Pelvic relapses of uterine neoplasms: transvaginal sonographic and Doppler features

Objective. To describe the sonographic and power Doppler features of pelvic relapses in endometrial and cervical cancer. Methods. We retrospectively analyzed the preoperative transvaginal sonographic reports of 45 women with a histological diagnosis of pelvic relapse. The three diameters of the lesion were recorded; then the shape, margins, content (solid or cystic), and location were analyzed. A subjective assessment of the vascularization (vascular score) was obtained with power Doppler. Results. Twenty-six patients had pelvic recurrence from endometrial cancer and 19 from cervical cancer. In 36 (80%) patients, the recurrence was a central pelvic mass located on the vaginal apex, while in six cases (13%), it was diagnosed as a pelvic side-wall recurrence, and in three (7%), the recurrence occupied the whole pelvis. The recurrences had diameters ranging from 1.0 to 6.8 cm (mean diameter: 3.0 cm, standard deviation: 1.5). In 44/45 cases (98%), the recurrence appeared as a solid nodular mass, while in one case (2%), it was defined as a cystic mass. In 32 (71%) women, the mass showed a hypoechoic content with respect to the surrounding bowel, while in 13 (29%), it manifested a nonhomogeneous content. Vascularization of the mass was assessed in all patients before surgery; in all cases, it was possible to visualize randomly dispersed blood vessels in the context of the relapse. The vascular score revealed scarce blood vessels in 19 relapses, moderate flow in 23, and abundant flow in three cases. Conclusions. Knowledge of the spectrum of ultrasonographic findings of pelvic relapses will help the physician in diagnosing a recurrent malignant disease at an early stage, when cure rates are high. The widespread availability and low cost of transvaginal sonography (TVS) support its use in routine surveillance of patients operated for uterine neoplasms.