ACR logo

Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C. Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol. 2003;4(11):670-678. Review/Other-Dx N/A To describe the relevant pathophysiology and natural history of GTN, and the use of imaging techniques in the diagnosis and management of these conditions. No results stated in abstract. 4
2. Goldstein DP, Berkowitz RS. Current management of gestational trophoblastic neoplasia. Hematol Oncol Clin North Am. 2012;26(1):111-131. Review/Other-Tx N/A To review current management of gestational trophoblastic neoplasia. No results stated in abstract. 4
3. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010;203(6):531-539. Review/Other-Dx N/A To discuss the epidemiology, pathology, clinical presentation, and diagnosis of the various gestational trophoblastic disease variants. No results stated in abstract. 4
4. Hoffner L, Surti U. The genetics of gestational trophoblastic disease: a rare complication of pregnancy. Cancer Genet. 2012;205(3):63-77. Review/Other-Dx N/A To describe  the current understanding of the morphology, epidemiology and genetics of gestational trophoblastic disease that followed the milestone findings by Kajii and Ohama. No results stated in abstract. 4
5. Worley MJ, Jr., Joseph NT, Berkowitz RS, Goldstein DP. Women with a partial mole during their first pregnancy and diagnosed earlier in gestation are at increased risk of developing gestational trophoblastic neoplasia. Int J Gynecol Cancer. 2014;24(5):941-945. Observational-Dx 111 patients To  identify factors associated with gestational trophoblastic neoplasia (GTN) after partial molar pregnancy. A total of 111 patients with a partial molar pregnancy were available for analysis. There was no significant difference between patients who did and did not develop GTN with respect to patient age, parity, history of prior molar pregnancy, presenting signs/symptoms, uterine size greater than gestational age, clinical diagnosis, preevacuation sonogram findings, or the preevacuation human chorionic gonadotropin value. Patients who developed GTN had fewer prior pregnancies (median, 2 vs 3; P = 0.02) and were more likely to have had a partial molar pregnancy as their first gestational event (37.1% vs 17.1%; P = 0.03). Among the 35 patients who developed GTN, the median time to diagnosis of GTN was 47 days (range, 25-119 days), and the median human chorionic gonadotropin value at the time of GTN diagnosis was 475 mIU/mL (range, 20-52,630 mIU/mL). All women (100%) who developed GTN had stage I disease, and all patients (100%) had low-risk GTN. All 35 women (100%) were able to achieve remission, and most (85.7%) of these patients received methotrexate as first-line chemotherapy. 4
6. Bolze PA, Attia J, Massardier J, et al. Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases. Eur J Cancer. 2015;51(13):1725-1731. Review/Other-Dx N/A To assess the level of agreement among an expert panel of the EOTTD in order to rationalise the management of patients in Europe. There was an agreement for 54 statements while the experts showed a disagreement for two statements. As there is little evidence from randomised trials on which to base recommendations about management of GTD, many of these recommendations are based on expert opinion derived from changes in management fact that have improved outcomes from nearly 100% fatality to nearly 100% cure rates. 4
7. Mangili G, Lorusso D, Brown J, et al. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S109-116. Review/Other-Dx N/A To provide a consensus review on gestational trophoblastic disease diagnosis and management from the combined International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Guidelines were constructed on the basis of literature review. After initial diagnosis in local centers, centralization of pathology review and ongoing care is recommended to achieve the best outcomes. 4
8. Shih Ie M. Gestational trophoblastic neoplasia--pathogenesis and potential therapeutic targets. Lancet Oncol. 2007;8(7):642-650. Review/Other-Dx N/A To summarize the recent advances in understanding the molecular aetiology of this group of diseases and highlight the molecules that can be potentially used for therapeutic targets to treat metastatic gestational trophoblastic neoplasia. No results stated in abstract. 4
9. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360(16):1639-1645. Review/Other-Dx 1 patient To discuss the case of a pregnant women whose pathological examination of the uterus indicates a complete molar pregnancy. No results stated in abstract. 4
10. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376(9742):717-729. Review/Other-Tx N/A To summarize strategies for management of gestational trophoblastic disease and address some of the controversies and future research directions. No results stated in abstract. 4
11. Berkowitz RS, Goldstein DP. Current management of gestational trophoblastic diseases. Gynecol Oncol. 2009;112(3):654-662. Review/Other-Dx N/A To describe current understanding of the natural history of molar pregnancy and persistent gestational trophoblastic neoplasia (GTN) as well as recent advances in their management. Studies in patients with familial recurrent molar pregnancy indicate that dysregulation of parentally imprinted genes is important in the pathogenesis of complete hydatidiform mole (CHM). CHM is now being diagnosed earlier in pregnancy in the first trimester changing the clinical presentation and making the histologic appearance more similar to partial hydatidiform mole (PHM) and hydropic abortion. While the classic presenting symptoms of CHM are less frequent, the risk of developing GTN remains unchanged. Flow cytometry and immunostaining for maternally-expressed genes are helpful in distinguishing early CHM from PHM or hydropic abortion. Patients with molar pregnancy have a low risk of developing persistent GTN after achieving even one non-detectable hCG level (hCG <5 mIU/ml). Patients with persistent low levels of hCG should undergo tests to determine if the hCG is real or phantom. If the hCG is real, then further tests should determine what percentage of the total hCG is hyperglycosylated hCG and free beta subunit to establish a proper diagnosis and institute appropriate management. Patients with non-metastatic GTN have a high remission rate with many different single-agent regimens including methotrexate and actinomycin D. Patients with high-risk metastatic GTN require aggressive combination chemotherapy in conjunction with surgery and radiation therapy to attain remission. After achieving remission, patients can generally expect normal reproduction in the future. 4
12. Piura E, Piura B. Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. Eur J Gynaecol Oncol. 2014;35(4):359-367. Review/Other-Dx N/A To review literature on brain metastases from gestational trophoblastic neoplasia. No results stated in abstract. 4
13. Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2011;204(1):11-18. Review/Other-Tx N/A To review the classification and management if gestational trophoblastic disease II. No results stated in abstract. 4
