Points are assigned for each variable to determine risk of resistance to single-agent chemotherapy. Scores exceeding 6 predict high-risk disease refractory to monochemotherapy, with patients maintaining good prognosis if managed with intensive combination chemotherapy [10]. Patients with brain metastases are automatically assigned a high-risk disease status, regardless of score [12]. Adjuvant surgical and/or radiation therapy can be added selectively to decrease disease burden and remove resistant lesions [21-23]. ETT and PSTT, biologically distinct tumors that are relatively refractory to chemotherapy and grow more slowly with local lymphatic rather than hematogenous metastases, are staged anatomically and primarily treated surgically [24]. Special Imaging Considerations A healthy twin live fetus may coexist alongside a partial or complete molar pregnancy. A rare phenomenon, this has been estimated to occur in 1 in 20,000 to 100,000 pregnancies [10]. The management of this entity is controversial as there is some concern that these patients may be more prone to developing GTN among other potential serious complications, such as pre-eclampsia, thyrotoxicosis, hemorrhage, trophoblastic embolism, and fetal demise [25,26]. Evidence from a series of 77 cases, however, suggests that approximately 40% of these patients may successfully deliver a healthy baby without increased incidence of malignant transformation [10,27]. Because this scenario is exceedingly rare, there is little high-quality evidence to support imaging guidelines. US Pelvis Transvaginal Transvaginal US is the accepted standard in the evaluation of early pregnancy and suspected complications. Although <50% of hydatidiform moles were prospectively identified on US in studies published >10 years ago [21,22], a more recent study reported improved sensitivity using contemporary US equipment with 86% of complete moles and 41% of partial moles diagnosed prospectively [23].
Gestational Trophoblastic Disease. Points are assigned for each variable to determine risk of resistance to single-agent chemotherapy. Scores exceeding 6 predict high-risk disease refractory to monochemotherapy, with patients maintaining good prognosis if managed with intensive combination chemotherapy [10]. Patients with brain metastases are automatically assigned a high-risk disease status, regardless of score [12]. Adjuvant surgical and/or radiation therapy can be added selectively to decrease disease burden and remove resistant lesions [21-23]. ETT and PSTT, biologically distinct tumors that are relatively refractory to chemotherapy and grow more slowly with local lymphatic rather than hematogenous metastases, are staged anatomically and primarily treated surgically [24]. Special Imaging Considerations A healthy twin live fetus may coexist alongside a partial or complete molar pregnancy. A rare phenomenon, this has been estimated to occur in 1 in 20,000 to 100,000 pregnancies [10]. The management of this entity is controversial as there is some concern that these patients may be more prone to developing GTN among other potential serious complications, such as pre-eclampsia, thyrotoxicosis, hemorrhage, trophoblastic embolism, and fetal demise [25,26]. Evidence from a series of 77 cases, however, suggests that approximately 40% of these patients may successfully deliver a healthy baby without increased incidence of malignant transformation [10,27]. Because this scenario is exceedingly rare, there is little high-quality evidence to support imaging guidelines. US Pelvis Transvaginal Transvaginal US is the accepted standard in the evaluation of early pregnancy and suspected complications. Although <50% of hydatidiform moles were prospectively identified on US in studies published >10 years ago [21,22], a more recent study reported improved sensitivity using contemporary US equipment with 86% of complete moles and 41% of partial moles diagnosed prospectively [23].