Evaluation of a routine second curettage for hydatidiform mole: a cohort study
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ORIGINAL ARTICLE
Evaluation of a routine second curettage for hydatidiform mole: a cohort study Eiko Yamamoto1,2 · Kimihiro Nishino2 · Kaoru Niimi2 · Eri Watanabe2 · Yukari Oda2 · Kazuhiko Ino3 · Fumitaka Kikkawa2 Received: 25 December 2019 / Accepted: 20 February 2020 © Japan Society of Clinical Oncology 2020
Abstract Objective The aim of this study was to evaluate routine second curettage for hydatidiform mole (HM) by comparing the characteristics and outcomes of developing gestational trophoblastic neoplasia (GTN). Study design This was a cohort study including 173 patients diagnosed with HM between January 2002 and August 2019 who were followed up at Nagoya University Hospital, Japan. After an evacuation, 105 and 68 patients were managed with the routine method (routine group) and elective method (elective group) for a second curettage, respectively. The routine second curettage was performed around 7 days after the first evacuation. Patients in the elective group underwent a second curettage if there was ultrasonographic evidence of molar remnants in the uterine cavity. Socio-clinical factors were retrospectively compared between the routine and elective groups, and between patients showing regression and those who developed GTN. Results The incidence of GTN was 15.2% in the routine group and 20.6% in the elective group, and the difference was not significant (P = 0.364). The median GTN risk score was significantly higher in the routine group than in the elective group (P = 0.033). Presence of a complete HM, gestational age, and a pre-treatment human chorionic gonadotropin level of ≥ 200,000 mIU/mL were independent risk factors for GTN in molar patients. Conclusion The incidence of GTN was unchanged but the risk score of GTN was higher in the routine group than in the elective group. Routine second curettage may not be necessary, but further study will be needed to confirm this. Keywords Gestational trophoblastic neoplasia · Hydatidiform mole · Routine second curettage · Elective second curettage
Introduction Gestational trophoblastic diseases (GTDs) are a group of diseases characterized by proliferation of atypical trophoblastic cells. GTDs can be divided into two groups: hydatidiform mole (HM), which is an abnormal pregnancy, and gestational trophoblastic neoplasia (GTN), such as invasive * Eiko Yamamoto [email protected]‑u.ac.jp 1
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai‑cho, Showa‑ku, Nagoya 466‑8550, Japan
2
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai‑cho, Showa‑ku, Nagoya 466‑8550, Japan
3
Department of Obstetrics and Gynecology, Wakayama Medical University School of Medicine, 811‑1 Kimiidera, Wakayama 641‑0012, Japan
mole, choriocarcinoma, placental site trophoblastic tumor, and epithelial trophoblastic tumor. HMs are pathologically classified into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM). Cytogenetically, a CHM is an androgenetic diplo
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