June 22nd, 2018

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Clinical Outcomes of Partial Hydatidiform Mole in the p57 Era
Authors:  T. Rinda Soong, M.D., Ph.D., MPH, Michelle R. Davis, M.D., Kevin M. Elias, M.D., Neil S. Horowitz, M.D., Liping Yuan, M.D., Donald P. Goldstein, M.D., Ross S. Berkowitz, M.D., and Bradley J. Quade, M.D., Ph.D.
  OBJECTIVE: To assess the prognostic value of ancillary testing strategies in predicting clinical outcomes of patients with partial hydatidiform mole (PHM) in the p57 era as compared with histology alone.

STUDY DESIGN: Patients diagnosed with PHM from 2004–2016 were identified. A blinded retrospective pathologic review was done to assess the sensitivity and specificity in diagnosing PHMs by histology alone as compared to histology plus ancillary tests. Effectiveness of p57 immunohistochemistry in distinguishing PHM from complete hydatidiform mole (CHM) was examined with archived samples and correlated to clinical and follow-up data obtained from the longitudinal medical record.

RESULTS: A total of 260 cases of PHMs were reviewed. Blinded pathologic review showed a sensitivity of 88% and a specificity of 95% in diagnosing PHMs with histology alone versus histology in combination with ancillary testing. In examining p57 expression in random archived samples, 100% of PHMs (n=56) expressed p57 staining, and 100% of CHMs (n=57) had absent staining. A total of 145 subjects had available clinical follow-up data. Sixteen cases in this series were diagnosed with gestational trophoblastic neoplasia (GTN). Thirteen cases of GTN were referred at persistence, giving an incidence of GTN in this cohort of 2.3%. As com-pared with subjects without GTN, there was no significant difference in the use of diagnostic regimens: histology alone, p57, or additional ancillary testing among those diagnosed with GTN (p=0.24, p=0.95, and p=0.99, respectively).

CONCLUSION: Histology alone has a high sensitivity and specificity for diagnosing PHM. In this series p57 is a reliable adjunct in distinguishing PHMs from CHMs but is not significantly better than histology alone in predicting progression to GTN by identifying missed diagnoses of CHM.
Keywords:  choriocarcinoma; gestational trophoblastic disease; gestational trophoblastic neoplasia; hydatidiform mole; hydatidiform mole, complete; hydatidiform mole, partial; molar pregnancy
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