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A well-circumscribed border with peripheral Doppler signal in sonographic image distinguishes epithelioid trophoblastic tumor from other gestational trophoblastic neoplasms.

Qin J, Ying W, Cheng X, Wu X, Lu B, Liang Y, Wang X, Wan X, Xie X, Lu W - PLoS ONE (2014)

Bottom Line: The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05).Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs.With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.

ABSTRACT
As epithelioid trophoblastic tumor (ETT) shares similar clinical features with other gestational trophoblastic neoplasms (GTNs), it is likely to be clinically misdiagnosed and subsequently treated in an improper way. This study aimed to identify the sonographic features of ETT that are distinct from other GTNs, including placental site trophoblastic tumor (PSTT) and invasive mole/choriocarcinoma (IM/CC). Here, we retrospectively analyzed ultrasound images of 12 patients with ETT in comparison with those of 21 patients with PSTT and 24 patients with IM/CC. The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05). However, a well-circumscribed border with hypoechogenic halo was identified in the gray-scale sonogram in all 12 cases of ETT, while only in 1 out of 21 cases of PSTT and 1 out of 16 cases of IM/CC (P<0.001 for ETT vs. PSTT or IM/CC). Moreover, a peripheral pattern of Doppler signals was observed in 11 out of 12 ETT lesions, showing relatively more Doppler signal spots around the tumor border than within the boundary, while a non-peripheral pattern of Doppler signals in all 21 PSTT cases and 14 out of 16 IM/CC cases: with minimal, moderate or remarkable signal spots within the tumor, but not along the tumor (P<0.001 for ETT vs. PSTT or IM/CC). These distinct sonographic features of ETT correlated with histopathologic observations, such as expansive growth pattern and vascular morphology. Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs. With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

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Related in: MedlinePlus

Ultrasonographic characteristics of ETT.(a) On gray-scale image, lesion was located in the left fundus of uterus, showing heterogeneously echogenic cystic-solid mass with distinct border (between cursors). (b) On Color Doppler, the abundant Doppler signals from blood flow distributed at the tumor periphery, while a few signals were showed within the boundary of tumor, which is named as “peripheral Doppler signal”.
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pone-0112618-g001: Ultrasonographic characteristics of ETT.(a) On gray-scale image, lesion was located in the left fundus of uterus, showing heterogeneously echogenic cystic-solid mass with distinct border (between cursors). (b) On Color Doppler, the abundant Doppler signals from blood flow distributed at the tumor periphery, while a few signals were showed within the boundary of tumor, which is named as “peripheral Doppler signal”.

Mentions: The ultrasonographic features of the uterine lesions among ETT, PSTT and IM/CC are listed in Table 2. More lesions located in the lower segment of uterus were observed for ETT than those for PSTT and IM/CC with the P-value of 0.005 and 0.002, respectively. On gray-scale images, ETT tended to exhibit a well-circumscribed tumor border surrounded by a hypoechogenic halo (Figure 1a and Figure S1), which was rarely observed for other two groups (both P<0.001, Figure 2a, 3a and Figure S2, S3). On Color Doppler images, ETT lesions demonstrated relatively more Doppler signal spots at the periphery than in the intratumoral area (Figure 1b and Figure S1). In contrast, both other two groups showed a non-peripheral pattern: minimal to moderate, even remarkable Doppler signal within the boundary, or throughout the tumor (Figure 2b, 3b and Figure S2, S3). The maximal diameter and all hemodynamic parameters, however, were not significantly different among ETT, PSTT and IM/CC (P>0.05).


A well-circumscribed border with peripheral Doppler signal in sonographic image distinguishes epithelioid trophoblastic tumor from other gestational trophoblastic neoplasms.

Qin J, Ying W, Cheng X, Wu X, Lu B, Liang Y, Wang X, Wan X, Xie X, Lu W - PLoS ONE (2014)

Ultrasonographic characteristics of ETT.(a) On gray-scale image, lesion was located in the left fundus of uterus, showing heterogeneously echogenic cystic-solid mass with distinct border (between cursors). (b) On Color Doppler, the abundant Doppler signals from blood flow distributed at the tumor periphery, while a few signals were showed within the boundary of tumor, which is named as “peripheral Doppler signal”.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232420&req=5

pone-0112618-g001: Ultrasonographic characteristics of ETT.(a) On gray-scale image, lesion was located in the left fundus of uterus, showing heterogeneously echogenic cystic-solid mass with distinct border (between cursors). (b) On Color Doppler, the abundant Doppler signals from blood flow distributed at the tumor periphery, while a few signals were showed within the boundary of tumor, which is named as “peripheral Doppler signal”.
Mentions: The ultrasonographic features of the uterine lesions among ETT, PSTT and IM/CC are listed in Table 2. More lesions located in the lower segment of uterus were observed for ETT than those for PSTT and IM/CC with the P-value of 0.005 and 0.002, respectively. On gray-scale images, ETT tended to exhibit a well-circumscribed tumor border surrounded by a hypoechogenic halo (Figure 1a and Figure S1), which was rarely observed for other two groups (both P<0.001, Figure 2a, 3a and Figure S2, S3). On Color Doppler images, ETT lesions demonstrated relatively more Doppler signal spots at the periphery than in the intratumoral area (Figure 1b and Figure S1). In contrast, both other two groups showed a non-peripheral pattern: minimal to moderate, even remarkable Doppler signal within the boundary, or throughout the tumor (Figure 2b, 3b and Figure S2, S3). The maximal diameter and all hemodynamic parameters, however, were not significantly different among ETT, PSTT and IM/CC (P>0.05).

Bottom Line: The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05).Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs.With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.

ABSTRACT
As epithelioid trophoblastic tumor (ETT) shares similar clinical features with other gestational trophoblastic neoplasms (GTNs), it is likely to be clinically misdiagnosed and subsequently treated in an improper way. This study aimed to identify the sonographic features of ETT that are distinct from other GTNs, including placental site trophoblastic tumor (PSTT) and invasive mole/choriocarcinoma (IM/CC). Here, we retrospectively analyzed ultrasound images of 12 patients with ETT in comparison with those of 21 patients with PSTT and 24 patients with IM/CC. The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05). However, a well-circumscribed border with hypoechogenic halo was identified in the gray-scale sonogram in all 12 cases of ETT, while only in 1 out of 21 cases of PSTT and 1 out of 16 cases of IM/CC (P<0.001 for ETT vs. PSTT or IM/CC). Moreover, a peripheral pattern of Doppler signals was observed in 11 out of 12 ETT lesions, showing relatively more Doppler signal spots around the tumor border than within the boundary, while a non-peripheral pattern of Doppler signals in all 21 PSTT cases and 14 out of 16 IM/CC cases: with minimal, moderate or remarkable signal spots within the tumor, but not along the tumor (P<0.001 for ETT vs. PSTT or IM/CC). These distinct sonographic features of ETT correlated with histopathologic observations, such as expansive growth pattern and vascular morphology. Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs. With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

Show MeSH
Related in: MedlinePlus