Repeat Curettage After Evacuation of Hydatidiform Mole

Lao, Tth; Lee, F. H. C.; Yeung, Sik-Wing

doi:10.3109/00016348709103641

Cited by 15 publications

(7 citation statements)

References 5 publications

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“…With the commonly used suction curettage for the evacuation of a hydatidiform mole, it is highly unlikely that this molar tissue bearing the extravillous trophoblasts will be completely removed. The study by Lao et al (21) compared the “histology result” (trophoblastic tissue, or no trophoblastic tissue) of a routinely performed second curettage in patients with a hydatidiform mole with the subsequent need for chemotherapy for PTD. The authors reported absence of such a correlation, meaning that this result contradicts the hypothesis that residual tissue after evacuation of a hydatidiform mole is the entirely unique cause of PTD.…”

Section: Discussionmentioning

confidence: 99%

Early identification of persistent trophoblastic disease with serum hCG concentration ratios

Trommel

Duc

Massuger

et al. 2008

International Journal of Gynecological Cancer

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The objective of the present study was to assess the diagnostic potential of serum human chorionic gonadotropin (hCG) ratios obtained at different intervals after evacuation of hydatidiform mole to diagnose persistent trophoblastic disease (PTD) and to compare its diagnostic accuracy with the current FIGO 2000 criteria as a gold standard. We calculated hCG ratios from serum hCG concentrations of 204 patients (86 with and 118 without PTD) registered with the Dutch Central Registry for Hydatidiform Moles between 1977-2004. The hCG ratios obtained in week 1, 3, and 5 after evacuation identified, respectively, 20%, 52%, and 79% of patients with PTD (median: 3.0 weeks) at the 95% specificity level, while FIGO 2000 criteria identified, respectively, 0%, 16%, and 66% (median: 4.7 weeks). It is concluded that a serum hCG ratio identifies patients with PTD approximately 2 weeks earlier than the internationally accepted FIGO 2000 criteria and identifies more than 75% of patients who develop PTD by the fifth week after evacuation.

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Section: Discussionmentioning

confidence: 99%

Early identification of persistent trophoblastic disease with serum hCG concentration ratios

Trommel

Duc

Massuger

et al. 2008

International Journal of Gynecological Cancer

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“…One study found that second curettage performed for suspected post-molar GTN had either no impact or only result in transient drop followed by a rise in hCG levels in majority of patients, with only 20% of patients had sustained drop in hCG levels and spontaneous remission [ 31 ]. Similarly, other studies have reported that a second curettage led to change in management in only about 10% of patients, by either inducing remission or providing malignant GTN histology [ 29 , 30 ]. Furthermore, the reported incidence of uterine perforation during second curettage was up to 8% [ 31 , 33 ].…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 93%

“…Second uterine evacuation has been utilised to remove residual trophoblastic tissue in the hope to allow spontaneous regression and avoid chemotherapy. Several retrospective series suggest that routine second uterine evacuation is unlikely to benefit the majority of patients with post-molar GTN [ 29 , 30 , 31 , 32 ]. One study found that second curettage performed for suspected post-molar GTN had either no impact or only result in transient drop followed by a rise in hCG levels in majority of patients, with only 20% of patients had sustained drop in hCG levels and spontaneous remission [ 31 ].…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Gestational trophoblastic disease (GTD) consist of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD are relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients in order to achieve cure. Hysterectomy is the mainstay treatment for PSTT or ETT, and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.

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“…Лишь у 20% пациенток наблюдались нормализация ХГЧ и наступление спонтанной ремиссии после повторной процедуры. Аналогичным образом другие исследователи отметили, что повторное раздельное диагностическое выскабливание (РДВ) после первичной эвакуации ПЗ имело эффект только у 10% пациенток, которые достигли ремиссии, или же для верификации ЗТО [6][7][8].…”

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“…Кровотечение после повторного выскабливания развилось у двух пациенток, у двух диагностирована перфорация мат-ки; осложнения купированы консервативно. Имеются данные, что у 77% больных при обнаружении остаточной ткани во время повторного выскабливания полости матки признаков персистирующей ТБ нет, а у 14% пациенток без остатков ткани ПЗ имелись признаки ПТО, что потребовало проведения ХТ [12,13].…”

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Surgical treatment of trophoblastic disease. Modern concept and contradictions (literature review)

et al. 2020

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A review of studies on the comparison of the effectiveness of surgical treatment of malignant trophoblastic tumors before the start of standard chemotherapy and in terms of combination treatment is presented. According to Russian and foreign studies, surgical treatment is relevant for patients with primary or metastatic tumor resistance. The article presents the results of treatment of patients after various types of operations. The most common volume of surgery was a hysterectomy. The article also discusses the results of treatment of benign forms of trophoblastic disease. Surgical treatment of a malignant trophoblastic tumor before the start of standard chemotherapy was performed according to vital indications or in connection with a tumor determined by imaging methods. And the analysis carried out in Blokhin National Medical Research Center of Oncology showed expected prognoses for patients who underwent surgical treatment prior to the start of standard chemotherapy regimens. Such patients were admitted to the clinic with a resistant or disseminated form of the tumor. During their treatment, high-dose chemotherapy or additional surgical interventions were required, which significantly worsened the prognosis of the disease. In the opposite case, when removing a localized resistant primary tumor or its metastasis, in the postoperative period, chemotherapy was not carried out in connection with marker remission.

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Repeat Curettage After Evacuation of Hydatidiform Mole

Cited by 15 publications

References 5 publications

Early identification of persistent trophoblastic disease with serum hCG concentration ratios

Early identification of persistent trophoblastic disease with serum hCG concentration ratios

Surgery including fertility-sparing treatment of GTD

Surgical treatment of trophoblastic disease. Modern concept and contradictions (literature review)

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