The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease

Abstract

Abstract Background and rational Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated. Patients and Methods This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018. Results In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy. Conclusion The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.