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

  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
  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
  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.