14. Kuru O, Cetin C, Iyibozkurt C, Yavuz E. Placental site trophoblastic tumor: report of a tertiary center experience. Eur J Gynaecol Oncol. 2015;36(6):708-710. Observational-Dx 8 patients To analyze the clinical and pathological characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment, and prognosis of PSTT. The mean age of the patients was 31 years. The antecedent pregnancy was full-term delivery in most of the patients (6/8, 75%). The mean interval from last pregnancy to diagnosis of PSTT was 35 months (range, six to 192). Serum human chorionic gonadotropin (hCG) levels at the time of diagnosis ranged from 0.1 to 2280 mIU/ml (mean, 614). All patients had Stage 1 disease and ultimately underwent hysterectomy. None of the patients received adjuvant chemotherapy. One patient died of an unknown reason, one month after the surgery. The rest of the patients were alive and without evidence of disease after an average of 3.5 years (range, one to 11) of follow-up. 4
15. Moutte A, Doret M, Hajri T, et al. Placental site and epithelioid trophoblastic tumours: diagnostic pitfalls. Gynecol Oncol. 2013;128(3):568-572. Observational-Dx 22 patients To describe the clinical and histological pitfalls in the diagnosis of placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT), two rare types of gestational trophoblastic neoplasia (GTN) The clinical presentation of these two types of tumour was irregular vaginal bleeding (55%) or amenorrhoea (27%), with a median plasma hCG level of 205IU/L. Seven of the 22 patients (32%) were initially misdiagnosed as an ectopic pregnancy. Median age at presentation was 35-years, with a median interval of 12months between the antecedent pregnancy and diagnosis of PSTT or ETT. The initial histological diagnosis was incorrect in 7/18 (39%) patients; there was a major disagreement with the referral pathologist in five of these seven patients (28%). 4
16. Doll KM, Soper JT. The role of surgery in the management of gestational trophoblastic neoplasia. Obstet Gynecol Surv. 2013;68(7):533-542. Review/Other-Tx N/A To discuss the the role of surgery in management of gestational trophoblastic disease. No results stated in abstract. 4
17. Fulop V, Szigetvari I, Szepesi J, Vegh G, Zsirai L, Berkowitz RS. The Role of Surgery in the Management of Gestational Trophoblastic Neoplasia The Hungarian Experience. J Reprod Med. 2016;61(5-6):197-204. Observational-Tx 371 low risk GTN patients; 190 high risk GTN patients To review the role of surgery in the management of gestational trophoblastic neoplasia (GTN) over the past 38 years in our national trophoblastic disease center. Over the period of 1977-2014 74 hysterectomies, 15 resections of vaginal metastases, 3 omentectomies, 13 adnexectomies, 9 lung resections, I nephrectomy, 1 lung resection and nephrectomy, and 2 craniotomies were performed among our patients. While hysterectomy was performed in 51 (26.8%) of 190 high-risk patients, hysterectomy was performed in only 23 (6.2%) of 371 low-risk patients (p < 0.01). From 1977-2006 metastases were resected in 18.3% (26/142) and from 2007-2014 in 16.7% (8/48) of high-risk patients. 2
18. Hanna RK, Soper JT. The role of surgery and radiation therapy in the management of gestational trophoblastic disease. Oncologist. 2010;15(6):593-600. Review/Other-Tx N/A To discuss the indications for and the role of surgical interventions during the management of women with hydatidiform moles and malignant gestational trophoblastic neoplasia and to review the use of radiation therapy in the treatment of women with malignant gestational trophoblastic neoplasia. No results stated in abstract. 4
19. Soper JT. Gestational trophoblastic disease. Obstet Gynecol. 2006;108(1):176-187. Review/Other-Tx N/A To summarize the primary management of molar pregnancies, surveillance after evacuation, and the evaluation and management of malignant gestational trophoblastic neoplasia (GTN). No results stated in abstract. 4
20. Kohorn EI. International Society for the Study of Trophoblastic Diseases. The FIGO 2002 Staging and Risk Factor Scoring System for Gestational Trophoblastic Disease. Update and Critical Discussion: 2015.  Available at: http://isstd.org/wp-content/uploads/2016/05/Chapter-7-FIGO-classification.pdf. Review/Other-Dx N/A To discuss the present problems with the staging and risk factor scoring system of gestational trophoblastic neoplasia. No results stated in abstract. 4
21. Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27(1):56-60. Observational-Dx 1053 cases To examine the accuracy of sonographic findings of routine ultrasound examinations in patients with a proven histological diagnosis of complete or partial hydatidiform mole referred to a supra-regional referral center, and to examine the relationship of sonographic findings to gestational age across the first and early second trimesters. 1053 consecutive cases were examined. The median maternal age was 31 (range, 15-54) years and the median gestational age was 10 (range, 5-27) weeks. 859 had a final review diagnosis of partial or complete hydatidiform mole (82%), including 253 (29%) complete moles and 606 (71%) partial moles. Non-molar hydropic miscarriage was diagnosed following histological review in 194 (18%). Overall, 378 (44%) cases with a final diagnosis of complete or partial hydatidiform mole had a pre-evacuation ultrasound diagnosis suggesting hydatidiform mole, including 200 complete moles and 178 partial moles, representing 79% and 29%, respectively, of those with complete (253) or partial (606) moles in the final review diagnosis. The ultrasound detection rate was significantly better for complete versus partial hydatidiform moles (Z = 13.4, P < 0.001). There was a non-significant trend towards improved ultrasound detection rate with increasing gestational age, with an overall detection rate of 35-40% before 14 weeks' gestation compared to around 60% after this gestation. The sensitivity, specificity, positive predictive value and negative predictive value for routine pre-evacuation ultrasound examination for detection of hydatidiform mole of any type were 44%, 74%, 88% and 23%, respectively. 3
22. Kirk E, Papageorghiou AT, Condous G, Bottomley C, Bourne T. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol. 2007;29(1):70-75. Observational-Dx 90 women To assess the first-trimester ultrasonographic findings in all women suspected of having hydatidiform mole on ultrasound and those subsequently diagnosed with hydatidiform mole after histological examination of removed products of conception after surgical evacuation of the uterus. The study group consisted of 90 women; 56 were suspected of having hydatidiform mole on ultrasound, and of these 27 (48%) had hydatidiform mole confirmed after histopathological examination of the products of conception, while no changes suggestive of hydatidiform mole were present in the other 29 cases. Overall, 61 women had hydatidiform mole confirmed on histology-41 (67%) partial hydatidiform moles (PHM) and 20 (33%) complete hydatidiform moles (CHM). The ultrasound findings in the 34 cases not suspected of hydatidiform mole were an empty sac in 8/34 (24%) women and a delayed miscarriage in the other 26/34 (76%). The overall sensitivity and positive predictive value for the ultrasound diagnosis of hydatidiform mole was 44% and 48%, respectively. For PHMs the respective values were 20% and 22% and for CHMs they were 95% and 40%. 3
