Iranian Society of Gynecology Oncology


1 Department of Gynecology and Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

2 Department of General Surgery, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

3 Department of Radiology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

4 Department of Obstetrics and Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran


Background: Gestational trophoblastic neoplasm (GTN) during pregnancy includes an associated heterogeneous group of lesions that originates from abnormal proliferation of placenta. It includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.
Objectives: The aim of this study was to predict the risk of invasive mole in patients with a molar pregnancy in association with β-hCG level after the evacuation of molar pregnancy.
Methods: The current study was a prospective cross-sectional cohort research conducted as a diagnostic study on 110 patients with molar pregnancy referring to Department of Gynecology and Oncology of Vali-Asr, Imam Khomeini Hospital of Tehran between the years of 2015 and 2016. Patients with molar pregnancy, who were hospitalized with a diagnosis of hydatidiform mole by transvaginal ultrasonography, were examined in the study. The ability to perform ultrasonography before and after evacuation as well as the consent to participate in the study was among the inclusion criteria for patients. The patients were studied for invasive mole followed by two ultrasonography examinations, one 48 hours and the other 21 days after evacuation. β-hCG levels were also measured in successive periods of one week to six months. The association of sonography findings 48 hours and 21 days after evacuation with post-evacuation β-hCG levels was investigated using Chi-square test and multinomial regression.
Results: In the current study conducted on 110 patients with hydatidiform mole, the results showed that 46 patients (41.8%) suffered from invasive mole. In 23 patients (50%) with invasive mole, the results of both ultrasonography 48 hours and 21 days after evacuation were positive. There was a significant correlation between ultrasonography after evacuation (positive and negative results) and the progress of β-hCG after evacuation in women with invasive mole (P = 0.001); this means that in 73% of women with invasive mole, the positive β-hCG results corresponded with positive 21-day sonography after evacuation, and in 41% cases, ultrasound results on day 21 were reported positive before the results of β-hCG.
Conclusions: Positive results of sonography accompanied with positive results of β-hCG have a high efficiency in the diagnosis of invasive mole; therefore, more definitive studies with a larger sample size are suggested to confirm this hypothesis.


  1. Berkowitz RS, Goldstein DP. Presentation and management of molar pregnancy. Gestational Trophoblastic Dis. 1997;1:127-42.
  2. Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, et al. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000;356(9223):36-9. [DOI:10.1016/S0140-6736(00)02432-6]
  3. Ngan S, Seckl MJ. Gestational trophoblastic neoplasia management: an update. Curr Opin Oncol. 2007;19(5):486-91. [DOI:10.1097/CCO.0b013e3282dc94e5]
  4. Lybol C, Thomas CM, Bulten J, van Dijck JA, Sweep FC, Massuger LF. Increase in the incidence of gestational trophoblastic dis ease in The Netherlands. Gynecol Oncol. 2011;121(2):334-8. [DOI:10.1016/j.ygyno.2011.01.002]
  5. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010;203(6):531-9. [DOI:10.1016/j.ajog.2010.06.073]
  6. Kirk E, Papageorghiou AT, Condous G, Bottomley C, Bourne T. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol. 2007;29(1):70-5. [DOI:10.1002/uog.3875]
  7. Lenhart M. Diagnosis and treatment of molar pregnancy. Postgrad Obstet Gynecol. 2007;27(17):1-4. [DOI:10.1097/01.PGO.0000287256.58743.89]
  8. Benson CB, Genest DR, Bernstein MR, Soto-Wright V, Goldstein DP, Berkowitz RS. Sonographic appearance of first trimester complete hydatidiform moles. Ultrasound Obstet Gynecol. 2000;16(2):188-91. [DOI:10.1046/j.1469-0705.2000.00201.x]
  9. Berkowitz RS, Goldstein DP, DuBeshter B, Bernstein MR. Management of complete molar pregnancy. J Reprod Med. 1987;32(9):634-9.
  10. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376(9742):717-29. doi: 10.1016/S0140-6736(10)60280-2. [DOI:10.1016/S0140-6736(10)60280-2]
  11. Benedet JL, Bender H, Jones H3, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70(2):209-62.
  12. KaYu T. Follow-up of hydatidiform moles modified. Obstet Gynaecol Reprod Med. 2015:39.
  13. Zhou Q, Lei XY, Xie Q, Cardoza JD. Sonographic and Doppler imaging in the diagnosis and treatment of gestational trophoblastic disease: a 12-year experience. J Ultrasound Med. 2005;24(1):15-24. [DOI:10.7863/jum.2005.24.1.15]
  14. Jean-Jacques C. The hydatidiform mole. Cell Adh Migr. 2015:1-10. [DOI:10.1080/19336918.2015.1093275]
  15. Garavaglia E, Gentile C, Cavoretto P, Spagnolo D, Valsecchi L, Mangili G. Ultrasound imaging after evacuation as an adjunct to beta-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia. Am J Obstet Gynecol. 2009;200(4):417 e1-5. [DOI:10.1016/j.ajog.2008.11.032]
  16. Stevens FT, Katzorke N, Tempfer C, Kreimer U, Bizjak GI, Fleisch MC, et al. Gestational Trophoblastic Disorders: An Update in 2015. Geburtshilfe Frauenheilkd. 2015;75(10):1043-50. [DOI:10.1055/s-0035-1558054]
  17. Sebire NJ, Rees H, Paradinas F, Seckl M, Newlands E. The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies. Ultrasound Obstet Gynecol.2001;18(6):662-5. [DOI:10.1046/j.0960-7692.2001.00589.x]
  18. Jones WB, Lauersen NH. Hydatidiform mole with coexistent fetus. Am J Obstet Gynecol. 1975;122(3):267-72. [DOI:10.1016/0002-9378(75)90165-9]