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

Abstract

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.

A Pictorial Ultrasound Essay of Gestational Trophoblastic Disease

“…50 The best cutoff points for predicting GTN were 1.38 or less before evacuation (77% sensitivity and 82% specificity) and 1.77 or less after evacuation (79% sensitivity and 86% specificity). 50 However, although these changes are indicative of malignant changes after uterine evacuation of a molar pregnancy, they are not diagnostic ( Figure 10).…”

“…In contrast, a normal Doppler and uterine appearance in the presence of a previous molar pregnancy and or an elevated hCG level is suggestive of extrauterine spread . A Doppler analysis has been also shown to predict a late response to chemotherapy and to help in defining both the diagnosis and prognosis . Recent data indicate that it could also be useful in the differential diagnosis of GTN subtypes, particularly in distinguishing a PSTT from the other entities.…”

ACR Appropriateness Criteria® Gestational Trophoblastic Disease

“…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]. 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].…”

Immune cell composition in the endometrium of patients with a complete molar pregnancy: Effects on outcome

“…In approximately 15% of all CHMs, trophoblastic activity after uterine suction curettage persists, a condition referred to as post-molar gestational trophoblastic neoplasia (GTN) [3]. Although much effort has been put into understanding the development from hydatidiform moles to GTN, the underlying mechanism is still unclear [4][5][6].…”