23. Savage JL, Maturen KE, Mowers EL, et al. Sonographic diagnosis of partial versus complete molar pregnancy: A reappraisal. J Clin Ultrasound 2017;45:72-78. Observational-Dx 70 women To assess the prospective sonographic diagnosis of molar pregnancy and compare sonographic features of complete versus partial molar pregnancy. Mean age of patients was 30.5 +/- 7.0 (SD) years (range, 16-49 years) with a mean gravidity of 3.2 +/- 2.3 (SD) (range 1-11). Mean gestational age was 74.0 +/- 19.1 day (range 39-138) and serum beta-human chorionic gonadotropin was 131 +/- 156 mIU/ml (range 447-662,000). Pathologic results showed 48 partial and 22 complete molar pregnancies. Sonographically, partial moles more commonly showed a yolk sac (56.3% versus 0%, p < 0.0001), fetal pole (62.5% versus 4.6%, p < 0.0001), fine septa within the sac (25.0% versus 4.6%, p = 0.05), and normal (31.3% versus 0%, p = 0.002) or minimally cystic placenta (27.1% versus 4.6%, p = 0.49), while complete moles had larger gestational sacs (612 versus 44 mm, p = 0.005), were more often avascular on color Doppler imaging (45.5% versus 18.8%, p = 0.02), had more often abnormal tissue in the uterus (82.6% versus 20.8%, p < 0.0001) and placental masses (86.9% versus 16.7%, p < 0.0001), and were more often diagnosed prospectively (86.4% versus 41.7%, p = 0.0005). 2
24. Schmid P, Nagai Y, Agarwal R, et al. Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study. Lancet. 2009;374(9683):48-55. Observational-Tx 62 patients To assess the long-term outcome of stage-adapted management by surgery, chemotherapy, or both for patients with the disorder. Probabilities of overall and recurrence-free survival 10 years after first treatment were 70% (95% CI 54-82) and 73% (54-85), respectively. Patients with stage I disease had a 10-year probability of overall survival of 90% (77-100) and did not benefit from postoperative chemotherapy. By contrast, patients with stage II, III, and IV disease required combined treatment with surgery and chemotherapy; probability of overall survival at 10 years was 52% (3-100) for patients with stage II disease and 49% (26-72) for stage III or IV disease. Outcome for patients who had recurrent or refractory disease was poor: only four (22%) patients achieved long-term survival beyond 60 months. Multivariate analysis showed that the only significant independent predictor of overall and recurrence-free survival was time since antecedent pregnancy. A cutoff point of 48 months since antecedent pregnancy could differentiate between patients' probability of survival (<48 months) or death (>/=48 months) with 93% specificity and 100% sensitivity, and with a positive predictive value of 100% and a negative predictive value of 98%. 4
25. Himoto Y, Kido A, Minamiguchi S, et al. Prenatal differential diagnosis of complete hydatidiform mole with a twin live fetus and placental mesenchymal dysplasia by magnetic resonance imaging. J Obstet Gynaecol Res. 2014;40(7):1894-1900. Observational-Dx 3 CHMTF patients; 3 PMD patients To assess the use of magnetic resonance imaging (MRI) for prenatal differentiation between complete hydatidiform mole with a twin live fetus (CHMTF) and placental mesenchymal dysplasia (PMD). In all six cases, the diseases were recognized as multicystic lesions by ultrasonography and MRI. In two of three CHMTF cases, patients continued with the pregnancy, which resulted in spontaneous abortion. In one case of CHMTF, the patient underwent artificial abortion, after which the mole progressed into an invasive mole with lung metastases. All three PMD patients had live births, and two of the three babies had fetal growth restriction. By MRI, CHMTF was located within an extra-fetal sac accompanied by intra- and/or extra-lesional hemorrhage, while PMD was located within the placenta in the fetal sac without hemorrhage. 4
26. Kutuk MS, Ozgun MT, Dolanbay M, Batukan C, Uludag S, Basbug M. Sonographic findings and perinatal outcome of multiple pregnancies associating a complete hydatiform mole and a live fetus: a case series. J Clin Ultrasound. 42(8):465-71, 2014 Oct. Observational-Dx 6 cases To present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF). The mean +/- SD maternal age was 25.3 +/- 1.9 years (median: 25; range: 23-29). The mean gestational age at diagnosis was 16.1 +/- 4.6 weeks (median: 17; range: 11-23). Two pregnancies were achieved by ovulation induction. Two couples opted for pregnancy termination. Four pregnancies resulted in fetal loss between the 11th and 23th week of gestation. One pregnancy ended with the preterm delivery of a live-born neonate at 34 weeks due to pre-eclampsia. One patient developed persistent trophoblastic disease, which was treated by hysterectomy. The mean +/- SD time for beta-human chorionic gonadotropin clearance was 3.7 +/- 0.5 weeks (median: 4; range: 3-4) in the six patients without persistent trophoblastic disease. 4
27. Sebire NJ, Foskett M, Paradinas FJ, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002;359(9324):2165-2166. Observational-Dx 77 twin pregnancies To assess 77 twin pregnancies, comprising complete hydatidiform mole (CHM) and healthy co-twin, to ascertain the risks to the mother and baby of continuing the pregnancy, versus termination. 24 women with histologically confirmed CHM and healthy co-twin pregnancies decided to have a termination. 53 women continued with their pregnancies, though two had to have terminations because of severe pre-eclampsia, and 23 spontaneously aborted (<24 weeks' gestation). 28 pregnancies lasted 24 weeks or more, resulting in 20 livebirths. Chemotherapy to eliminate persistent gestational trophoblastic disease (pGTD) was required in three of 19 women (16%; 95% CI 3-39) who terminated their pregnancies in the first trimester, and in 12 of 58 (21%; 95% CI 11-33%) who continued their pregnancies. CHM and healthy co-twin pregnancies have a high risk of spontaneous abortion, but about 40% result in livebirths, without significantly increasing the risk of pGTD. 4
28. Buza N, Hui P. Immunohistochemistry and other ancillary techniques in the diagnosis of gestational trophoblastic diseases. Semin Diagn Pathol. 2014;31(3):223-232. Review/Other-Dx N/A To propose  an algorithmic approach combining histology and ancillary tests to provide the best diagnostic practice possible. No results stated in abstract. 4
29. Muminhodzic L, Bogdanovic G. Ultrasonographic signs of partial hydatidiform mole. Med Arch. 2013;67(3):205-208. Observational-Dx 70 pregnant women To investigate ultrasonographic features of partial hydatidiform mole to establish a proper diagnosis. Theca lutein cysts and hydropic degeneration of villi, enlarged uterus and empty gestational sac, intrauterine hematoma significantly prevailed in the pregnant women with the molar pregnancies. Diagnosis of the partial hydatidiform mole in the first trimester is likely though not enough reliable. 4
