PERSISTENT POSTMOLAR GESTATIONAL TROPHOBLASTIC DISEASE - USE OF TRANSVAGINAL SONOGRAPHY AND COLOR-FLOW DOPPLER

Invasive moles have been difficult to diagnose except at hysterectomy. Many patients with persistent gestational trophoblastic disease (GTD) have been treated without ever demonstrating the site of the persiste nt trophoblastic focus. High resolution transvaginal sonography (TVS) has provided a technique of demonstrating very small uterine lesions, previously unsuspected by transabdominal sonography. The addition of c olour flow Doppler further increased diagnostic sensitivity and provid es another means of monitoring response to therapy. Three patients wit h persistent GTD, scanned by TVS and CFD (colour flow Doppler) perform ed as part of their metastatic work-up are presented. The only abnorma lities detected were foci demonstrated within the myometrium that demo nstrated increased flow on CFD. Single agent chemotherapy was commence d and the patients were monitored periodically through their course wi th repeat ultrasonography. After an initial lag period, the lesions de creased in size as the beta-HCG titres fell. An unsuspected adnexal ma ss was diagnosed on 1 patient, later proving to be a mature ovarian te ratoma.