Trial Information

The Role of Functional MRI and Doppler Sonography in Assessing Intratumoral Angiogenesis of Endometrial Cancer Patients

Adenocarcinoma of the endometrium is the fourth most frequent cancer in women. Surgery is
the treatment of choice in patients with noninvasive or locally advanced disease. The
surgical technique consists of an exploratory laparotomy, with total hysterectomy, bilateral
oophorectomy, peritoneal washing, and, in selected high-risk patients, omental and
peritoneal biopsies and lymphadenectomy. Therefore, preoperative clinical and instrumental
staging of the local spread of disease, as well as local and distant lymph node involvement,
represent a critical step in tailoring the extent and the radicalness of surgery.

The role of angiogenesis in cancer growth and metastasis has been gaining much attention for
decades. Recent clinical evidence supports this notion. The gradual increase in angiogenesis
intensity with tumor progression in malignant melanoma has been reported. Abulafia et al.
observed that increasing angiogenicity from simple hyperplasia, complex hyperplasia,
atypical hyperplasia, and Stage IA endometrial carcinoma to invasive endometrial carcinoma
has been found by histopathologic examination. Several articles have reported that
transvaginal color and pulse Doppler ultrasound may be helpful blood in the evaluation of
various gynecologic tumors. Besides, our previous studies have also shown that incremental
angiogenesis could be demonstrated in the tumorigenesis and the possibility of lymph node
metastasis in endometrial malignancy. Other growth factors such as vascular endothelial
growth factor (VEGF), TGF-, IL-6, and IL-8 have also been reported to correlate with the
angiogenesis and the metastasis of endometrial cancer. It seems that tumor angiogenesis of
endometrial cancer could be utilized as an important parameter to assess the disease
severity of the endometrial cancer.

Determining microvessel density is regarded as a standard procedure to quantitate tumor
angiogenesis. However, microvessel density always has been assessed retrospectively and in
vitro. Preoperative prediction of the microvessel density would be of value clinically for
evaluating severity and progression of disease.

So, we would like to propose this proposal to focus on the tumor angiogenesis in endometrial
cancer patients. Endometrial cancer patients who will receive staging surgery will be
enrolled in this study. Functional MRI, and transvaginal sonography will be undergone before
the surgery in each patient. The angiogenesis-related growth factors will be evaluated later
from the surgical specimens. The clinical pathologic items, various angiogenic parameters
obtained from the MRI and sonography, and angiogenesis-related factors will be compared and
correlated together. There are several purposes in this study. First, we will evaluate and
compare tumor angiogenesis surveyed from functional MRI and power Doppler sonography in
endometrial cancer patients who receive surgery. Second, we will evaluate whether tumor
angiogenesis could be a marker to predict the disease severity of endometrial cancer. Third,
we will elucidate the role of functional MRI in endometrial cancer.

Endometrial cancer patients with histopathologic proof who are arranged to receive staging
surgery are eligible. All patients will undergo surgery, including total abdominal
hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/or para-aortic lymph node
dissection or sampling. Surgical specimens will be evaluated for tumor size, histologic
grading, depth of myometrial invasion, and presence of lymphovascular emboli and lymph node
metastasis. Stage will be determined using the International Federation of Gynecology and
Obstetrics classification. Tumors of histologic types other than adenocarcinoma and
adenoacanthoma will be excluded. The carcinomas were classified using a three-grade system:
grade 1 carcinomas showed glandular formation in more than 95% of the tumor, grade 2
carcinomas showed a solid growth pattern in 5-50%, and grade 3 carcinomas showed a solid
pattern in more than 50%. All of the patients who will be enrolled into this study need to
sign the consent form and the study protocol will be under the approval of the Institutional
Review Board of the patient's hospital.