30. Malek M, Moradi B, Mousavi AS, Ahmadinejad N, Kazemi MA, Gity M. Complementary Role of Ultrasound in Management of Gestational Trophoblastic Disease. Iran J Radiol. 2015;12(2):e13955. Observational-Dx 19 patients To identify an effective method to identify high-risk patients for developing malignancy after molar evacuation. Ovarian theca lutein cysts (P = 0.018) (among pre-evacuation factors) and first week ultrasound (P = 0.02) can help in detecting high-risk patients. Even though, when beta-hCG titer is not available in a high-risk patient, post evacuation myometrial involvement (P = 0.005) is a useful sign for detecting persistency. 4
31. Seckin KD, Baser E, Yeral I, Togrul C, Ozdal B, Gungor T. The impact of ultrasonographic lesion size and initial human chorionic gonadotropin values on treatment success in cases with complete hydatidiform mole. Eur Rev Med Pharmacol Sci. 2013;17(24):3381-3384. Observational-Dx 112 cases To assess  the impact of sonographically measured lesion size and initial human chorionic gonadotropin levels on treatment success in cases of complete hydatidiform mole (CHM). Mean patient age was 27.3 +/- 8.2 years. Suction curettage was employed as the primary treatment in all of the study cases. No perioperative complications were encountered. None of the patients were treated with prophylactic adjuvant chemotherapy. Twelve patients (10.7%) required adjuvant chemotherapy. Beta-hCG NT did not have an association with patient age and initial beta-hCG levels (p > 0.05). Also, patient age, gravidity, parity, smoking, initial beta-hCG and ultrasonographic mean lesion size did not predict adjuvant chemotherapy requirement (p > 0.05). 4
32. Dipi RM, Amin MS, Islam MN, Khan NA, Chaiti MM, Hossain MM. Comparison of transabdominal and transvaginal sonography in the evaluation of uterine mass with histopathological correlation. Mymensingh Med J. 22(1):69-74, 2013 Jan. Observational-Dx 53 patients To demonstrate the role of transvaginal (TVS) and transabdominal sonography (TAS) to detect clinically suspected uterine mass in 53 patients which could not be differentiated clinically. TAS and TVS revealed 20(37.7%) & 20(37.7%) had leiomyoma, 12(22.6%) & 14(26.4%) had Ca cervix, 6(11.3%) & 7(13.2%) had endometrial carcinoma, 1(1.9%) & 1(1.9%) had hydatidiform mole respectively. TAS revealed 5(9.4%) had thickened endometrium, and no detectable mass were detected in 9(17.0%) cases. TVS revealed polyp in 7(13.2%), and no detectable mass were detected in 4(7.5%) cases. Histopathologically confirmed leiomyoma were in 18(34.0%) cases, Ca cervix in 14(26.4%), endometrial carcinoma in 6(11.3%), adenomyosis in 1(1.9%), polyp in 7(13.2%), chronic cervicitis in 2(3.8%), hydatidiform mole in 1(1.9%) and no detectable mass were detected in 4(7.5%) cases. Sensitivity of TAS and TVS to diagnose uterine mass were 83.7% and 95.9%, specificity 25.0% and 50.0%, positive predictive value 93.2% and 95.9%, negative predictive value 11.1% and 50.0% and accuracy 79.2% and 92.5% respectively. Sensitivity of TAS & TVS to diagnose leiomyoma was 88.9% & 94.9%, specificity 88.6% & 91.4%, positive predictive value 80.0% & 85.0%, negative predictive value 93.9% & 97.0%, and accuracy 88.7% & 92.5% respectively. Sensitivity of TAS & TVS to diagnose Ca cervix were 57.1% & 78.6%, specificity 89.7% & 92.3%, positive predictive value 66.9% & 78.6%, negative predictive value 85.4% & 92.3%, and accuracy 81.1% & 88.7% respectively. 3
33. Garavaglia E, Gentile C, Cavoretto P, Spagnolo D, Valsecchi L, Mangili G. Ultrasound imaging after evacuation as an adjunct to beta-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2009;200(4):417 e411-415. Observational-Dx 189 patients To identify prognostic factors associated with development of gestational trophoblastic neoplasia (GTN) after hydatidiform mole (HM). Fourteen patients experienced GTN (7.4%). After univariate analysis, uterine size (P = .0139) and positive ultrasound results (P < .0001) were associated significantly with GTN development. At multivariate analysis, only positive ultrasound results maintained significance (likelihood ratio test: chi(2) = 0.0000). 4
34. Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RP. Is Doppler ultrasound useful for evaluating gestational trophoblastic disease? Clinics (Sao Paulo). 2015;70(12):810-815. Review/Other-Dx 28 articles To summarize data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. No results listed in abstract. 4
35. Asmar FTC, Braga-Neto AR, de Rezende-Filho J, Villas-Boas JMS, Charry RC, Maesta I. Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study. Clinics (Sao Paulo). 2017;72(5):284-288. Observational-Dx 246 patients To compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission and to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia. No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index </=1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index </=1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia. 4
36. Shaaban AM, Rezvani M, Haroun RR, et al. Gestational Trophoblastic Disease: Clinical and Imaging Features. RadioGraphics. 2017;37(2):681-700. Review/Other-Dx N/A To discuss the clinical imaging of gestational trophoblastic disease. No results stated in the abstract. 4
37. Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi39-50. Review/Other-Dx N/A To present guidelines for diagnosis, treatment and follow-up of gestational trophoblastic disease. No abstract available. 4
38. Price JM, Lo C, Abdi S, et al. The Role of Computed Tomography Scanning of the Thorax in the Initial Assessment of Gestational Trophoblastic Neoplasia. Int J Gynecol Cancer. 2015;25(9):1731-1736. Observational-Dx 191 patients 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. 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. 4
39. Mutch DG, Soper JT, Baker ME, et al. Role of computed axial tomography of the chest in staging patients with nonmetastatic gestational trophoblastic disease. Obstet Gynecol. 1986;68(3):348-352. Observational-Dx 39 patients To evaluate women with nonmetastatic gestational trophoblastic disease as determined by conventional staging studies. Sixteen patients (41%) had pulmonary micrometastases detected by CAT, which were not detected by routine chest x-ray. Eight patients (20.5%) had indeterminate scans, and only 15 patients (38%) had negative scans. Eight of 16 patients (50%) with pulmonary micrometastases failed initial therapy with methotrexate-folinic acid rescue while one of eight (12.5%) patients in the indeterminate group and one of 15 (6.7%) patients in the true nonmetastatic group failed initial therapy (P less than .006). All patients who failed methotrexate-folinic acid rescue ultimately achieved prolonged remission with actinomycin D. Time to remission was significantly decreased in patients without evidence of pulmonary micrometastases (P = .03), but the total number of courses of chemotherapy was not significantly different (P = .06). No life-threatening toxicity occurred. 3
