Petra – Jordan

Diagnosis of trophoblastic diseases

SOGC/GOC Clinical Guideline #408, January 2021

  • GTDs are most often detected by imaging before the patient exhibits clinical symptoms other than vaginal bleeding or by pathologic examination post-evacuation of an abnormal pregnancy.
  • An increasing level of hCG will help differentiate GTD from other diagnoses, such as clear egg or terminated pregnancy.
  • It is possible to misdiagnose PHM in a rare case of a twin pregnancy consisting of a MHC and a biparental (viable) diploid fetus.
  • Workup for suspected GTD includes physical examination to detect complications such as anemia, pre-eclampsia, hyperthyroidism, or other symptoms suggestive of metastatic disease.
  • Biological examinations include complete blood count, electrolytes, TP/PTT, creatinine, liver enzymes, TSH, quantitative total hCG and urinary proteins.
  • Imaging for patients with molar pregnancy consists of pelvic ultrasound only; additional examinations will be requested depending on the symptoms.
  • The risk of clinically significant metastases is negligible in the absence of pulmonary or vaginal metastases.
  • Pulmonary micrometastases detected during a thoracic CT-scan have no impact on clinical results in stage I patients.
  • If the results of the chest X-ray are suspicious or positive, it is recommended to perform a chest and abdominal CT-scan with hepatic arterial phase and a cerebral MRI.
  • There is no advantage to using a PET-scan or CT-scan over conventional imaging with regard to tumor staging but may be useful for ambiguous cases with elevated hCG levels.
  • Metastatic spread of GTNs is primarily hematogenously to the lungs and vagina.
  • Biopsy of suspicious lesions is contraindicated due to the risk of significant bleeding.

2021. Guideline No. 408: Management of Gestational Trophoblastic Diseases. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier Ph. J Obstet Gynaecol Can;43(1):91-105.

Modified on 12/23/2023