Transvaginal sonography and color doppler imaging in the follow-up of patients with gestational trophoblastic disease

ABSTRACT

Uterine morphology assessed by transvaginal sonography [TVS] and the hemodynamics of intra-tumoral vessels assessed by color Doppler ultrasound [CDU] were prospectively correlated with the clinical outcome of 9 patients with gestational trophoblastic disease [GTD]. Six patients were managed and followed without treatment and 4 of them achieved complete local resolution. Three patients were referred for sonographic evaluation of persistent trophoblastic disease. Our four patients with one referred subject did not need any further treatment [Observation group, n = 5]. Two of our patients plus two of the three referred patients were found to have persistent disease and they received chemotherapy [Treatment group, n = 4]. In the observation group both techniques; TVS and CDU, had 100% accuracy in predicting local resolution or local persistence. Persistence was predicted 1-2 weeks before the increase of B human chorionic gonadotropin [B-hCG] levels, whereas resolution was observed up to 6 weeks before the disappearance of beta-hCG. In one patient normal uterine morphology and vascularization in the presence of elevated hCG levels was associated with extrauterine spread. In the treatment group, normal uterine ultrasound morphology and negative color Doppler results had 75% negative predictive value, A false-positive result was observed in one case. We conclude that ultrasound evidence of abnormal uterine morphology or persistent vascularization on color Doppler examination with persistent hCG levels is indicative of local persistence. Normal uterine morphology with negative color Doppler results may be associated with extrauterine spread