Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?

Lin, Lawrence Hsu; Bernardes, Lisandra Stein; Hase, Eliane Azeka; Fushida, Koji; Francisco, Rossana Pulcineli Vieira

doi:10.6061/clinics/2015(12)08

Cited by 22 publications

(13 citation statements)

References 28 publications

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“…At color Doppler US, the mass is usually highly vascular due to intralesional arteriovenous shunts, resulting in increased vascularity within the myometrium (Fig 10b). However, varying degrees of vascularity have been described with different types of GTN, ranging from minimally to highly vascular lesions (37,39,40). At spectral Doppler US, trophoblastic vessels demonstrate a high-velocity lowresistance waveform (37).…”

Section: Imaging Of Primary Tumormentioning

confidence: 99%

Gestational Trophoblastic Disease: Clinical and Imaging Features

et al. 2017

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Gestational trophoblastic disease (GTD) is a spectrum of both benign and malignant gestational tumors, including hydatidiform mole (complete and partial), invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. The latter four entities are referred to as gestational trophoblastic neoplasia (GTN). These conditions are aggressive with a propensity to widely metastasize. GTN can result in significant morbidity and mortality if left untreated. Early diagnosis of GTD is essential for prompt and successful management while preserving fertility. Initial diagnosis of GTD is based on a multifactorial approach consisting of clinical features, serial quantitative human chorionic gonadotropin (β-hCG) titers, and imaging findings. Ultrasonography (US) is the modality of choice for initial diagnosis of complete hydatidiform mole and can provide an invaluable means of local surveillance after treatment. The performance of US in diagnosing all molar pregnancies is surprisingly poor, predominantly due to the difficulty in differentiating partial hydatidiform mole from nonmolar abortion and retained products of conception. While GTN after a molar pregnancy is usually diagnosed with serial β-hCG titers, imaging plays an important role in evaluation of local extent of disease and systemic surveillance. Imaging also plays a crucial role in detection and management of complications, such as uterine and pulmonary arteriovenous fistulas. Familiarity with the pathogenesis, classification, imaging features, and treatment of these tumors can aid in radiologic diagnosis and guide appropriate management. RSNA, 2017.

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Section: Imaging Of Primary Tumormentioning

confidence: 99%

Gestational Trophoblastic Disease: Clinical and Imaging Features

et al. 2017

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“…Moreover, the highly abnormal flow patterns seen in invasive gestational trophoblastic neoplasia can be measured by Doppler US as early as two weeks post-evacuation, which is before the appearance of lesions 12 or an hCG plateau or rise 10 . However, it remains controversial whether uterine artery Doppler flow velocimetry (DFV) parameters can predict GTN following CHM 13 .…”

Section: Introductionmentioning

confidence: 99%

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

Asmar¹,

Braga²,

Filho³

et al. 2017

Clinics

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OBJECTIVES:Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia.METHODS:This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis.RESULTS:No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia.CONCLUSIONS:Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia.

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“…In a prospective analysis of 246 women with complete mole, Doppler pulsatility index showed potential as a predictor of subsequent development of GTN [35]. In a retrospective analysis of 189 patients with hydatidiform mole, US evidence of nodules and hypervascularization within the myometrium or endometrium 3 weeks following initial molar evacuation had a high specificity (95.5%) but low sensitivity (53.9%) for later development of GTN [33,34]. Doppler US can also confirm the absence of vascular flow within a mass, a useful technique in patients with GTD where clot or blood products may simulate solid tissue.…”

Section: Us Pelvis Transabdominalmentioning

confidence: 98%

“…There is some support for a role for Doppler US in the initial diagnosis and postevacuation follow-up of patients with GTD. A lower uterine artery resistive index before molar evacuation is associated with the development of trophoblastic tumors, a potentially useful means to prospectively recognize patients who are at high risk for progression and warrant closer follow-up [33,34]. In a prospective analysis of 246 women with complete mole, Doppler pulsatility index showed potential as a predictor of subsequent development of GTN [35].…”

Section: Us Pelvis Transabdominalmentioning

confidence: 99%

“…There is some evidence to support a role for Doppler US in GTN. A recent systematic literature review summarizing data from 28 studies up to 2014 demonstrated a lower uterine artery resistance pattern in women with GTN compared with women with hydatidiform mole, recent termination, no current pregnancy, or first trimester pregnancy [34]. Doppler measurement of the uterine artery pulsatility index serves as a noninvasive marker of tumor vascularity and neoangiogenesis and may prove useful in patient selection for first-line therapy [56][57][58].…”

Section: Us Pelvis Transabdominalmentioning

confidence: 99%

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