Gestational trophoblastic neoplasia diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Ultrasound is the diagnostic study of choice for gestational trophoblastic neoplasia. Anomalous rise in the level of serum beta hCG can also serve as an adjunct investigation to rule in gestational trophoblastic neoplasia.

Diagnostic Study of Choice

Study of Choice

Ultrasound is the diagnostic study of choice for gestational trophoblastic neoplasia. It is usually the first test done if gestational trophoblastic tumour is suspected.^[1]

It is used to:

Identify most types of gestational trophoblastic disease
Check for metastasis in the pelvis or abdomen
Plan treatment

Staging

The Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) staging system ^[2]


Stage	FIGO Anatomical Staging

I	Disease confined to the uterus
II	GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament)
III	GTN extends to the lungs, with or without known genital tract involvement
IV	All other metastatic sites

Modified WHO prognostic scoring system as adapted by Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)^[3]

Score	0	1	3	4
Age	< 40	40	-	-
Antecedent pregnancy	Mole	Abortion	Term	-
Interval months from index pregnancy	< 4	4 - < 7	7 - < 13	≥ 13
Pre-treatment serum βhCG (iu/l)	< 10³	10³ - < 10⁴	10⁴ - < 10⁵	≥ 10⁵
Largest tumor size (including uterus)	-	3 - < 5 cm	≥ 5cm	-
Site of metastases	Lung	Spleen, Kidney	Gastrointestinal	Liver, Brain
Number of metastases	-	1 - 4	5 - 8	> 8
Previous failed chemotherapy	-	-	1 drug	2 or more drugs

References

↑ Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 12, 2015
↑ Stage Information for Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq#section/_11 URL Accessed on October 7, 2015
↑ Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S (October 2003). "Gestational trophoblastic neoplasia, FIGO 2000 staging and classification". Int J Gynaecol Obstet. 83 Suppl 1: 175–7. PMID 14763174.

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[qqq-1] Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 12, 2015

[eee-2] Stage Information for Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq#section/_11 URL Accessed on October 7, 2015

[pmid14763174-3] Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S (October 2003). "Gestational trophoblastic neoplasia, FIGO 2000 staging and classification". Int J Gynaecol Obstet. 83 Suppl 1: 175–7. PMID 14763174.

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