July 21st, 2018

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Differential Diagnosis of Patients with Persistent β-hCG Elevation and Myometrial Invasion Following Nonmolar Gestation
Authors:  Shiping Liu, M.D., Chenchen Fan, M.S., Fengzhi Feng, M.D., Yang Xiang, M.D., Xirun Wan, M.D., and Tong Ren, M.D.
  OBJECTIVE: To identify preoperative predictors of gestational trophoblastic neoplasia (GTN) in patients with persistent β–human chorionic gonadotropin (β-hCG) elevation and myometrial invasion following nonmolar gestation and to evaluate the safety of uterine mass laparoscopic resection in the diagnosis of GTN.

STUDY DESIGN: Patients with persistent β-hCG elevation following nonmolar pregnancy, ultrasound show-ing myometrial invasion, and having undergone laparoscopic resection of the uterine mass were retrospectively included from a database of endoscopic surgeries. The 38 patients identified were divided into 2 groups based on histologic outcomes: GTN (n=12) and non-GTN (n=26). Preoperative variables of the 2 groups were compared by univariate analysis. Response to chemotherapy and prognosis were also analyzed.

RESULTS: There was no statistical difference between the 2 groups in the variables analyzed. All GTN patients received postoperative chemotherapy, and the rate of complete remission was 100%. The mean follow-up time was 23±15.1 months, and no patient showed signs of relapse.

CONCLUSION: No preoperative variable analyzed here can accurately confirm the diagnosis of GTN in patients with persistent β-hCG elevation and myometrial invasion following nonmolar pregnancy. Laparoscopic resection of the uterine mass followed by chemotherapy may be an effective and safe way to obtain histologic tissues in these patients.
Keywords:  abortion, incomplete; differential diagnosis; gestational trophoblastic neoplasia; laparoscopy; myometrium
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