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The Role of Computed Tomography Scanning of the Thorax in the Initial Assessment of Gestational Trophoblastic Neoplasia
  1. James M. Price, MBChB, MRCP*,
  2. Christine Lo, MBChB, BMedSci, MRCP,
  3. Shahram Abdi, MBChB, MRCS, FRCR,
  4. Matthew C. Winter, MBChB, MRCP, MD,
  5. Rob E. Coleman, MBBS, FRCP, MD,
  6. John Tidy, MD, BSc, FRCOG and
  7. Barry W. Hancock, MBChB, MD, FRCP, FRCR
  1. *Department of Clinical Oncology, Royal Derby Hospital, Derby;
  2. Trophoblastic Disease Centre, Weston Park Hospital; and
  3. Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
  1. Address correspondence and reprint requests to James M. Price, MBChB, MRCP, Department of Clinical Oncology, Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE, United Kingdom. E-mail: jamesprice202{at}gmail.com.

Abstract

Objective The aim of this study was to determine whether lesions found on computed tomography (CT) imaging of the thorax would affect FIGO (International Federation of Gynecology and Obstetrics) 2000 risk score and/or alter clinical management.

Methods The Sheffield Trophoblastic Disease database was searched for all new patients registered for staging/scoring investigations between January 1, 2006, and June 30, 2010. The FIGO 2000 score was noted and then recalculated using information from CT scan reports. Where a change of risk score would have affected a patient’s management, the case notes were further reviewed.

Results 191 patients had undergone both modalities of imaging. Using standard FIGO scoring, 169 and 22 patients were noted to be at low and high risk, respectively. Using information from CT imaging, only a further 20 patients would have been reclassified as high risk. Fifteen of these “new” high-risk patients required salvage treatment with intravenous chemotherapy; all were cured.

Conclusions With no potential advantage in terms of patient outcome and significantly increased radiation dose, there is little justification for routine CT imaging of the thorax in the initial assessment of new patients with gestational trophoblastic neoplasia.

  • Choriocarcinoma
  • Gestational trophoblastic disease
  • Gestational trophoblastic neoplasia

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Footnotes

  • The authors declare no conflicts of interest.

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