Dynamic staging and risk factor scoring for gestational trophoblastic disease.
It is proposed that a dynamic staging and risk factor scoring system is introduced for the classification of gestational trophoblastic disease as a logical development of the system presently used by the FIGO. Modern computer technology permits such change as the disease changes and particularly if it progresses. By allowing a change of both stage and risk factor score for each patient reported, a dynamic scoring system results. Moreover, such a system allows the introduction of more clinical detail than is permitted by the present FIGO system. FIGO combining its anatomic staging, first devised by Professor Song of Beijing, with the World Health Organization risk factor scoring, first devised by Professor Kenneth Bagshawe of Charing Cross Hospital, London, in 2002 was a significant progress. The most important change of the FIGO 2002 modification was that criteria were defined for the diagnosis of postmolar gestational trophoblastic neoplasia. However, hydatidiform mole still has no place in that classification. Also, the time when the staging occurs is not mandated. The present FIGO classification allows for no change in the status of the patient. A dynamic staging and risk factor scoring system would allow such changes to be recorded and, therefore, permit a more precise account of the patient's disease. A third issue is whether invasive mole should be included in the classification, as the Japanese Gynecologic Cancer Society insists is necessary. This problem may also be solved by the use of a dynamic risk factor scoring system.
Kohorn
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EI
Trophoblast Center, Department of Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA. ernest.kohorn@yale.edu
D000328:Adult; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D006828:Hydatidiform Mole / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D009367:Neoplasm Staging; D011247:Pregnancy; D012307:Risk Factors; D012720:Severity of Illness Index; D014594:Uterine Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology