Evaluation of serial beta-human chorionic gonadotrophin levels after primary treatment of molar pregnancies : can the follow-Up for surveillance of persistence or malignant transformation be shortened?

Hall, Warren J. (2012-12)

Thesis (MMed)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: Objective: The aim of the study was to determine whether Beta-hCG levels at various time intervals during the follow-up period after primary treatment of molar pregnancies could be used to predict progression of the disease later, in an attempt to shorten the period of surveillance. Furthermore an assessment of the demographic details and risk factors for the development of persistent trophoblastic disease was examined. Levels of compliance to the current surveillance protocol were evaluated. Method: A retrospective analysis of all patients diagnosed with molar pregnancies at Tygerberg Hospital, Cape Town from January 2000 to December 2010. Results: Among the 120 patients, 13 (19.7%) of complete moles and 10 (20%) of partial moles developed persistent trophoblastic disease. There was no statistical significance of the demographic data when comparing the two types of moles. 66% of complete and 50% of partial moles were lost to follow-up within the first six months of surveillance. A potential Beta-hCG cut-off value of 148mIU/ml at week 6 offered a sensitivity of 0.89 and specificity of 0.88 that surveillance could be terminated. Conclusions: Patient compliance is a limiting factor in the evaluation of molar pregnancy surveillance. However, based on our results, the suggestion that termination of surveillance after primary evacuation could occur at 6 weeks if the Beta-hCG level was 148 mIU/ml or lower remains undecided, and it is our opinion that higher sensitivities and specificities are required. Further research is needed to solidify this claim. The acquisition of demographic information of our population remains a priority, in order for more informed decisions to be made.

AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om te bepaal of Beta-mCG vlakke of verskillende intervalle, gedurende die opvolg periode na primêre behandeling van mola swangerskappe gebruik kan word om siekte progressie te voorspel, en sodoende die tydperk van opvolg te verminder. Verder was die demografiese besonderhede en risiko faktore vir die ontwikkeling van persisterende trofoblastiese siekte ondersoek. Die nakoming tot die huidige toesighouding protokol was geevalueer. Metode: ‘n Retrospektiewe analise van al die pasiënte wat gediagnoseer is met ‘n mola swangerskap by Tygerberg Hospitaal, Kaapstad vanaf Januarie 2000 tot Desember 2010. Resultate: Van die 120 pasiënte het 13 (19.7%) van die volledige molas en 10 (20%) van die gedeeltelike molas persisterende trofoblastiese siekte ontwikkel. Daar was geen statistiese belang in die demografiese data, wanneer die twee tipe molas met mekaar vergelyk is nie. 66% van die volledige en 50% van die gedeeltelike molas was verlore met opvolg binne die eerste ses maande van opvolg. ‘n Potensiële Beta-mCG afsnywaarde van 148mIU/ml op ses weke het ‘n sensitiwiteit van 0.89 en spesifisiteit van 0.88 gewys dat toesighouding getermineer kan word. Opsomming: Pasiënt nakoming is ‘n beperkende faktor in die opvolg van mola swangerskappe. Alhoewel, gebaseer op ons resultate, ons kan voorstel dat terminasie van “surveillance/toesighouding” na primêre lediging, kan plaasvind op 6 weke indien die Beta-mCG vlak 148mIU/ml of minder is, bly dit onbeslis. Dit is ons opinie dat hoër vlakke van sensitiwiteit en spesifisiteit nodig is. Verdere navorsing is nodig om hierdie voorstelling te staaf. Die invordering van demografiese inligting van ons populasie bly ‘n prioriteit, om sodoende meer ingeligte besluite te neem.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/71695
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