A 31-year-old woman presents 4 weeks after evacuation of a partial hydatidiform mole with serum hCG rising from 800 to 1,200 IU/L over 2 weeks. Pelvic ultrasound shows a 3 cm vascularized intrauterine lesion. Chest X-ray is normal. According to FIGO scoring for GTN, all of the following are scored ZERO points EXCEPT:

• A Interval from antecedent pregnancy < 4 months
• B Pre-treatment hCG < 1,000 IU/L
• C Largest tumor size < 3 cm
• D Site of metastasis: lung ✓

Explanation

In the FIGO/WHO GTN scoring system, lung metastases score 1 point (not zero), distinguishing them from no metastasis (0 points). Sites scoring higher include spleen/kidney = 1, gastrointestinal tract = 2, and brain/liver = 4. For zero points: interval < 4 months = 0; hCG < 1,000 = 0; tumor size < 3 cm = 0. Having a lung metastasis (if present on CT even with normal CXR) scores 1 point. Pre-treatment hCG 1,200 IU/L scores 0 (< 1,000 = 0; 1,000–10,000 = 1). This patient's score would be low risk, supporting single-agent methotrexate therapy.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.