The role of color Doppler flow in the management of nonmetastatic gestational trophoblastic disease.
Three patients with findings suggestive of invasive gestational trophoblastic neoplasm and lung metastasis were assessed by color Doppler transvaginal ultrasound, before and during chemotherapy. The sonographic findings were correlated with beta-hCG levels measured at various stages of treatment. Results were compared with blood flow indices found during normal first trimester pregnancies, and those following elective termination of pregnancy. The mean resistance indices were significantly lower in the patients treated with chemotherapy (0.410 +/- 0.04) than in the early pregnancy control group (5-8 weeks gestation; n = 20, resistance index = 0.494 +/- 0.06). The difference between the groups was statistically significant (chi 2; p < 0.05). No pathological flow patterns could be discerned in 10 patients, who after termination of pregnancy had beta-hCG levels below 5 IU/ml. The response of gestational trophoblastic neoplasms to chemotherapy could be reliably assessed by observing the changes in flow resistance, which paralleled the gradual decrements in serial measurements of beta-hCG levels. Thus, the statistically significant results of our study are very encouraging and may indicate that color Doppler flow is a noninvasive, reproducible, useful and highly reliable new diagnostic approach for the diagnosis and management of patients suffering from uterine malignant gestational trophoblastic disease.
Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar Saba, Israel.
R
R
Tepper
A
A
Shulman
M
M
Altaras
S
S
Goldberger
R
R
Maymon
M
M
Holzinger
Y
Y
Beyth
D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000097:blood; D003609:Dactinomycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014328:Trophoblastic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary; D018615:Ultrasonography, Doppler, Color; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy
D006063:Chorionic Gonadotropin; D003609:Dactinomycin