Objective To evaluate the added value of a centralized pathology review of the diagnoses of gestational trophoblastic diseases by expert pathologists and its potential impact on clinical management in a prospective multicenter study based on the Belgian Gestational Trophoblastic Diseases Registry.
Methods From July 2012 to December 2020, the two referral centers of the registry were solicited to advise on 1119 cases. Referral pathologists systematically reviewed all of the initial histological diagnoses. Cases initially assessed by expert pathologists were excluded. A total of 867 files were eligible for the study. Concordance between diagnoses of gestational trophoblastic diseases made by general ‘non-expert’ and expert pathologists was analyzed together with the potential impact of the alterations on clinical management. Expert pathologists were working in an academic setting with high exposure to placental pathology and national recognition.
Results The rate of discordance between expert and non-expert pathologists for the initial diagnoses was 35%. Almost 95% of complete moles were confirmed by the expert pathologists, but only 61% for partial moles. Compared with previous studies, ancillary techniques (p57 immunohistochemistry, karyotype) were used twice as often by both groups of pathologists in this survey. The diagnosis of gestational trophoblastic neoplasia was altered in 42% of cases. When the initial diagnosis was altered, the clinical relevance of this correction was estimated as down staging, up staging, or not relevant in 65%, 33% and 2% of cases respectively.
Conclusion Systematic centralized pathological review of gestational trophoblastic diseases modified the diagnosis in a third of cases. The results also show that a change in diagnosis would impact clinical management in 98% of patients.
- Gestational Trophoblastic Disease
- Hydatidiform Mole
- Trophoblastic Neoplasms
Data availability statement
Data are available upon reasonable request. Data are filed by the first author and are available on request.
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Contributors FG and SH established the study design, participated in patient recruitment and data analysis, and revised and approved the final manuscript. SS participated in data acquisition and analysis, performed data and statistical analyses, and wrote the manuscript. KD, A-SVR, EM, J-CN, PD, and PM participated in patient recruitment and pathological review, and revised and approved the final manuscript. IV and FK contributed to the establishment of the study design, and revised and approved the final manuscript. AV participated in the data acquisition. FG is the guarantor of this study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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