Interpretation Of Hcg

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  • 1. INTERPRETATION OF hCG LEVELS?

2.

  • Glycoprotein withandchains
  • subunit is specific to hCG
  • Secreted by trophoblastic tissue, some amount by fetal tissues, adult ant pituitary
  • Many isoforms of hCG with variable crossreactivity between various assays
  • More than 100 commercial assays
  • Sandwich type immunoassay: Sens - 1mIU/ml
  • Immuno radiometric assays: more Sensitive

3.

  • Pregnancy
  • Gestational trophoblastic neoplasia
  • Non gestational
  • Trophpoblastic neoplasia
  • Mixed germ cell tumors

4.

  • Always rule out pregnancy whenever hCG is positive.
  • It does not localize the pregnancy
  • USG to lacalise the pregnancy
  • Significantly higher levels
  • Multiple pregnancy
  • Erythroblastosis fetalis
  • Downs syndrome
  • Low levels : ectopic pregnancy, abortions

5.

  • +ve 7-9 days after the midcycle surge that precedes ovulation.(time of blastocyst implantation)
  • Blood levels rise rapidly, double every 1.4 - 2 days, max value at 8-10 wks.
  • Peak values: 60-80 days of LMP(1 lac mIU/ml)
  • 10-20 wks POG: begin to fall, nadir levels by 20 wks & maintained at lower levelsthru out pregnancy

6. Return of hCGNVD3 wks Abortions 6 wks Molar pregnancy 8-9 wks 7.

  • Discriminatorylevel
    • Lower limit above which one can reliably visualise
    • pregnancy
    • 1500 mIU/ml for TVS
  • Doubling time
    • IUP : serum hCG levels 66% every 48 hrs
    • Inappropirately rising serum hCG-> dying pregnacy & not its location

8. Positive urinary hCG TVS Pregnancy of Unknown location Serial serum hCG and progesterone Initial progesterone 66% rise IUP TVS Failing pregnancy D&C 12.

  • Medical treatment
    • Pre T/t level:5000 mIU/ml 92% success
    • Follow up: D 1 -- baseline
  • D 4 -- level >D 1
  • D 7 -- 15% fall from D 4
  • Every week till 15 IU/L
    • 20% will have decline of hCG < 15% :second dose of Methotrexate
    • Average duration for hCG levelto reach normal-36 days
  • Longestduration- 109 days
  • Expectant treatment
  • < 1000 mIU/ml
  • < 200 IU/L-----spontaneous resolution in 88-96 %

13.

  • High risk molar: > one lac mIU/ml
  • Follow up :within 48 hrs of evacuation
  • every wk till hCG is normalx 3wks
  • every month x 6 months
  • FIGO criteria for chemo
  • Plateauing ( +10% value ,4 values over 3 wks)
  • Rising hCG(increase of > 10% of 3 values recorde over a 2 week duration)
  • Persistent hCG after 6 months of evacuation

14. FIGO score 0 1 2 4 Age (years) 39 Antecedent pregnancy Hydatidiform mole Abortion Term pregnancy Interval from index pregnancy (months) 12 Pretreatment hCG (mIU/mL) 100,000 Largest tumor size including uterus (cm) 3-4 5 Site of metastases Spleen Kidney Gastrointestinal Brain lever Number of metastases identified 0 1-4 4-8 >8 Previous failed chemotherapy Single drug >2 drugs 15. Category Criteria Non-metastatic GTN No evidence of metastases; not assigned to prognostic categoryMetastatic GTN Any extrauterine metastases Good prognosis metastatic GTN No risk factors: Short duration ( 40,000 mIU/ mL Brain or liver metastases Antecedent term pregnancy Prior chemotherapy 16. Surveillance During And After Therapy of GTN

  • Monitor serum quantitative hCG levels every week during chemotherapy:
  • Response:> 10% decline in hCG during one cycle
  • Plateau:+10% change in hCG during one cycle
  • Resistance:>10% rise in hCG during one cycle or plateau for two Remission: 3 consecutive normal weekly hCG values
  • Surveillance of remission:
  • hCG values every 2 weeks X 3 months
  • hCG valuesevery month to complete one year of follow-up
  • hCG values every 6-12 months indefinitely; at least 3-5 years

17.

  • 75 -110 mIU/L ( max reported 300 mIU/L)
  • After chemo/ surgery of GTN
  • No clinical/radiological evidence of trophoblastic tissue
  • phantom hCGQuiscent GTN
  • (false +ve)(real +ve)
  • (Benign or inactive)

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  • Phantom hCG
  • Heterophilic abs
  • React with animal Ag in immuno sandwich assay
  • Confirm by
    • Urine hCG ve
    • different assays
    • no change in dilutions
    • other techniques to srip/ block/ inactivate abs
  • Quiscent GTN
  • Most often after molar, GTN, pregnancy
  • Do not respond to chemo
  • Diagnosis
    • Hyperglycosylated hCG < 6%
    • (hCG H)
    • Serial hCG titres: plateau5,10,20,22,8,25,24
    • Withhold chemo
  • Premalignant (1-11%)
  • Monthly FU, glycosylated hCG,
  • Slow growing syncytiotrophoblast

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