Laparoscopy and/or Hysteroscopy in Differential Diagnosis and Treatment of Suspected Gestational Trophoblastic Neoplasia

  Objective  To investigate the application of laparoscopy and/or hysteroscopy in differential diagnosis and treatment of suspected gestational trophoblastic neoplasia (GTN), and its potential impact on outcome.

  Methods  From January 2005 to December 2013, 160 patients with a suspected diagnosis of GTN were admitted to Peking Union Medical College Hospital and underwent laparoscopy and/or hysteroscopy for it. The clinical data, diagnosis, and outcome of these patients were retrospectively analyzed.

  Results  Among the 160 eligible patients, 26 were confirmed with GTN, including choriocarcinoma in 15 cases, invasive mole in 6 cases, and placental site trophoblastic tumor (PSTT) in 5 cases. The diagnosis of GTN was ruled out in the other 134 cases, including intrauterine gestational residues in 106 (51 cases of incomplete abortion, 52 cases of residues of cornual pregnancy, 2 cases of placental remnants, 1 case of residual hydatidiform mole), cesarean scar pregnancyin 23, cornual pregnancy in 3, intramural pregnancy in 2. There was no significant difference in most of the clinical data between GTN patients and non-GTN patients except for the type of last pregnancy (P < 0.001). All of the GTN and the non-GTN patients achieved complete remission or cure by subsequent chemotherapy or surgical therapy except one patient lost to follow-up during the course of the treatment.

  Conclusions  Laparoscopy and/or hysteroscopy could be an effective strategy to facilitate diagnosis when it is difficult to differentiate GTN from non-GTN diseases by clinical data. Furthermore, that technique would not affect the outcome for GTN patients, while for non-GTN patients they could offer effective treatment.