NONMETASTATIC GESTATIONAL TROPHOBLASTIC NEOPLASIA - ROLE OF ULTRASONOGRAPHY AND MAGNETIC-RESONANCE-IMAGING

OBJECTIVE: To determine whether routine imaging using grey-scale ultra sound, pulse and color Doppler flow, endovaginal ultrasound and magnet ic resonance imaging (MRI) provide information that significantly help s determine therapy in patients with nonmetastatic gestational trophob lastic disease. STUDY DESIGN: A literature search runs performed to se ek all publications in English and German that reported on investigati ons of imaging by ultrasound and MRI in patients with a diagnosis of t rophoblastic tumor without evidence of metastases. Studies performed t o make a diagnosis of hydatidiform mole were excluded. Included were s tudies that investigated the clinical usefulness and efficacy of these imaging methods in the diagnosis of invasive mole as a visual confirm ation of the diagnosis based on human chorionic gonadotropin (hCG) and histology. Furthermore, the usefulness and efficiency of imaging in d etermining the effectiveness of chemotherapy were investigated. RESULT S: Analysis of these reports showed that lesions are detectable by ima ging modalities at relatively high levels of hCG but may not be visual ized at lower levels of hCG, when chemotherapy is nevertheless indicat ed and the diagnosis of neoplasia is fully justified. Moreover, myomet rial lesions have been observed by MRI in patients who subsequently ac hieved spontaneous resolution of their disease without chemotherapy. A t lower levels of hCG (< 700 mIU/mL), intramyometrial lesions may not be visualized by either ultrasound or MRI. Myometrial abnormalities ma y persist with resolution of the tumor. Thus, the sensitivity of eithe r method is no better than 70% and the specificity is even lower. CONC LUSION: Weekly serial levels of serum hCG remain the most accurate, re liable and definitive arbiter of treatment management. Pelvic ultrasou nd or MRI need not be an integral part of pretreatment assessment. Ima ging techniques are expensive yet not decisive in managing nonmetastat ic trophoblastic disease. This finding applies to nonmetastatic diseas e only. With metastases, ultrasound, MRI and computed tomography do pl ay an integral role in diagnosis, staging and management.