Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Sydney, Australia.
Best Pract Res Clin Obstet Gynaecol. 2009 Aug;23(4):565-73. doi: 10.1016/j.bpobgyn.2009.03.001. Epub 2009 Apr 17.
Gestational trophoblastic disease (GTD) is a group of interrelated tumours originating from the placenta. Hydatidiform molar (HM) pregnancy is the most common form of GTD; this includes both partial hydatidiform molar (PHM) and complete hydatidiform molar (CHM) pregnancies. The importance of such a condition derives from its potential for persistent trophoblastic disease; this is noted to be more common after a CHM (10-20%) compared to a PHM (0.1-11%). The recent routine use of high-resolution trans-vaginal ultrasound (TVS) in early pregnancy has improved the recognition and thus pre-surgical diagnosis of molar pregnancy. Pre-surgical recognition aids planning of surgery, decreases intra-operative complications and identifies women with potential persistent trophoblastic disease. Despite the introduction of TVS, its performance in preoperative diagnosis is quite poor. This is primarily because of the histomorphometric features of the hydropic villi. A significant proportion of HM cases demonstrates minimal hydropic change in the first trimester and therefore is likely to remain unidentifiable by ultrasound examination prior to surgical evacuation, even with improved sonographer expertise. The overall sensitivity for the ultrasound diagnosis of HM is 50-86%. Ultrasound diagnosis of CHM can be made in approximately 80% of the cases, whilst ultrasound diagnosis of PHM is less accurate and nearly 70% of cases will be missed. Correlation of the ultrasonographic findings with human chorionic gonadotropin levels can further improve the recognition of HM pregnancy pre-surgery. Although ultrasound can be helpful in the diagnosis of molar pregnancies, histological confirmation is mandatory. Histological confirmation post-curettage is still the gold standard for the diagnosis of GTD. In this article, we critically evaluate the role of TVS in the pre-surgical recognition of GTD.
妊娠滋养细胞疾病（GTD）是一组来源于胎盘的相关肿瘤。葡萄胎妊娠是 GTD 中最常见的形式；包括部分葡萄胎（PHM）和完全葡萄胎（CHM）妊娠。这种情况的重要性源于其持续存在的滋养细胞疾病的可能性；CHM（10-20%）后比 PHM（0.1-11%）更常见。最近在早期妊娠中常规使用高分辨率经阴道超声（TVS）提高了对葡萄胎妊娠的认识和术前诊断。术前识别有助于手术计划、减少术中并发症并识别出有潜在持续滋养细胞疾病的妇女。尽管引入了 TVS，但它在术前诊断中的表现相当差。这主要是因为葡萄胎绒毛的组织形态特征。相当一部分 HM 病例在孕早期显示出最小的水肿性改变，因此即使在超声检查方面的经验丰富的超声医师也可能在手术前无法识别，即使进行了超声检查。超声诊断 HM 的总体敏感性为 50-86%。CHM 的超声诊断可以在大约 80%的病例中做出，而 PHM 的超声诊断则不太准确，近 70%的病例会漏诊。将超声表现与人绒毛膜促性腺激素水平相关联可以进一步提高手术前对 HM 妊娠的认识。虽然超声有助于诊断葡萄胎妊娠，但组织学确认是必须的。刮宫术后的组织学确认仍然是 GTD 诊断的金标准。在本文中，我们批判性地评估了 TVS 在 GTD 术前识别中的作用。
