Cargando…
Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study
OBJECTIVES: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia fo...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439099/ https://www.ncbi.nlm.nih.gov/pubmed/28591340 http://dx.doi.org/10.6061/clinics/2017(05)05 |
_version_ | 1783237883976482816 |
---|---|
author | Asmar, Flavia Tarabini Castellani Braga-Neto, Antonio Rodrigues de Rezende-Filho, Jorge Villas-Boas, Juliana Marques Simões Charry, Rafael Cortés Maesta, Izildinha |
author_facet | Asmar, Flavia Tarabini Castellani Braga-Neto, Antonio Rodrigues de Rezende-Filho, Jorge Villas-Boas, Juliana Marques Simões Charry, Rafael Cortés Maesta, Izildinha |
author_sort | Asmar, Flavia Tarabini Castellani |
collection | PubMed |
description | OBJECTIVES: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia. METHODS: This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis. RESULTS: No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia. CONCLUSIONS: Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia. |
format | Online Article Text |
id | pubmed-5439099 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo |
record_format | MEDLINE/PubMed |
spelling | pubmed-54390992017-05-22 Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study Asmar, Flavia Tarabini Castellani Braga-Neto, Antonio Rodrigues de Rezende-Filho, Jorge Villas-Boas, Juliana Marques Simões Charry, Rafael Cortés Maesta, Izildinha Clinics (Sao Paulo) Clinical Science OBJECTIVES: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia. METHODS: This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis. RESULTS: No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia. CONCLUSIONS: Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2017-05 2017-05 /pmc/articles/PMC5439099/ /pubmed/28591340 http://dx.doi.org/10.6061/clinics/2017(05)05 Text en Copyright © 2017 CLINICS http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited. |
spellingShingle | Clinical Science Asmar, Flavia Tarabini Castellani Braga-Neto, Antonio Rodrigues de Rezende-Filho, Jorge Villas-Boas, Juliana Marques Simões Charry, Rafael Cortés Maesta, Izildinha Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title | Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title_full | Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title_fullStr | Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title_full_unstemmed | Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title_short | Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
title_sort | uterine artery doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study |
topic | Clinical Science |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439099/ https://www.ncbi.nlm.nih.gov/pubmed/28591340 http://dx.doi.org/10.6061/clinics/2017(05)05 |
work_keys_str_mv | AT asmarflaviatarabinicastellani uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy AT braganetoantoniorodrigues uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy AT derezendefilhojorge uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy AT villasboasjulianamarquessimoes uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy AT charryrafaelcortes uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy AT maestaizildinha uterinearterydopplerflowvelocimetryparametersforpredictinggestationaltrophoblasticneoplasiaaftercompletehydatidiformmoleaprospectivecohortstudy |