GTN misdiagnosed as ectopic pregnancy: a 17-year retrospective cohort study

Area of Science:

• Gynecology
• Oncology
• Reproductive Medicine

Background:

• Gestational trophoblastic neoplasia (GTN) is a rare complication of pregnancy.
• Accurate diagnosis is crucial for effective treatment and patient outcomes.
• Misdiagnosis can significantly impact the management and prognosis of GTN.

Purpose of the Study:

• To assess the impact of misdiagnosis on chemotherapy response and prognosis in GTN patients.
• To identify strategies for improving the precision management of uncertain GTN cases.
• To compare outcomes between misdiagnosed GTN and correctly diagnosed GTN.

Main Methods:

• Retrospective analysis of GTN patients misdiagnosed as ectopic pregnancies.
• Comparison with a control group of GTN patients without misdiagnosis, matched for age, WHO risk score, and admission year.
• Statistical analysis using Mann-Whitney test and Chi-square/Fisher's exact test to evaluate differences in outcomes.

Main Results:

• Misdiagnosed GTN cases (35) showed a higher proportion of high-risk GTN (57.1%) and antecedent nonmolar pregnancy (88.6%).
• Misdiagnosed patients had lower pretreatment hCG levels and significantly higher recurrence rates (28.6% vs 5.7%, p=0.011).
• A trend towards increased resistance rates was observed in the misdiagnosed group (22.9% vs 14.3%).

Conclusions:

• GTN following nonmolar pregnancy with low hCG is prone to misdiagnosis, increasing WHO risk scores, resistance, and relapse rates.
• Surgical intervention, specifically lesion resection over methotrexate, is advised for atypical GTN.
• Early and accurate diagnosis is vital for optimal GTN management and improved patient survival.