40. Hong DG, Cho YL, Park IS, Lee YS. Chest computed tomography before evacuation of hydatidiform mole. Eur J Gynaecol Oncol. 2009;30(2):151-154. Observational-Dx 48 patients To evaluate the usefulness of chest CT for assessing pulmonary micrometastasis in hydatidiform moles. Of 14 patients who underwent chest CT at their initial evaluation, 57% had pulmonary micrometastasis. The time to remission of serum beta-hCG after evacuation, serum beta-hCG before evacuation and the largest diameter of the uterus were statistically significant. Persistent GTD developed in 38% of the metastatic group, but in only 25% of the nonmetastatic group. Micrometastasis was missed by chest X-ray in 64% of 11 patients suspected of having micrometastasis. 3
41. Darby S, Jolley I, Pennington S, Hancock BW. Does chest CT matter in the staging of GTN? Gynecol Oncol. 2009;112(1):155-160. Observational-Tx 96 low risk metastatic GTN patients; 102 low risk non-metastatic GTN patients To determine whether or not CT scan significantly influences outcome of patients with GTN in terms of a need to change to second line chemotherapy or time to remission. There was no significant difference in the need to change to second line chemotherapy or in time to remission in those patients with metastatic GTN whose score or risk was changed when CT scan was used in place of CXR. Low risk patients with metastatic disease were, however, significantly more likely to need to change to second line chemotherapy than patients with non-metastatic GTN although there was no significant difference in time to remission between these groups. 4
42. Xu XJ, Lou FL, Zhang MM, Pan ZM, Zhang L. Usefulness of low-dose CT in the detection of pulmonary metastasis of gestational trophoblastic tumours. Clin Radiol. 2007;62(10):998-1003. Observational-Dx 39 patients To determine whether a low-dose spiral chest computed tomography (CT) examination could replace standard-dose chest CT in detecting pulmonary metastases in patients with gestational trophoblastic tumour (GTT). The CT dose index (CTDI) for the standard-dose and low-dose CT protocols was 10.4 mGy and 1.4 mGy, respectively. One thousand, six hundred, and eighty-two metastases were detected by standard-dose CT, and 1460 lesions by the low-dose protocol. The numbers detected by low-dose CT were significantly less than those detected by standard-dose CT (Z=-3.776, p<0.001), especially for nodules smaller than 5mm (Z=-4.167, p<0.001). However, the disease staging and risk score of the patients were not affected by use of the low-dose protocol. 3
43. Strohl AE, Lurain JR. Postmolar choriocarcinoma: An independent risk factor for chemotherapy resistance in low-risk gestational trophoblastic neoplasia. Gynecol Oncol. 2016;141(2):276-280. Observational-Dx 678 patients To evaluate the effect of a clinicopathologic diagnosis of choriocarcinoma (CCA) on clinical characteristics, extent of disease, and response to chemotherapy in low-risk gestational trophoblastic neoplasia (GTN). Of 678 women with low-risk GTN, 129 (19.0%) had a clinicopathologic diagnosis of CCA. Patients with CCA had higher parity (median 1 vs. 0, p=0.003), more pretreatment human chorionic gonadotropin (hCG) levels at >100,000mIU/mL (12.7% vs. 5.9%, p=0.009), longer duration of disease (19.6 vs. 9.9weeks, p<0.001), and higher FIGO scores (median 2 vs. 1, p<0.001) compared with those with other histology; however, patients with CCA and postmolar GTN presented with similar stage of disease (stage I, 83.1% vs 88.2%, p=0.126). Although there was no difference in survival between groups, increased resistance to first-line methotrexate chemotherapy was significantly associated with a diagnosis of postmolar CCA (OR 2.67, p=0.007)), pretreatment hCG level at >10,000mIU/mL (OR 2.62, p=0.002), and higher FIGO score (3-4: OR 2.02, p=0.027; 5-6: OR 5.56, p<0.001) on multivariate analysis. 4
44. Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract. 2014;2014:842751. Review/Other-Dx N/A To review gestational trophoblastic disease and a multimodality imaging approach with impact on diagnosis and management No results listed in abstract. 4
45. Kani KK, Lee JH, Dighe M, Moshiri M, Kolokythas O, Dubinsky T. Gestatational trophoblastic disease: multimodality imaging assessment with special emphasis on spectrum of abnormalities and value of imaging in staging and management of disease. Curr Probl Diagn Radiol. 2012;41(1):1-10. Review/Other-Dx N/A To review the types, pathology, diagnosis, and management of various forms of gestational trophoblastic neoplasia. No results stated in abstract. 4
46. Sefidbakht S, Hosseini F, Bijan B, Hamedi B, Azizi T. Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease? Eur J Radiol. 2017;88:71-76. Observational-Dx 23 patients To describe the diffusion-weighted imaging (DWI) appearance of gestational trophoblastic disease (GTD) and to determine its apparent diffusion coefficient (ADC) values and to evaluate the feasibility of DWI to predict progression of hydatidiform mole (HM) to persistent disease. : Among the 23 studied patients, 19 (83%) were classified as molar and 4 (17%) as non-molar, based on pathology reports. After 6-12 months of follow-up, 5 (26%) cases progressed to persistent disease and 14 (74%) cases were benign HM. There was no significant difference between ADC values for HM (1.93+/-0.33x10(-3)mm(2)/s) and persistent neoplasia (2.03+/-0.28x10(-3)mm(2)/s) (P=0.69). The ADC of non-molar pregnancies was (0.96+/-0.46x10(-3)mm(2)/s), which was significantly different from GTD (1.96 +/-0.32x10(-3)mm(2)/s) (P=0.001). Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity were more common in GTD compared to non-molar pregnancy (P<0.05). 3
47. Mangili G, Bergamini A, Giorgione V, et al. [(1)(8)F]fluorodeoxyglucose positron emission tomography/computed tomography and trophoblastic disease: the gynecologist perspective. Q J Nucl Med Mol Imaging. 2016;60(2):103-116. Review/Other-Dx N/A To examine the role of [18F]FDG PET/computed tomography (CT) in diagnosis, treatment and follow up of different disease subtypes. Regarding HM a potential prognostic relevance of maximum standardized uptake value (SUV max) of molar tissue within the uterus before evacuation has been suggested. Considering CC staging, most [18F]FDG PET evaluations confirmed the results of conventional imaging. However [18F]FDG PET played a key role in discriminating ambiguous lesions on routine imaging work-up. [18F]FDG PET was particularly useful in evaluating disease recurrence and chemo-resistance, thanks to the possibility of an early identification of the active tumor site. Since the main treatment of PSTT is surgery, the contribution of [18F]FDG PET in differential diagnosis and in providing a more precise mapping of resectable metastasis or the complete response to treatment is advisable. 4
48. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775-779. Observational-Tx 74 patients To determine if the clinical presentation of complete hydatidiform mole has changed in recent years compared with historic controls (1965-1975). aginal bleeding remained the most common presenting symptom, occurring in 62 of 74 (84%) current patients, compared with 297 of 306 (97%) controls (P = .001). However, anemia was present in only four of 74 (5%) current patients, compared with 165 of 306 (54%) controls (P = .001). Excessive uterine size, preeclampsia, and hyperemesis occurred in only 21 of 74 (28%), one of 74 (1.3%), and six of 74 (8%) current patients, respectively, compared with 156 of 306 (51%), 83 of 306 (27%), and 80 of 306 (26%), respectively, of historic controls (P = .001). No cases of clinical hyperthyroidism or respiratory distress were found in recent years. Ultrasound diagnosed complete hydatidiform mole before the onset of clinical symptoms in seven of 69 (10%) current patients. Among patients not receiving chemoprophylaxis, persistent gestational trophoblastic tumor developed in 23% of current patients and 18.6% of historic controls. CONCLUSION: Fewer current patients with complete hydatidiform mole present with the traditional symptoms of complete hydatidiform mole (excessive uterine size, anemia, preeclampsia, hyperthyroidism, or hyperemesis) when compared with historic controls. 4
49. Sun SY, Melamed A, Goldstein DP, et al. Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia? Gynecol Oncol. 2015;138(1):46-49. Observational-Dx 375 patients To compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among recent (1994-2013) and historical (1988-1993) cases of complete hydatidiform mole (CHM). In the current cohort (1994 to 2013) the median gestational age at diagnosis continued to decline compared to our prior cohort (1988-1993) (9weeks versus 12weeks). Patients from the current cohort were significantly more likely to be diagnosed prior to the 11th week of gestation (56 versus 41%, p=0.04). Patients in the current cohort were also significantly less likely to present with vaginal bleeding (46 versus 84%, p<0.001). Earlier diagnosis of complete mole did not result in a decrease in the rate of postmolar GTN. The frequencies of postmolar GTN in the current (1994-2013) and prior (1988-1993) cohorts were 19 and 23%, respectively. In the current cohort, even diagnosis prior to ten weeks gestation did not decrease the risk of developing GTN. 4
50. El-Helw LM, Hancock BW. Treatment of metastatic gestational trophoblastic neoplasia. Lancet Oncol. 2007;8(8):715-724. Review/Other-Tx N/A To discuss treatment of metastatic gestational trophoblastic neoplasia. No results stated in abstract. 4
51. Kohorn EI. Imaging practices in the diagnosis and management of gestational trophoblastic disease: an assessment. J Reprod Med. 2012;57(5-6):207-210. Review/Other-Dx N/A To discuss several of the problems associated with imaging in gestational trophoblastic disease based on critical assessment of the literature. No results stated in abstract. 4
52. Shen X, Xiang Y, Guo L, et al. Analysis of clinicopathologic prognostic factors in 9 patients with epithelioid trophoblastic tumor. Int J Gynecol Cancer. 2011;21(6):1124-1130. Observational-Dx 9 patients To investigate the clinicopathologic features and prognostic factor in patients with epithelioid trophoblastic tumor (ETT). Of 9 patients, 8 (88.9%) had metastases. The histopathologic results of 7 patients (77.8%) with poor outcomes showed diffuse multifocal disease within the uterus, full-thickness myometrial invasion, uterine serosal involvement, and extensive necrosis. The size of the uterus exceeded 8 weeks of gestation in 7 patients. Two of them had poorly differentiated carcinoma. All patients were treated with multimodality treatment that combined with surgery and chemotherapy. After the initial treatments, 5 patients with International Federation of Gynecology and Obstetrics stage I achieved complete remission (CR), 1 patient achieved partial remission, and 3 patients (33.3%) had no response to treatments and died of progressive disease. After following up for 6 to 107 months (mean, 24 months), 4 (44.4%) of the 5 patients with initial CR had relapse: 3 of them achieved a second CR and the other 1 was under treatment. 4
53. Qin J, Ying W, Cheng X, et al. A well-circumscribed border with peripheral Doppler signal in sonographic image distinguishes epithelioid trophoblastic tumor from other gestational trophoblastic neoplasms. PLoS One. 2014;9(11):e112618. Observational-Dx 12 ETT patients;21 PSTT patients; 24 IM/CC patients To  identify the sonographic features of ETT that are distinct from other GTNs, including placental site trophoblastic tumor (PSTT) and invasive mole/choriocarcinoma (IM/CC). The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05). However, a well-circumscribed border with hypoechogenic halo was identified in the gray-scale sonogram in all 12 cases of ETT, while only in 1 out of 21 cases of PSTT and 1 out of 16 cases of IM/CC (P<0.001 for ETT vs. PSTT or IM/CC). Moreover, a peripheral pattern of Doppler signals was observed in 11 out of 12 ETT lesions, showing relatively more Doppler signal spots around the tumor border than within the boundary, while a non-peripheral pattern of Doppler signals in all 21 PSTT cases and 14 out of 16 IM/CC cases: with minimal, moderate or remarkable signal spots within the tumor, but not along the tumor (P<0.001 for ETT vs. PSTT or IM/CC). These distinct sonographic features of ETT correlated with histopathologic observations, such as expansive growth pattern and vascular morphology. 3
54. Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol. 1998;22(11):1393-1403. Observational-Dx 14 patients To describe the clinicopathologic and immunohistochemical features of 14 cases of epithelioid trophoblastic tumor (ETT), a distinctive but rare gestational trophoblastic tumor. Two of the 14 patients presented with extrauterine ETT without evidence of prior gestational trophoblastic disease in the uterus. Serum human chorionic gonadotropin levels were elevated in eight of nine patients in whom this information was available. In the uterus, ETT presented as a discrete, hemorrhagic, solid and cystic lesion that was located either in the fundus, lower uterine segment, or endocervix. Microscopically, the tumor was composed of a relatively uniform population of mononucleate intermediate trophoblastic cells forming nests and solid masses. The cells resemble the trophoblastic cells in the chorion laeve, and we have therefore designated them "chorionic-type intermediate trophoblast." Typically, islands of trophoblastic cells were surrounded by extensive necrosis and were associated with a hyaline-like matrix creating a "geographic" pattern that is quite characteristic of this lesion. The mean mitotic count was two mitoses per 10 high-power fields, and the average Ki-67 nuclear labeling index was 18%. Immunohistochemically, all cases were diffusely positive for inhibin-alpha, cytokeratin (AE1/AE3), epithelial membrane antigen, E-cadherin, prolyl 4-hydroxylase, and epidermal growth factor receptor but were only focally immunoreactive for human placental lactogen, human chorionic gonadotropin, PlAP, and Mel-CAM. The monomorphic growth pattern of ETT resembles placental site trophoblastic tumor to a much greater degree than choriocarcinoma which is characterized by a dimorphic population of trophoblast. In contrast to placental site trophoblastic tumor, the cells of ETT are smaller and display less nuclear pleomorphism. In addition, ETT grows in a nodular fashion compared with the infiltrative pattern of placental site trophoblastic tumor. In some of the cases, the trophoblastic cells in ETT replaced the endocervical surface epithelium, giving the appearance that the tumor was derived from the cervix. Moreover, because the associated hyaline-like material in ETT resembles keratin, the tumor can be misinterpreted as a keratinizing squamous cell carcinoma of the cervix. Ten patients underwent total hysterectomy and two had an endometrial curettage only. The two patients who presented with extrauterine ETT underwent small bowel resection and lung resection. Two of 12 patients with ETT in the uterus developed metastasis in the lungs and bone. One of these patients is alive with disease at 43 months and one patient was lost to follow-up after 2 months. One of the two patients who had extrauterine disease died of widespread tumor 36 months after diagnosis. The remainder of the patients are alive and well from 1 to 120 months. I 4
