Re: persistent trophoblastic tumor
From: Terry J. DuBose (duboseterryj@uams.edu)
Tue Sep 30 17:05:52 2003
Here are some abstracts with some references that might help... good luck, Terry J DuBose, M.S, RDMS
Search for: 3 and 4
Citations: 2-9
Database: MEDLINE <1966 to September Week 3 2003>
Search Strategy:
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1 ULTRASONOGRAPHY, DOPPLER, PULSED/ or ULTRASONOGRAPHY, DOPPLER, COLOR/ or ULTRASONOGRAPHY, DOPPLER, DUPLEX/ or Doppler.mp. or ULTRASONOGRAPHY, DOPPLER/ (49796)
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2 Gestational Trophoblastic Neoplasms/ or Trophoblastic Neoplasms/ or Uterine Neoplasms/ or persistent trophoblastic tumor.mp. or Hydatidiform Mole/ (25524)
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3 1 and 2 (172)
4 TROPHOBLASTIC NEOPLASMS/ or GESTATIONAL TROPHOBLASTIC NEOPLASMS/ or TROPHOBLASTIC TUMOR, PLACENTAL SITE/ (2087)
5 3 and 4 (39)
6 from 5 keep 2-6,9-11 (8)
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***************************Citation <1>
Unique Identifier
--
12039472
Medline Identifier
22035297
Authors
Yalcin OT. Ozalp SS. Tanir HM.
Institution
Unit of Gynecologic Oncology, Department of Gynecology and Obstetrics, Osmangazi University School of Medicine, 26120 Eskisehir, Turkey. omertyalcin@isnet.net.tr
Title
Assessment of gestational trophoblastic disease by Doppler ultrasonography.
Source
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 103(1):83-7, 2002 Jun 10.
Local Messages
Not locally available; ask about Interlibrary Loan
Abstract
OBJECTIVES: To relate uterine artery blood flow characteristics to serum human chorionic gonadotropin (hCG) levels in patients with gestational trophoblastic disease (GTD). STUDY DESIGN: Twenty-one patients with GTD were investigated by serum hCG titers and Doppler ultrasonography of uterine arteries. The relations between the Doppler indices and the serum hCG titers were evaluated by paired-t, Mann-Whitney U tests, and Pearson's correlation analysis. RESULTS: Significant but weak negative
correlations were observed between systole/diastole (S/D) ratios, resistance indices (RIs) and pulsatility indices (PIs) and the absolute values of serum hCG levels with correlation coefficients of -0.31, -0.37, and -0.33 (P < 0.05). However, the same Doppler indices had more significant and strong negative correlations with the logarithmic values of the serum hCG levels with correlation coefficients of -0.65, -0.58, and -0.63, respectively (P < 0.01). Five patients who received chemotherapy
had significantly lower Doppler indices than those 16 patients with spontaneous regression (P < 0.001). CONCLUSIONS: Uterine artery Doppler indices might be used for the surveillance of the patients with GTD.
Citation <2>
Unique Identifier
7741920
Medline Identifier
95199972
Authors
Huang SC. Chou CY.
Title
The role of transvaginal ultrasonography in the management of gestational trophoblastic tumor.[comment].
Comments
Comment on: Am J Obstet Gynecol. 1993 Nov;169(5):1218-23; PMID: 8238187
Source
American Journal of Obstetrics & Gynecology. 172(3):1063-4, 1995 Mar.
Local Messages
All @ UAMS
Citation <3>
Unique Identifier
8039048
Medline Identifier
94313457
Authors
Yang JM. Wang KG.
Institution
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Title
Transvaginal color flow imaging in the follow-up of invasive gestational trophoblastic disease: a case report.
Source
Chung Hua i Hsueh Tsa Chih - Chinese Medical Journal. 53(5):315-8, 1994 May.
Local Messages
Not locally available; ask about Interlibrary Loan
Abstract
A case of invasive gestational trophoblastic disease after partial hydatidiform mole was presented in this study in which the diagnosis was made along with the treatment being monitored by means of transvaginal color Doppler ultrasound. In this case, the appearance or disappearance of vascular changes induced by invasive mole corresponded with serum beta human chorionic gonadotropin (beta-hCG) titer. Vascular changes displayed on color Doppler scanning may thus complement the application of hCG
in postmolar pregnancy surveillance.
Citation <4>
Unique Identifier
11981931
Medline Identifier
22021675
Authors
Zalel Y. Gamzu R. Lidor A. Goldenberg M. Achiron R.
