OBJECTIVE:To evaluate the predictive value of gestational age and maternal serum β-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS:This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum β-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS:There was a significant difference in maternal serum β-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum β-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION:The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum β-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high β-hCG concentrations.

译文

目的:评价孕龄和孕产妇血清β-hCG浓度对确定滋养细胞浸润输卵管壁的深度的预测价值。
方法:这是一项回顾性试验,针对接受壶腹部切除术的诊断为壶腹妊娠的妇女(71名)。初次入院时获得血清β-hCG测量值。组织学调查由一位经验丰富的病理学家进行,该病理学家对患者的临床和实验室特征视而不见。根据滋养细胞向输卵管壁的浸润深度在组织学上对壶腹妊娠进行分类:滋养细胞仅限于输卵管粘膜(I期),延伸至肌层(II期),完全输卵管壁浸润至浆膜层(III期)。
结果:就滋养细胞侵袭的组织学阶段而言,母体血清β-hCG浓度存在显着差异。对于第三阶段滋养细胞浸润最好的预测血清β-hCG浓度为6,475 mIU / ml,敏感性为100%,特异性为92%。
结论:滋养细胞组织渗入输卵管壁的深度与血清β-hCG水平有关,与胎龄无关。这些发现可能解释了高β-hCG浓度女性EP保守治疗失败的原因。

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