Objectives: To evaluate the clinical utility of transvaginal ultrasonography (TVS) with Doppler examination in detecting invasive trophoblastic uterine involvement and response to chemotherapy (CT) in nonmetastatic GTT patients. Methods: In addition to beta-human chorionic gonadotrophin (β- hCG) estimation, TVS was performed in 20 GTT patients at initial diagnosis, during cytotoxic courses and until ultrasonic normalization of uterine morphology after the end of CT. Parameters evaluated at TVS scan and compared to β-hCG trend were size in millimeters, echo pattern, vascularization (Doppler examination) of uterine lesions and perimetrium involvement. Results: In 19/20 GTT patients uterine localization was detected by TVS (74% myometrial nodules; 16% endometrial involvement; 10% both). In three patients with chemo-resistance, TVS showed growth of myo-nodules without changes in echogenicity. Two patients were switched to second-line CT and the third underwent hysterectomy; histological examination confirmed the persistence of an invasive mole. Another three patients were managed on the basis of TVS changes despite changes in β-hCG levels. A β-hCG plateau that occurred during methotrexate (MTX) treatment should have indicated a switch to second-line CT (MTX resistance), but TVS supported a uterine response (decrease in size and vascularization of myo- nodules and changes in echo pattern), and these patients received further MTX with subsequent normalization of β-hCG. In all other patients the trend in β-hCG levels was consistent with TVS findings. 12/19 patients had ultrasonically normal morphology of the uterus at the end of treatment, while in 5/19 cases uterine restitutio ad integrum was observed within 1 to 12 months after normalization of β-hCG. Conclusions: Although β-hCG remains the best tumoral marker in GTT, TVS monitoring allows a closer evaluation of uterine disease either in defining response to chemotherapy or suggesting resistance to chemotherapy.
Transvaginal ultrasound in treatment follow-up of gestational trophoblastic tumors (GTT) / Spagnolo, D; Valsecchi, L; Gentile, C; Garavaglia, E; Montoli, S; Cavoretto, P; Mangili, G. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 1469-0705. - 30(2007), p. 471. (Intervento presentato al convegno ISUOG 2007) [10.1002/uog.4443].
Transvaginal ultrasound in treatment follow-up of gestational trophoblastic tumors (GTT).
Cavoretto P;
2007-01-01
Abstract
Objectives: To evaluate the clinical utility of transvaginal ultrasonography (TVS) with Doppler examination in detecting invasive trophoblastic uterine involvement and response to chemotherapy (CT) in nonmetastatic GTT patients. Methods: In addition to beta-human chorionic gonadotrophin (β- hCG) estimation, TVS was performed in 20 GTT patients at initial diagnosis, during cytotoxic courses and until ultrasonic normalization of uterine morphology after the end of CT. Parameters evaluated at TVS scan and compared to β-hCG trend were size in millimeters, echo pattern, vascularization (Doppler examination) of uterine lesions and perimetrium involvement. Results: In 19/20 GTT patients uterine localization was detected by TVS (74% myometrial nodules; 16% endometrial involvement; 10% both). In three patients with chemo-resistance, TVS showed growth of myo-nodules without changes in echogenicity. Two patients were switched to second-line CT and the third underwent hysterectomy; histological examination confirmed the persistence of an invasive mole. Another three patients were managed on the basis of TVS changes despite changes in β-hCG levels. A β-hCG plateau that occurred during methotrexate (MTX) treatment should have indicated a switch to second-line CT (MTX resistance), but TVS supported a uterine response (decrease in size and vascularization of myo- nodules and changes in echo pattern), and these patients received further MTX with subsequent normalization of β-hCG. In all other patients the trend in β-hCG levels was consistent with TVS findings. 12/19 patients had ultrasonically normal morphology of the uterus at the end of treatment, while in 5/19 cases uterine restitutio ad integrum was observed within 1 to 12 months after normalization of β-hCG. Conclusions: Although β-hCG remains the best tumoral marker in GTT, TVS monitoring allows a closer evaluation of uterine disease either in defining response to chemotherapy or suggesting resistance to chemotherapy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