55. Zhou Y, Lu H, Yu C, Tian Q, Lu W. Sonographic characteristics of placental site trophoblastic tumor. Ultrasound Obstet Gynecol. 2013;41(6):679-684. Observational-Dx 14 patients To investigate clinical features and ultrasound findings in cases of placental site trophoblastic tumor (PSTT). The most frequent symptoms associated with PSTT were abnormal vaginal bleeding, which was present in 11 cases, and amenorrhea, which was present in five cases. The interval from antecedent pregnancy to diagnosis was 4-36 (median, 12.5) months. Blood serum was positive for beta-human chorionic gonadotropin (beta-hCG) at the time of ultrasound examination, although the level was generally low, with a median of 166.2 IU/L (range, 4.5-3480.2). Sonographic presentation of PSTT was classified into one of three types according to the characteristics observed on TVS: Type I, heterogeneous solid mass in the uterine cavity (four cases), with minimal to a moderate degree of vascularization on color Doppler imaging; Type II, heterogeneous solid mass in the myometrium (six cases), with minimal to a high degree of vascularization (only one case was highly vascularized); and Type III, cystic lesions in the myometrium (four cases) with a high degree of vascularization (lacunar-type lesions). 4
56. Agarwal R, Harding V, Short D, et al. Uterine artery pulsatility index: a predictor of methotrexate resistance in gestational trophoblastic neoplasia. Br J Cancer. 2012;106(6):1089-1094. Observational-Dx 286 patients To test the hypothesis, in a prospective patient cohort, that in low-risk gestational trophoblastic neoplasia (LR-GTN) the uterine artery pulsatility index (UAPI), a measure of tumour vascularity, can predict resistance to methotrexate chemotherapy (MTX-R). 239 patients were assessable for both UAPI and MTX-R. The median UAPI was lower (higher vascularity) in MTX-R compared with MTX-sensitive patients (0.8 vs 1.4, P<0.0001). In multivariate logistic regression, UAPI</=1 predicted MTX-R, independent of both CXH and FIGO scores. The risk of MTX-R in patients with a FIGO score of 6 and UAPI</=1 was 100% vs 20% in patients with UAPI>1 (chi(2) P<0.0001). 3
57. Cavoretto P, Gentile C, Mangili G, et al. Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in stage I low-risk trophoblastic neoplasia. Ultrasound in Obstetrics & Gynecology. 40(1):99-105, 2012 Jul. Observational-Tx 24 patients To identify low-risk non-metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau. MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX-resistance rate. 3
58. Sita-Lumsden A, Medani H, Fisher R, et al. Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6. BJOG. 2013;120(8):1012-1015. Observational-Tx 92 patients To hypothesize that a UAPI </= 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R). UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI </= 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI </= 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036). 3
59. Wang W, Tian X, Zhang T, Wang Y, Han Z, An R. Characteristics of Three-Dimensional Power Doppler in Gestational Trophoblastic Disease. Dis Markers. 2015;2015:917687. Observational-Tx 52 patients To evaluate the reliability of three-dimensional power Doppler in detecting and assessing of gestational trophoblastic disease (GTD). Three-dimension power Doppler indicated that there were significant differences in the resistance index, vascularization index, flow index, and vascularization-flow index between the healthy individuals and each subgroup of patients (P < 0.01). Further, in combining invasive hydatidiform mole and choriocarcinoma groups, there was a significant difference between hydatidiform mole and the combined malignant group (P < 0.01). And the abnormal sonographic and power Doppler findings in GTD were resolved when chemotherapy was done successfully. 2
60. Lazovic B, Milenkovic V, Dordevic S. Treatment of gestational trophoblastic disease--a 10-year experience. Med Pregl. 2012;65(5-6):244-246. Observational-Dx 11 patients To identify the frequency of GTD metastases, success of their treatment and epidemiological characteristics of patients. Of eleven patients who were found to have metastases (10.6%), 72.7% had pulmonary metastases, 27.3 had vaginal, and one patient had both pulmonary and brain metastases. The average age was 33.9. Antecedent molar pregnancy was recorded in 63.6% patients. Invasive mole was more frequent than choriocarcinoma (63.6%). According to the World Health Organization criteria, 7 patients (63.6%) had high risk score (the average World Health Organization score was 8.4). All patients were treated by chemotherapy, the average number of courses being 1.8. Complete remission was achieved in all patients. 4
61. Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61(4):301-313. Review/Other-Dx N/A To describe the relevant pathophysiology and natural history of GTN, and the use of imaging techniques in the diagnosis and management of these conditions. No results stated in abstract. 4
62. Price JM, Hancock BW, Tidy J, Everard J, Coleman RE. Screening for central nervous system disease in metastatic gestational trophoblastic neoplasia. J Reprod Med. 2010;55(7-8):301-304. Observational-Dx 154 patients To evaluate the Sheffield Trophoblastic Tumour Centre protocol for central nervous system (CNS) involvement in high-risk patients with gestational trophoblastic neoplasia (GTN) and determine the impact of brain imaging and lumbar puncture (LP) results on subsequent clinical care. To evaluate the Sheffield Trophoblastic Tumour Centre protocol for central nervous system (CNS) involvement in high-risk patients with gestational trophoblastic neoplasia (GTN) and determine the impact of brain imaging and lumbar puncture (LP) results on subsequent clinical care. 4
63. American College of Radiology. ACR Appropriateness Criteria®: Headache. Available at: https://acsearch.acr.org/docs/69482/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
64. American College of Radiology. ACR Appropriateness Criteria®: Acute Mental Status Change, Delirium, and New Onset Psychosis. Available at: https://acsearch.acr.org/docs/3102409/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute mental status change, delirium, and new onset psychosis. No abstract available. 4
