Evaluation of chest X-ray findings to determine metastatic gestational trophoblastic disease according to the proposed new staging system: a case series.

Recently, a new staging system has been proposed for gestational trophoblastic disease (GTD) to ensure uniformity in staging as well as to facilitate comparison of treatment outcomes. However, the use of a chest X-ray was considered adequate for the detection of lung metastases. We describe a case-series of patients with malignant GTD and pulmonary metastases undetected by conventional chest X-ray. The scoring and therefore treatment according to high-risk or low-risk depends on various risk factors, including the number of metastases. In all three patients described, a computerised axial scan (CT) of the chest confirmed the presence of lung metastases. With the increasing availability of CT scanning in most parts of the world, particularly in tertiary hospitals in which trophoblastic tumours are likely to be managed, we propose that CT scan of the chest be performed if the chest X-ray is negative, especially if the clinical findings point to a diagnosis of malignant GTD.