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Abstract
Introduction/Background Misclassification of a triploid partial mole leaves women uncertain about the risk of Gestational Trophoblastic Neoplasia (GTN). Accurate diagnosis by histology alone is challenging, while cytogenetic analyses offers confirmation of triploidy. Our study examined GTN incidence in histopathologically diagnosed partial moles and cytogenetically confirmed triploid cases. Moreover, we investigated whether termination approach, i.e. medical versus suction curettage, affects this risk.
Methodology Up to December 2023, we searched MEDLINE and Embase for studies on partial moles and GTN. Inclusion required histopathological diagnosis and, if performed, diagnosis of triploidy by cytogenetic analysis. Studies lacking clear GTN criteria were excluded. Using bivariate random-effects models, we calculated GTN proportions for both histopathologically confirmed partial moles and cytogenetically confirmed triploid partial moles, presenting pooled incidence with 95% CIs. Additionally, we conducted a sub-analysis on termination approach and assessed statistical heterogeneity using I2 statistics.
Results Of 1289 potential studies, 28 studies were included, comprising 8688 women with histopathologically confirmed partial moles and 1952 cytogenetically confirmed triploid ones. The pooled incidence of GTN in the first was 1.59% (95% CI 1.05–2.13) and 0.51% (95% CI 0.01–1.01) in the latter. In 566 women with partial moles (7 studies) suction curettage (SC) was performed in 79.5% (n=450), dilatation and curettage (D&C) in 19.4% (n=110) and prostaglandin in 1.1% (n=6). The pooled incidence of GTN in partial moles was 4.42% (95% CI 2.49–6.34) 0.75% (95% CI 0.00–2.91) and 0% (95%CI 0.00–20.75%) after SC, D&C and prostaglandin, respectively. GTN did not occur in 61 cytogenetically confirmed triploid partial moles.
Conclusion Pregnant women with a triploid partial mole have a low GTN risk (0.51%), and information about medical termination is limited. Whether medical termination is safe and raises GTN risk compared to suction curettage needs further study. This research will aid in counseling women on termination approaches, helping them weigh the pros and cons.
Disclosures Nothing to declare.
