Association of ultrasound morphological features with serum β subunit human chorionic gonadotrophin and histopathology among sonologically diagnosed cases of gestational trophoblastic neoplasia in a tertiary hospital

Abstract

BACKGROUND: Gestational trophoblastic neoplasia (GTN) presents as vascular mass of varying morphology on ultrasound and confirmed through quantitative serum β subunit human chorionic gonadotrophin (β-hCG). In regions with limited access to β-hCG, ultrasound plays a crucial role in the initial diagnosis for timely management. OBJECTIVES: This study aimed to investigate the associations between ultrasound vascular morphologic features, serum β-hCG levels, and histopathology in GTN cases. METHODOLOGY: A cross-sectional review was conducted on 113 cases with ultrasound impression of GTN over an 8-year period. The patient data were extracted from case records, and ultrasound images were categorized based on the distinct features. Associations with β-hCG levels and histopathology were analyzed using the Chi-square test and Mann–Whitney U-test. Statistical significance was set at P < 0.05. RESULTS: A significant association was observed between ultrasound category and serum β-hCG (P < 0.0001). The compact and diffuse types were more prevalent with β-hCG levels between 104 to <105 mIU/mL, while the lacunar type was common among patients with ≥105 mIU/mL. However, there was no significant association between ultrasound categories and mean β-hCG levels. Regarding histopathology, the lacunar type was more common in invasive moles, whereas the compact and diffuse types tended to be seen with choriocarcinoma, although these were not statistically significant (P = 0.182). CONCLUSIONS: Morphologic types of GTN by gray scale and Doppler ultrasound vary across the different levels of serum β-hCG and may suggest the histopathological diagnosis. This study provides valuable insights into the ultrasonographic characteristics of GTN, which can aid in its diagnosis and management.