INVASIVE HYDATIDIFORM MOLE: ADVANCES IN DIAGNOSIS AND EARLY DETECTION STRATEGIES

Abstract

This review article addresses the challenges and advances in the diagnosis of hydatidiform mole (HM), the most common form of gestational trophoblastic disease (GTD), with a particular focus on its locally invasive complication, invasive mole. The introduction establishes the relevance of the topic, highlighting that HM, an abnormal pregnancy, has the potential to progress to Gestational Trophoblastic Neoplasia (GTN), requiring close follow-up. Invasive mole, characterized by the penetration of molar tissue into the myometrium, poses a significant risk of serious complications such as uterine hemorrhage. The central problem identified is the low accuracy of conventional diagnostic methods—ultrasonography and histopathology—which are highly observer-dependent. The objective of the study is to consolidate knowledge about refined diagnostic strategies and early detection. The methodology consisted of a narrative review of the literature, with a search of the PubMed database for articles addressing the diagnosis and treatment of invasive hydatidiform mole. The results of the review demonstrate the inadequacy of conventional diagnosis, citing a multicenter study that found an accuracy of only 44% for ultrasound and 66% for histopathology in the classification of HM. To overcome this limitation, the article highlights the indispensable role of ancillary techniques. Immunohistochemistry for the p57 protein is presented as a robust tool for differentiating complete molars (p57-negative) from partial and non-molars (p57-positive). As the gold standard, molecular genotyping by microsatellite (STR) analysis is highlighted for its ability to determine the parental origin of chromosomes, accurately confirming the nature of the lesion. Initial management is uterine evacuation, followed by serial monitoring of β-hCG to detect persistent disease, whose main treatment is single-agent chemotherapy, such as methotrexate. Surgical alternatives for fertility preservation in selected cases are also discussed.