65. Kageyama S, Kanoto M, Sugai Y, et al. MR Imaging of Uterine Epithelioid Trophoblastic Tumor: A Case Report. Magn Reson Med Sci. 2016;15(4):411-415. Review/Other-Dx 1 patient To report a case of uterine ETT with special attention to the MRI findings. No results stated in abstract. 4
66. Chang TC, Yen TC, Li YT, et al. The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study. Eur J Nucl Med Mol Imaging. 2006;33(2):156-163. Observational-Tx 14 patients To evaluate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in gestational trophoblastic tumours (GTTs). Sixteen PET scans were performed, with one patient having three serial studies. Benefits of additional PET were seen in 7 of 16 (43.8%) scans; these benefits included disclosure of chemotherapy-resistant lesions (n = 2), exclusion of false-positive CT lesions (n = 1), detection of an additional lesion not found by conventional imaging (n = 1) in high-risk GTT at the start of primary chemotherapy, and confirmation of complete response to treatment for PSTT or to salvage therapy for recurrent/resistant GTT (n = 3). On the other hand, in two instances there were false-negative PET findings, six scans yielded no benefit, and one showed an indeterminate lesion. 3
67. Lai CH, Yen TC, Chang TC. Positron emission tomography imaging for gynecologic malignancy. [Review] [53 refs]. Curr Opin Obstet Gynecol. 19(1):37-41, 2007 Feb. Review/Other-Tx N/A To examine publications in the area of positron emission tomography (PET) in gynecologic malignancy. No results stated in abstract. 4
68. Mapelli P, Mangili G, Picchio M, et al. Role of 18F-FDG PET in the management of gestational trophoblastic neoplasia. Eur J Nucl Med Mol Imaging. 2013;40(4):505-513. Observational-Tx 41 patients To evaluate the role of FDG PET or PET/CT in primary staging and in monitoring treatment efficacy. When compared to TV-US, chest radiography and CT for staging, PET showed a concordance in 91 %, 84 % and 81 % of patients, respectively. In 8 of the 41 patients with extrauterine disease during staging, PET/CT showed a complete response to therapy after betaHCG normalization. PET and PET/CT identified the sites of persistent disease in all seven high-risk patients with betaHCG resistance, of whom four underwent second-line chemotherapy, two surgical removal of resistant disease instead of additional chemotherapy, and one surgical removal of resistant disease and second-line chemotherapy with subsequent negative betaHCG. 3
69. Yen TC, Lai CH. Positron emission tomography in gynecologic cancer. Semin Nucl Med. 2006;36(1):93-104. Review/Other-Dx N/A No abstract available. No results stated 4
70. Ngu SF, Chan KK. Management of Chemoresistant and Quiescent Gestational Trophoblastic Disease. Curr Obstet Gynecol Rep. 2014;3:84-90. Review/Other-Tx N/A To examine management of chemoresistant and quiescent GTD. No results stated in abstract. 4
71. Powles T, Savage P, Short D, Young A, Pappin C, Seckl MJ. Residual lung lesions after completion of chemotherapy for gestational trophoblastic neoplasia: should we operate? Br J Cancer. 2006;94(1):51-54. Observational-Tx 76 patients To investigate the outcome of patients patients who undergo completion of chemotherapy in regards to residual lung metastasis from malignant gestational trophoblastic neoplasm. Overall 53 (70%) patients had no radiological abnormality on CXR or CT after completion of treatment. Eight (11%) patients had residual disease on CXR alone 15 patients had residual disease on CT (19%). During follow-up, two patients (2.6%) relapsed. One of these had had a complete radiological response post-treatment whereas the other had residual disease on CT. 3
72. Dhillon T, Palmieri C, Sebire NJ, et al. Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia. J Reprod Med. 2006;51(11):879-887. Observational-Dx 11 patients To evaluate the usefulness of positron emission tomography with 18-fluorodeoxyglucose (18FDG-PET) in locating residual or relapsed gestational trophoblastic neoplasia (GTN). All patients had elevated beta-human chorionic gonadotropin (beta-hCG) at the time of the investigation; none were false positive. In 7 patients the 18FDG-PET scans correctly confirmed the presence (4 of 7 cases) or absence (3 of 7 cases) of disease sites defined by other imaging investigations. In 2 patients positive PET-guided appropriate surgical resection of lung lesions that appeared of equivocal significance on computed tomography (CT) resulted in -hCG normalization. One patient had a pulmonary metastasis on CT not considered positive on 18FDG-PET (false negative). One patient with enlarged mediastinal lymph nodes on CT that were 18FDG-PET positive also had a vascular uterus on magnetic resonance imaging/Dopper ultrasound that was negative on PET (false negative). Hysterectomy led to hCG normalization and cure. The mediastinal lymph nodes were positive on CT and PET due to sarcoidosis (false positive). Patients with serum hCG levels <10 IU/L could have positive PET scans; that can contribute to patient care. 4
73. Yang J, Xiang Y, Wan X, Feng F, Ren T. Analysis of the prognosis and related factors for patients with stage IV gestational trophoblastic neoplasia. Int J Gynecol Cancer. 2014;24(3):594-599. Observational-Tx 105 patients To investigate and analyze the treatments and prognoses of patients with stage IV gestational trophoblastic neoplasia (GTN). After the treatments, of the 105 patients, 71 (67.6%) patients achieved complete remission, 15 (14.3%) patients exhibited partial remission, and 19 (18.1%) patients exhibited progression of the disease. In total, of the 105 patients, 30 (28.6%) patients died. Our statistical analyses have revealed that a previously failed multidrug chemotherapy history, multiorgan metastasis concomitant with renal metastasis, and surgical intervention all affected the prognoses of patients with stage IV GTN. In addition, patients with stage IV GTN with International Federation of Gynecology and Obstetrics scores below 12 were relatively more likely to obtain complete remission. 4
74. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/pregnant-pts.pdf Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
75. Iraha Y, Okada M, Toguchi M, et al. Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions. Jpn J Radiol. 2018;36(1):12-22. Review/Other-Tx N/A To review multimodality imaging in secondary postpartum or postabortion hemorrhage. No results stated in abstract. 4
76. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
77. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
78. American College of Radiology. Manual on Contrast Media. Available at: https://www.acr.org/Clinical-Resources/Contrast-Manual. Review/Other-Dx N/A To assist radiologists in recognizing and managing risks associated with the use of contrast media. No abstract available. 4
79. Expert Panel on MR Safety, Kanal E, Barkovich AJ, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 37(3):501-30, 2013 Mar. Review/Other-Dx N/A To help guide MR practitioners regarding MR safety issues and provide a basis for them to develop and implement their own MR policies and practices. No abstract available. 4
80. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
No of Rows: 80