Institution
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan 52621, Israel.
Title
Color Doppler imaging in the sonohysterographic diagnosis of residual trophoblastic tissue.
Source
Journal of Clinical Ultrasound. 30(4):222-5, 2002 May.
Local Messages
Part @ UAMS & ACH (Click Lib. Holdings) & LRVA(latest 10 yrs)
Abstract
PURPOSE: The purpose of this study was to evaluate the role of color Doppler imaging during sonohysterography in the diagnosis of residual trophoblastic tissue. METHODS: This prospective cohort study involved 25 consecutive women with clinical and sonographic signs of an echogenic intrauterine mass who were referred to the sonography unit of our institution for evaluation. All women underwent saline infusion sonohysterography with color Doppler sonographic evaluation. An operative hysteroscopy
with histologic examination was performed in 17 cases. RESULTS: Thirteen women (group A) had sonohysterographic features suggestive of residual trophoblastic tissue (ie, an echogenic intrauterine lesion not detached from the uterine wall after introduction of saline). The initial diagnosis was confirmed by histologic analysis in all cases. Blood flow was detected wit
hin the intrauterine mass in 6 (46%) of these 13 women; the resistance indices were low in all 6 cases (mean +/- standard error, 0.38 +/- 0.01). Twelve women (group B) had sonohysterographic findings negative for retained tissue, and no blood flow was detected within any of the intrauterine masses in this group (p < 0.05). CONCLUSIONS: Our results confirm the potential role of color Doppler sonography in the initial diagnosis of residual trophoblastic tissue. The detection of color Doppler
signals, especially with lo
w-resistance flow, within an intrauterine lesion should increase the confidence of the sonologist in the diagnosis of residual trophoblastic tissue. Copyright 2002 Wiley Periodicals, Inc.
Citation <5>
Unique Identifier
12006530
Medline Identifier
22001008
Authors
Agarwal R. Strickland S. McNeish IA. Patel DC. Foskett M. Boultbee JE. Newlands ES. Seckl MJ.
Institution
Department of Health Gestational Trophoblastic Disease Unit, Charing Cross Hospital Campus, Imperial College, London W6 8RF, United Kingdom.
Title
Doppler ultrasonography of the uterine artery and the response to chemotherapy in patients with gestational trophoblastic tumors.
Source
Clinical Cancer Research. 8(5):1142-7, 2002 May.
Local Messages
All @ UAMS
Abstract
PURPOSE: Increasing new blood vessel formation (neoangiogenesis) within tumors is an adverse prognostic factor for survival in several cancers. Neoangiogenesis is usually determined histopathologically and not in vivo. To assess neoangiogenesis in vivo, we have used Doppler ultrasonography (US) to measure the uterine artery pulsatility index (UAPI) in patients with gestational trophoblastic tumors (GTTs). Here, we assess whether the UAPI can provide independent prognostic information predictive
of methotrexate resistance (MTX-R), a drug central to the management of GTT. EXPERIMENTAL DESIGN: All patients treated for GTTs between March 1994 and January 1999 had their records reviewed to determine their pretreatment Charing Cross Hospital (CXH) prognostic score, uterine volume,
the lowest UAPI of either uterine artery, number of metastases, and human chorionic gonadotropin (hCG) concentration. Of the 164 patients for whom all data were available, 47 subsequently developed MTX-R, defined as a plateaued or rising hCG in two consecutive samples. RESULTS: UAPI, hCG, uterine volume, presence of metastases, and the overall CXH prognostic score were all predictive of MTX-R on univariate analysis. Moreover, the UAPI remained a significant independent predictor of MTX-R on
multiple logistic regress
ion analysis. After adjustment for the CXH prognostic score, the odds ratio for the risk of MTX-R in patients with a UAPI < or =1 compared with those with a UAPI >1 was 2.68 (95% confidence interval, 1.25-5.74; P = 0.01). The unadjusted odds ratio for the above comparison was 2.32 (95% confidence interval, 1.14-4.7; P = 0.02). CONCLUSIONS: The UAPI, as an indirect in vivo measure of functional tumor vascularity, independently predicts the response to chemotherapy in GTTs.
Citation <6>
Unique Identifier
10954498
Medline Identifier
20411029
Authors
Vitellas KM. Bennett WF. Bova JG.
Title
Case 2. Placental site trophoblastic tumor.
