli M, Sorosky JI, Knopp MV, Buatti JM (2006) Serial therapy-induced changes in tumor shape in cervical cancer and their impact on assessing tumor volume and treatment response. AJR Am J Roentgenol 187(1):65–72CrossRefPubMedGoogle Scholar
  16. 16.
    Chou CY, Hsu KF, Wang ST, Huang SC, Tzeng CC, Huang KE (1997) Accuracy of three-dimensional ultrasonography in volume estimation of cervical carcinoma. Gynecol Oncol 66(1):89–93CrossRefPubMedGoogle Scholar
  17. 17.
    Benedetti-Panici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, Giannarelli D, Amunni G, Raspagliesi F, Zola P, Mangioni C, Landoni F (2002) Neoadjuvant chemo-therapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. J Clin Oncol 20(1):179–188CrossRefPubMedGoogle Scholar
  18. 18.
    Hsu KF, Su JM, Huang SC, Cheng YM, Kang CY, Shen MR, Chang FM, Chou CY (2004) Three-dimensional power Doppler imaging of early-stage cervical cancer. Ultrasound Obstet Gynecol 24(6):664–671CrossRefPubMedGoogle Scholar
  19. 19.
    Tanaka K, Umesaki N (2010) Impact of three-dimensional (3D) ultrasonography and power Doppler angiography in the management of cervical cancer. Eur J Gynaecol Oncol 31(1):10–17PubMedGoogle Scholar
  20. 20.
    Alcázar JL, Jurado M, López-García G (2010) Tumor vascularization in cervical cancer by 3-dimensional power Doppler angiography: correlation with tumor characteristics. Int J Gynecol Cancer 20(3):393–397CrossRefPubMedGoogle Scholar
  21. 21.
    Belitsos P, Papoutsis D, Rodolakis A, Mesogitis S, Antsaklis A (2012) Three-dimensional power Doppler ultrasound for the study of cervical cancer and precancerous lesions. Ultrasound Obstet Gynecol 40(5):576–581CrossRefPubMedGoogle Scholar
  22. 22.
    Bolla D, In- Albon S, Papadia A, Di Naro E, Gasparri ML, Mueller MM, Raio L (2015) Doppler ultrasound flow evaluation of the uterine arteries significantly correlates with tumor size in cervical cancer patients. Ann Surg Oncol 22(3):S959–S963CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • George Daskalakis
    • 1
  • Diamantis Diamantopoulos
    • 1
  • Mariana Theodora
    • 1
  • Anysia Semertzidou
    • 1
    • 2
    Email author
  • Kaliopi Pappa
    • 1
  • Panagiotis Antsaklis
    • 1
  • Mihail Sindos
    • 1
  • Alexandros Rodolakis
    • 1
  • Konstantinos Kalmantis
    • 1
  1. 1.1st Department of Obstetrics and Gynecology, “Alexandra” Maternity HospitalNational and Kapodistrian University of AthensAthensGreece
  2. 2.Institute of Reproductive and Developmental Biology, Surgery and CancerImperial College LondonLondonUK

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