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Association of Serum ß -hCG Levels With Myosalpingeal Invasion and Viable Trophoblast Mass in Tubal Pregnancy

From the Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut; the Division of Reproductive Endocrinology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas; and the Department of Pathology, New Britain General Hospital, New Britain, Connecticut

Abstract

Objective: To test the hypothesis that myosalpingeal invasion and viable trophoblast mass are associated with serum ß-hCG levels in tubal-ampullary pregnancy.

Methods: Twenty-seven salpingectomy specimens of tubal- ampullary pregnancies were assessed for the presence or absence of myosalpingeal invasion. The mass of viable trophoblast was quantified in terms of the number of highpower fields (X400) occupied. The cases were stratified into three groups: small, less than one field; medium, one or two fields; and large, more than two fields and/or embryo present. Beta-hCG was measured before the procedure (mIU/mL, Third International Standard).

Results: The mean (± standard error of the mean) ß-hCG level for the nine cases exhibiting myosalpingeal invasion was significantly higher than for the 18 cases without invasion (13,665 ± 2986 versus 2169 ± 870 mIU/mL; P=.0001). Beta-hCG levels greater than or equal to 5400 mIU/mL predicted myosalpingeal invasion in eight of nine cases (positive predictive value 89%). In contrast, levels less than 5400 mIU/mL were associated with lack of myosalpingeal invasion in 17 of 18 cases (negative predictive value 94%). The volume of trophoblast mass correlated with both /J-hCG levels (r=0.647, P=.0003) and myosalpingeal invasion (r=0.735, P=.0001). There was no invasion in the 13 cases in the group with small trophoblast mass, whereas two of five cases in the medium-mass group displayed myosalpingeal invasion. In this group, the mean 0-hCG for cases with myosalpingeal invasion was higher than in the cases without invasion (16,917 ± 117 versus 3799 ± 1094 mIU/mL; P=.003). In the group with large trophoblast mass, seven of nine specimens showed myosalpingeal invasion.

Conclusion: Both myosalpingeal invasion and viable trophoblast mass correlate positively with serum levels of ß-hCG. Myosalpingeal invasion is highly likely when /3-hCG levels reach 5400 mIU/mL.

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