Source
AJR. American Journal of Roentgenology. 175(3):896; 898-900, 2000 Sep.
Local Messages
All @ UAMS; LRVA (latest 10 years)
Citation <7>
Unique Identifier
10428349
Medline Identifier
99355303
Authors
Xie H. Hata K. Lu M. Kong Q. Miyazaki K.
Institution
Department of Ultrasound, First Affiliated Hospital of Sum Yat-sen University of Medical Sciences, Guangzhuo, China.
Title
Color Doppler energy and related quantitative analysis of gestational trophoblastic tumors.
Source
International Journal of Gynaecology & Obstetrics. 65(3):281-6, 1999 Jun.
Local Messages
Not locally available; ask about Interlibrary Loan
Abstract
OBJECTIVE: To assess the reliability of color Doppler energy (CDE) and a related quantitative analysis for detection and follow-up of uterine involvement in gestational trophoblastic tumor. METHOD: CDE was performed in 19 patients with trophoblastic tumor, in 25 women in early pregnancy and 25 non-pregnant women. The blood flow area ratio (BFAR) in CDE was used as an index representing uterine involvement. In nine of the 19 patients, BFAR was measured before, during and at termination of
chemotherapy. RESULT: The BFAR (mean +/- S.D.) of uterine profiles in 19 patients (39.9 +/- 1.3%) was significantly higher than that in 25 pregnant women (24.6 +/- 10.1%, P = 0.002) and in 25 non-pregnant women (14.8 +/- 5.7%, P = 0.001). In the follow-up of n
ine patients, when beta-hCG was less than 3.1 ng/ml during the treatment, the BFAR (38.7 +/- 11.9%) decreased below that (44.2 +/- 14.6%) seen prior to treatment (P = 0.009) and was much lower at termination of treatment (27.5 +/- 12.3%, P = 0.048). CONCLUSION: These data support the use of CDE and the related quantitative analysis as a new method for detecting and follow-up of uterine involvement in patients with trophoblastic tumors.
Citation <8>
Unique Identifier
10349813
Medline Identifier
99279447
Authors
Bidzinski M. Sobiczewski P. Derlatka P. Pietrzak K. Wierzba W.
Institution
Kliniki Nowotworow Narzadow Plciowych Kobiecych Centrum Onkologii-Instytutu im. Marii Sklodowskiej-Curie w Warszawie.
Title
[Clinical usefulness of color doppler flow examination during treatment of gestational trophoblastic disease]. [Polish]
Source
Ginekologia Polska. 70(2):88-92, 1999 Feb.
Local Messages
Not locally available; ask about Interlibrary Loan
Abstract
Neovascularisation is the integral part of tumor development. Presence and type of pathological vascularisation can be used in therapy monitoring and follow up. The value of beta HCG and pulsatility index (PI) and resistance index (RI) in 14 women treated for nonmetastatic persistent trophoblastic disease (NMTD) were been compared. There was statistical, significant correlation between dropped BHCG level and increased value of RI. No correlation between BHCG blood concentration and values of PI
was observed. In summary it should be stated that color Doppler ul
trasonography is useful method in monitoring patients with NMTD.
ultrasound@obgyn.net writes:
>Any one have information about the Doppler waveform for this type of
>GTD?
>
>Patient was 4 weeks post elective AB (7 wk GA embryo) with continued
>bleeding. A relatively small area of endometrium had a complex
>appearance with a 3mm echogenic mass. With color Doppler this appeared
>highly vascular. The RI was 0.4, PSV 50cm/s . For obvious reasons this
>wasn't angle corrected, however sample gate was 2mm, and the beam was
>(presumed ) to be perpendicular.
>
>OF COURSE bHCG was not available at time of scan. I have seen a fair
>number of RPOC (retain products of conception) confirmed by pathology.
>None had this vascular pattern, or appearance.
>
>I'm assuming the physician will also check hPL ( palacental lactogen) ,
>though I realize that these type of tumors are so rare as to be
>unlikely.
>
>Can RPOC have a similar (Doppler) appearance?
>
Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
Assistant Professor & Director, Diagnostic Medical Sonography Program
University of Arkansas for Medical Sciences, CHRP
4301 West Markham St. Mail Slot #563
Little Rock, Arkansas, 72205 USA
501-686-6510
DuBoseTerryJ@UAMS.edu
http://www.io.com/~dubose/
http://www.uams.edu/chrp/dms/default.asp
http://www.obgyn.net/us/panel/panel.htm
