Identification of vascular hotspots and analysis of micro-vessel flow velocity waveforms in high-grade squamous intraepithelial lesions of the cervix

Objectives: To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and explore associations with high-grade squamous intraepithelial lesions (HSIL, cervical intraepithelial neoplasia [CIN] II and III). Methods: In all, 62 patients with confirmed HPV-HSIL (14 CIN II, 48 CIN III) and 65 age- and parity-matched women with neither HPV infection nor CIN were compared. Seven parameters by TV-PDU were used to assess vascular classification and micro-vessel flow velocity, including vascular grading (class I, II, III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED). Results: HSIL was primarily associated with vascular class I (75.8%), followed by class II (14.5%) and class III (9.7%). PI, RI, and VI in HSIL were significantly lower than the control group (P < 0.0001). Mean PI, RI, and VI values decreased progressively from the normal cervix to CIN II–III. At a PI cutoff of 1.03, sensitivity was 88.7%, specificity was 83.8%, and area under the curve (AUC) was 95.0. At an RI cutoff of 0.68, sensitivity was 96.8%, specificity 61.5%, and AUC 84.0. At a VI cutoff of 2.84, sensitivity was 85.5%, specificity 78.5%, and AUC 85.0. Conclusion: Based on different patterns of hotspot vascular classification and micro-vessel flow velocity waveforms, particularly PI between HSIL and the normal cervix, TV-PDU may offer a potential role for aiding the planning for patients with suspicious HSIL. Further studies are needed to validate the findings.