TY - JOUR
T1 - Persistent low levels of human chorionic gonadotropin
T2 - A premalignant gestational trophoblastic disease
AU - Khanlian, Sarah A.
AU - Smith, Harriet O.
AU - Cole, Laurence A.
N1 - Funding Information:
The USA hCG Reference Service is a College of American Pathologist monitored (No. 7176750-01) and Department of Health and Human Services CLIA certified (No. 32D0972561) reference facility. The service considers brief patient histories and the results of multiple tests on supplied parallel serum and urine samples. Samples are initially tested by using the automated DPC Immulite hCG test, the DPC Immulite free hCGβ test, Abbott AxSym total hCG test, and other commercial hCG tests as needed. Serum and urine samples are also analyzed by using specialized assays at the feference service laboratory. These include the microtiter plate intact hCG only enzyme immunometric assay, the invasive trophoblast antigen (ITA) enzyme immunometric assay, the nicked hCG only enzyme immunometric assay, the free hCG-β subunit only enzyme immunometric assay, and the hCG-β subunit core fragment only enzyme immunometric assay. These specialized tests have been described in detail in previous publications. 1-8 Tests are run with and without the Scantibodies, Inc (San Diego, Calif), heterophilic antibody blocking agent to detect substances that falsely elevate hCG titers. Different tests are run as needed, including Sigma Diagnostics (St Louis, Mo) urine creatinine test and the automated DPC Immulite LH test. 1-8 Clinical reports are prepared from the abbreviated patient history, from the patient's hCG test record, the USA hCG Reference Service–generated data with major commercial automated and “in house” specialized assays, and published data. 1-7 All data presented in the article is limited to that received by the USA hCG Reference Service from centers throughout the United States accompanying patient serum and urine samples, and to results specifically generated for patient records. No information was collected for research purposes. The accumulation of data from the USA hCG Reference Service records for this article was reviewed and approved by the University of New Mexico Human Research Review Committee. It was the review committee's opinion that further review was not required from the many other institutions that referred patients to the USA hCG Reference Service for clinical purposes. In most cases, the USA hCG Reference Service received only limited patient information. We were also informed by the review committee that access to any additional patient information would, however, require separate internal review board approval from the referring centers. For this reason, data summarized in this report are limited to that provided at the time of referral.
PY - 2003/5/1
Y1 - 2003/5/1
N2 - OBJECTIVE: This study was undertaken to evaluate the significance of persistent low-level human chorionic gonadotropin (hCG) titers (usually <50 IU/L) in the absence of clinical evidence of pregnancy or gestational trophoblastic disease. STUDY DESIGN: The USA hCG Reference Service consulted on 114 cases with persistent low levels of hCG; 51 had false-positive hCG results. The remaining 63 cases had real hCG results and are presented here. RESULTS: Antecedent gestational events included hydatidiform mole (27), pregnancy (35), and gestational trophoblastic neoplasm (1). Forty of the 63 (64%) cases received therapy, including chemotherapy (38), hysterectomy (2), or both (10). Despite treatment, in all cases, low hCG titers persisted. After 1 to 4.5 years of low titers, four women had a sudden rapid increase in hCG levels, and malignant disease was confirmed or clearly suggested (gestational trophoblastic neoplasm [3] and placental site trophoblastic tumor [1]). Invasive trophoblast antigen (ITA) is a marker of invasive cytotrophoblast cells. ITA was measured in 38 of the cases with persistent low hCG, in all cases ITA accounted for less than 25% of the hCG concentration. It was also determined in the 4 cases indicated with malignant disease, accounting for more than 80% of the hCG. CONCLUSION: The presence of persistent low-level hCG titers defines a subset of women with preinvasive or quiescent gestational trophoblastic disease. ITA effectively detected the presence or absence of invasive cells in these cases. The recommended management of the quiescent disease is close surveillance without therapy until malignant disease detected.
AB - OBJECTIVE: This study was undertaken to evaluate the significance of persistent low-level human chorionic gonadotropin (hCG) titers (usually <50 IU/L) in the absence of clinical evidence of pregnancy or gestational trophoblastic disease. STUDY DESIGN: The USA hCG Reference Service consulted on 114 cases with persistent low levels of hCG; 51 had false-positive hCG results. The remaining 63 cases had real hCG results and are presented here. RESULTS: Antecedent gestational events included hydatidiform mole (27), pregnancy (35), and gestational trophoblastic neoplasm (1). Forty of the 63 (64%) cases received therapy, including chemotherapy (38), hysterectomy (2), or both (10). Despite treatment, in all cases, low hCG titers persisted. After 1 to 4.5 years of low titers, four women had a sudden rapid increase in hCG levels, and malignant disease was confirmed or clearly suggested (gestational trophoblastic neoplasm [3] and placental site trophoblastic tumor [1]). Invasive trophoblast antigen (ITA) is a marker of invasive cytotrophoblast cells. ITA was measured in 38 of the cases with persistent low hCG, in all cases ITA accounted for less than 25% of the hCG concentration. It was also determined in the 4 cases indicated with malignant disease, accounting for more than 80% of the hCG. CONCLUSION: The presence of persistent low-level hCG titers defines a subset of women with preinvasive or quiescent gestational trophoblastic disease. ITA effectively detected the presence or absence of invasive cells in these cases. The recommended management of the quiescent disease is close surveillance without therapy until malignant disease detected.
KW - Gestational trophoblastic disease
KW - Human chorionic gonadotropin
KW - Quiescent gestational trophoblastic disease
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U2 - 10.1067/mob.2003.271
DO - 10.1067/mob.2003.271
M3 - Article
C2 - 12748494
AN - SCOPUS:0038395984
SN - 0002-9378
VL - 188
SP - 1254
EP - 1259
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 5
ER -