Does three-dimensional power Doppler ultrasound predict histopathological findings of uterine fibroids? A preliminary study.

OBJECTIVES: To compare three-dimensional (3D) power Doppler sonographic characteristics of fibroids with histopathological parameters.

METHODS: We evaluated sonographically 73 fibroids before myomectomy or hysterectomy. For each, the total fibroid volume, a shell of 3 mm and a 1-cm(3) spherical sample from the most vascularized area on subjective assessment were captured. 3D power Doppler vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were generated in the acquired volumes. The degree of cellularity, ischemic necrosis and fibrosclerosis, as well as CD31 and Ki-67 staining for vascular density and proliferation index, respectively, were estimated using the surgical sample. Pathological data were considered as dependent variables and ultrasound data as independent variables in multivariable logistic regression models including patients' characteristics.

RESULTS: A high histological 'cellular activity score', combining hypercellularity, a fibrosclerosis rate < 25% and positive Ki-67 staining, was statistically related in multivariate analyses to high 3D power Doppler VI in spherical samples (odds ratio (OR), 1.1 (95% CI, 1.0-1.3), P < 0.05) and VFI (OR, 1.3 (95% CI, 1.0-1.8), P < 0.05). Positive CD31 staining was statistically related to high 3D power Doppler VI in spherical samples (OR, 1.1 (95% CI, 1.0-1.3), P < 0.05). In contrast, ischemic necrosis was statistically related to low 3D power Doppler VI in the total volume (OR, 0.6 (95% CI, 0.4-1.0), P < 0.05) and VFI (OR, 0.4 (95% CI, 0.1-1.1), P < 0.05).

CONCLUSION: Vascular density, ischemic necrosis and histological cellular activity score are statistically significantly associated with some 3D power Doppler indices.