Data di Pubblicazione:
2007
Citazione:
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].
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.
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.
Tipologia CRIS:
4.2 Abstract in Atti di convegno
Keywords:
Gestational trophoplastic neoplasia; Ultrasound; GTN
Elenco autori:
Spagnolo, D; Valsecchi, L; Gentile, C; Garavaglia, E; Montoli, S; Cavoretto, P; Mangili, G
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