US Pelvis Transabdominal Transvaginal US has superior sensitivity and specificity in the diagnosis of uterine masses when compared with transabdominal US, although, given the rarity of GTN, literature comparing both modalities is lacking [32]. Radiography Chest The lungs are the most common site of metastasis in GTN [7,36,60]. Chest radiographs are the primary imaging method recommended by FIGO to detect and count lung metastases for purposes of risk assessment in patients with GTN. However, approximately 30% to 40% of patients assumed to have nonmetastatic disease by radiographs may have CT evidence of micrometastases [20,38,39]. The emphasis on radiographs may in part reflect the global scope of FIGO, which provides recommendations that must apply to both industrialized countries and underresourced medical care environments. CT chest may be preferred where available because of its greater sensitivity, although controversy persists regarding the prognostic significance of tiny nodules detected by CT, as discussed below. However, the statement that chest radiographs are used for counting the number of metastases, not CT chest, was also rated as highly appropriate by a panel of 45 experts from 16 countries in association with the EOTTD [6]. CT Chest The lungs are the most common site of metastasis in GTN [7,36,60]. Approximately 30% to 40% of patients assumed to have nonmetastatic disease by radiographs may have CT evidence of micrometastases [20,38-40]. However, the clinical importance of these tiny lesions remains controversial as there is no definitive evidence of impact on long-term survival [38,41]. Assessment of the literature is complicated by the fact that suspected pulmonary micrometastases from GTN are often not confirmed histologically because they typically regress completely with treatment and biopsy is not recommended [40].
Gestational Trophoblastic Disease. US Pelvis Transabdominal Transvaginal US has superior sensitivity and specificity in the diagnosis of uterine masses when compared with transabdominal US, although, given the rarity of GTN, literature comparing both modalities is lacking [32]. Radiography Chest The lungs are the most common site of metastasis in GTN [7,36,60]. Chest radiographs are the primary imaging method recommended by FIGO to detect and count lung metastases for purposes of risk assessment in patients with GTN. However, approximately 30% to 40% of patients assumed to have nonmetastatic disease by radiographs may have CT evidence of micrometastases [20,38,39]. The emphasis on radiographs may in part reflect the global scope of FIGO, which provides recommendations that must apply to both industrialized countries and underresourced medical care environments. CT chest may be preferred where available because of its greater sensitivity, although controversy persists regarding the prognostic significance of tiny nodules detected by CT, as discussed below. However, the statement that chest radiographs are used for counting the number of metastases, not CT chest, was also rated as highly appropriate by a panel of 45 experts from 16 countries in association with the EOTTD [6]. CT Chest The lungs are the most common site of metastasis in GTN [7,36,60]. Approximately 30% to 40% of patients assumed to have nonmetastatic disease by radiographs may have CT evidence of micrometastases [20,38-40]. However, the clinical importance of these tiny lesions remains controversial as there is no definitive evidence of impact on long-term survival [38,41]. Assessment of the literature is complicated by the fact that suspected pulmonary micrometastases from GTN are often not confirmed histologically because they typically regress completely with treatment and biopsy is not recommended [40].