[Value of hysteroscopy and laparoscopy in differential diagnosis of gestational trophoblastic neoplasia]

Abstract

Objective: To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases, including gestational trophoblastic neoplasia (GTN), incomplete abortion and ectopic pregnancy.

Methods: Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006, and underwent hysteroscopy and laparoscopy. Clinical data of patients were reviewed retrospectively. Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin (beta-hCG) level for a median (53 +/- 37) days (range, 15 - 125 days) after evacuation. Ultrasound revealed a lesion with affluent blood flow in intrauterine, unilateral horn of uterus, or myometrium. No positive findings were revealed by computerized tomography or X-ray of the chest in all patients. Eleven patients underwent evacuation under hysteroscope, 10 patients were diagnosed and treated by laparoscopy, and 6 by hysteroscopy and laparoscopy.

Results: Choriocarcinoma was diagnosed in 4 patients, who achieved complete remission by chemotherapy later. The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12, pregnancy in rudimentary horn in 1, and incomplete abortion in 10, who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.

Conclusions: The major causes of pregnancy-related abnormal bleeding include incomplete abortion, ectopic pregnancy, and GTN. Hysteroscopy and laparoscopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.