The Role of Computed Tomography Scanning of the Thorax in the Initial Assessment of Gestational Trophoblastic Neoplasia.
OBJECTIVE
The aim of this study was to determine whether lesions found on computed tomography (CT) imaging of the thorax would affect FIGO (International Federation of Gynecology and Obstetrics) 2000 risk score and/or alter clinical management.


METHODS
The Sheffield Trophoblastic Disease database was searched for all new patients registered for staging/scoring investigations between January 1, 2006, and June 30, 2010. The FIGO 2000 score was noted and then recalculated using information from CT scan reports. Where a change of risk score would have affected a patient's management, the case notes were further reviewed.


RESULTS
191 patients had undergone both modalities of imaging. Using standard FIGO scoring, 169 and 22 patients were noted to be at low and high risk, respectively. Using information from CT imaging, only a further 20 patients would have been reclassified as high risk. Fifteen of these "new" high-risk patients required salvage treatment with intravenous chemotherapy; all were cured.


CONCLUSIONS
With no potential advantage in terms of patient outcome and significantly increased radiation dose, there is little justification for routine CT imaging of the thorax in the initial assessment of new patients with gestational trophoblastic neoplasia.
*Department of Clinical Oncology, Royal Derby Hospital, Derby; †Trophoblastic Disease Centre, Weston Park Hospital; and ‡Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
James M
JM
Price
Christine
C
Lo
Shahram
S
Abdi
Matthew C
MC
Winter
Rob E
RE
Coleman
John
J
Tidy
Barry W
BW
Hancock
D061605:Administration, Intravenous; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary*; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D011247:Pregnancy; D013902:Radiography, Thoracic; D018570:Risk Assessment; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D005047:Etoposide; D008727:Methotrexate