Initial presenting features in gestational trophoblastic neoplasia: does a decade make a difference?

Objective: To compare the initial clinical presentation of patients who were treated at our center for gestational trophoblastic neoplasia (GTN) between 1996 and 1998 and between 2006 and 2008.

Study Design: All patients seen at Weston Park Hospitalfor GTN (excluding placental site trophoblastic tumor [PSTT]) between 1996 and 1998 (total, 79) and between 2006 and 2008 (total, 139) were identified and their medical records reviewed. Features from when they first presented with gestational trophoblastic disease (GTD), excluding PSTT, were recorded. During those time periods 1,391 and 1,623 patients, respectively, were registered at our center with GTD.

Results: The following results were noted: abnormal vaginal bleeding remains the most common presentation; the proportion of abnormal ultrasound scans at initial diagnosis has risen from 1% to 12%; the mean gestational age of the antecedent pregnancy has dropped from 11.3 to 10.1 weeks; the mean number of evacuations has fallen from 1.9 to 1.2, and the proportion of patients having 2 evacuations has more than halved; and the proportion of patients presenting with GTD requiring chemotherapy for GTN was 4.2% (59 of 1,391) for 1996-1998 and 6.7% (109 of 1,623) for 2006-2008.

Conclusion: An improvement in ultrasound technology and expertise in early pregnancy is likely to have contributed to a trend toward a lower gestational age at diagnosis of GTD. We noted a major shift in practice towards a higher threshold for repeat evacuations and an increased proportion of patients with GTN receiving chemotherapy.