Evaluation of the vessels of the cardinal ligament by transrectal ultrasonography with color Doppler imaging

Abstract

Radical hysterectomy is the standard treatment for early-stage cervical cancer. Although during surgery the vessels of the cardinal ligament are divided one by one until the splanchnic nerve is identified before they are dissected, there are individual differences in the numbers of vessels. In this preliminary study, we evaluated the accuracy of preoperative detection of the vessels of the cardinal ligament by transrectal sonography with color Doppler imaging (TR-CDUS) with respect to the number of vessels detected intraoperatively. We included patients that underwent radical hysterectomy for cervical cancer in our hospital. The vessels of the cardinal ligament were detected preoperatively by TR-CDUS. Radical hysterectomy was subsequently performed and the number of vessels found at surgery was recorded. A total of 21 patients were included. The median number of the left vessels detected by TR-CDUS and intraoperatively were 2 (range, 1-4) and 2 (range, 1-5), respectively. The median numbers of the right vessels detected were 3 (range, 2-4) and 3 (range, 2-4), respectively. The accuracy rates were 90.5% for the left cardinal ligament, 85.7% for the right ligament, and 81.0% for both cardinal ligaments. The results suggest that TR-CDUS may be useful for preoperative detection of the number of the vessels of the cardinal ligament.