Differential diagnosis of patients with persistent β-hCG elevation and myometrial invasion following nonmolar gestation

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 eleva- tion following nonmolar pregnancy, ultrasound showing 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 myome- trial 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.