Role of ultrasound and doppler flow study in management of malignant gestational trophoblastic neoplasia

ABSTRACT

Forty four patients with malignant gestational trophoblastic neoplasia [GTN] were enrolled in the study. They were followed up by serum B-HCG and abdomino-pelvic ultrasound during chemotherapy. In addition, the last 6 patients recruited in the study were assessed by doppler flow study. The cure rate was 100% for patients with non metastatic GTN [n = 27] and low risk metastatic GTN [n = 12]. For patients with high risk metastatic GTN [n = 5], the cure rate was only 40%. Ultrasound failed to localize uterine lesions in 4 out of 44 patients [9%] one of them had brain metastatases. Positive findings were found in the other 40 Cases [90%] [e.g. enlarged uterus, focal uterine lesion, ovarian thecalutein cysts liver metastases]. There was also regression of the detected lesions with normalization of B-HCG titre in responding patients [33/38] patients while the lesions persisted in patients with resistance to chemotherapy [5 patients]. Doppler flow study diagnosed 6 out of 6 cases of malignant GTN [100%] and the uterine vasculature decreased in 5 cases who responded to chemotherapy and remained high [Low resistance index and high peak systolic velocity] in one case who was not responding to chemotherapy as indicated by persistently high B-HCG. In conclusion, utrasonography and pulsed doppler flow study of the uterus are complementary tools to serum B-HCG in diagnosis and follow up of malignant GTN during chemotherapy. They can help in selection of patients for more aggressive chemotherapy to minimize relapse rate and hence increase cure rate