Sonographic diagnosis of gestational trophoblastic disease and comparison with retained products of conception.
OBJECTIVE
Gestational trophoblastic disease (GTD) and retained products of conception (RPC) can be difficult to distinguish sonographically. The aim of this study was to determine whether there were any sonographic criteria that could prospectively distinguish one from the other.


METHODS
Institutional ethics approval was obtained, and acquisition of consent was waived by the Institutional Review Board. A retrospective review of gynecologic oncology and pathology databases identified 17 cases of GTD and 14 cases of RPC. Findings from the pre-evacuation transvaginal sonographic examinations were analyzed. The scans were independently reviewed by 2 senior radiologists with specific expertise in pelvic sonography using several predetermined sonographic features. The reviewers were blinded to the diagnosis. A consensus reading was obtained.


RESULTS
The sonographic features that predicted GTD were a myometrial epicenter (P = .0002; odds ratio [OR] = 28), depth of myometrial invasion of more than one third (P = .001; OR = 20), placental venous lakes (P = .04; OR = 9), maximum mass dimensions of more than 3.45 cm (P = .009), and maximum endometrial thickness of less than 12 mm (P = .02). The remaining criteria were not statistically significant and included the characteristics of the mass, ascites, a "snowstorm" appearance, mass vascularity (including resistive index and peak systolic velocity), and the presence of ovarian cysts.


CONCLUSIONS
There are specific transvaginal sonographic features that can accurately differentiate GTD and RPC.
Betel
Cara
C
Department of Medical Imaging, Sunnybrook and Women's College Hospital, University of Toronto, ON M4N 3M5, Canada. carrie.betel@sunnybrook.ca
Atri
Mostafa
M
Arenson
Anna-Marie
AM
Khalifa
Mahmoud
M
Osborne
Raymond
R
Tomlinson
George
G
D000027:Abortion, Incomplete / Q000000981:diagnostic imaging*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D010048:Ovarian Cysts / Q000000981:diagnostic imaging*; D011247:Pregnancy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016216:Ultrasonography, Prenatal / Q000379:methods; D014599:Uterus / Q000000981:diagnostic imaging* / Q000473:pathology
D006063:Chorionic Gonadotropin