Significance of Chest Computed Tomography in the Clinical Outcome of Patients with Low-Risk Gestational Trophoblastic Neoplasia

OBJECTIVE: To determine the significance of pulmonary metastases diagnosed only by chest computed tomography (CT) on the clinical outcome of patients with low-risk gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A retrospective cohort study which included low-risk GTN patients with normal baseline chest x-ray findings who underwent chest CT managed at the section of trophoblastic diseases in a tertiary government hospital. RESULTS: Following chest CT scan, 13 patients were proven to have pulmonary lesions, while 45 patients had normal chest CT scan. All 58 patients who underwent chest CT scan went into remission regardless of the presence or absence of pulmonary micrometastasis. Of those, 52 were able to have regular hCG monitoring 2 years after remission and were able to maintain normal hCG levels. However, it was noted that 5 out of the 13 patients with pulmonary micrometastasis had resistance after the first line of treatment, but eventually all went into remission after second line or salvage chemotherapy. CONCLUSION: The presence of pulmonary micrometastasis diagnosed only by chest CT does not seem to alter the clinical outcome among patients with low-risk GTN. Thus, a chest CT may not be necessary prior to starting single-agent chemotherapy in this group of patients.