Pelvic arteriography in invasive trophoblastic neoplasia

Arteriographic abnormalities were present in 39 of 43 patients with invasive trophoblastic neoplasia and frequently these abnormalities were gross. 2. The appearances were sometimes characteristic of ITN. The spectrum of abnormality observed overlaps the appearances found in early pregnancy, missed abortion, hydatidiform mole and abdominal pregnancy. 3. Arteriographic abnormalities were found when curettage, and in one case hysterectomy, had not revealed evidence of trophoblastic neoplasia. Curettage revealed evidence of choriocarcinoma in one patient whose arteriogram was normal. 4. Arteriography failed to show evidence of ITN in some patients in whom this was known to be present by virtue of HCG production. The converse did not occur. 5. No reliable basis for distinction between choriocarcinoma following mole and invasive mole was found. Minor abnormalities only were found in several cases of choriocarcinoma following non-molar pregnancy. 6. Serial arteriography did not provide a reliable guide to treatment. Arteriographic abnormalities continued to resolve long after chemotherapeutic destruction of the tumour had been completed. 7. Despite these limitations pelvic arteriography was often useful in the management of ITN. It provided visual localisation of a disease process when the only other indication of abnormality was HCG excretion. It provided evidence of extrauterine, intrapelvic extension of choriocarcinoma which was not obtainable by other means. Demonstration of the vascular changes which accompany active trophoblastic invasion has extended knowledge of the natural history of the tissue and its tumours.