OP29.03: Identification of parametria by 2D-3D ultrasound in patients with cervical cancer: new perspectives and future applications

Objectives: The aim of this study was to evaluate the feasibility of distinguishing the ventral parametrium (vesico-uterine ligament), the lateral parametrium (paracervix), and the dorsal parametrium (recto-uterine ligament) by 2D and 3D ultrasound (US) scan in patients affected by cervical cancer (CC), using anatomy during surgery as probative evidence. Methods: From November 2009 to February 2011, we prospectively analysed 38 consecutive patients, affected by early and locally advanced CC. All patients underwent pelvic US with both transabdominal and transvaginal approaches. Each exam was performed by 2 different operators with 2D and 3D-US scan. Anatomical observations of parametria revealed during the ultrasound evaluations were confirmed by intraoperative live scan. Results: We identified ultrasonographically the ventral and dorsal parametrium in a longitudinal scan, the lateral parametrium in a transversal scan. At the US, the ventral parametrium appears as a hiperechoic ligament with vessels, that starts from the cervix and ends at the lateral side of the bladder. The lateral parametrium is a hiperechoic ligament that starts from the lateral cervix and ends laterally under the iliac vessel. The dorsal parametrium starts from the sacro-uterine and ends at the rectum. We always identified the uterine artery. Proof of the correct identification of the different parts of the parametria was conducted during surgery. The surgeon applied one clip in every parametrium and it was identified by intraoperative live scan procedures. We could identify ventral and lateral parametria in every patient. We could not recognize the dorsal parametria in 8 patients (23.5%). Conclusions: The evaluation of the different cervical parametria can be considered feasible. The identification of dorsal parametria is more difficult than ventral and lateral parametria. We concluded that this method could be used in most cases as an aid in the assessment of parametrial involvement.