Reviewer’ s report
Title: The impact of pre-evacuation ultrasound examination in histologically confirmed
hydatidiform mole in missed abortion
Version: 1Date: 25 Jul 2020
Reviewer's report:
Among highligths:
"beta hCG may not have clinical significance to predict hydatidiform mole in missed abortion." Ithink this highligth could be modified because although there was an overlaping in the hCG valueamong the two groups, in hydatiform moles hCG was significantly higher than in non-molarabortion. You can retrieve the interval between the hCG and the uterine evacuation. If hCG inmissed non-molar abortion was collected early in pregnancy, it could not reflect the hCGimmediately before the uterine evacuation.
p3 lines 10 to 15 "Although more than 80% mole is sucessfully treated, 10 to 15% of cases may
develop into ... " it should be replaced by: "Although more than 80% mole has spontaneousremission, 10 to 15% of cases may develop into ...
p.4 lines 34 to 41: "Recently with the increasing performance of ultrasound examination either
routinely in the first trimester of pregnancy of early pregnancy complications (7), hydatidiformmole may be able to be detected before developing into invasive moles or choriocarinoma." Thereference number 7 is from 1998; so, it is not recent. You can modifies the written or prefer a newpaper Jauniaux paper. ( Jauniaux E, Memtsa M, Johns J, Ross JA, Jurkovic D. New insights in thepathophysiology of complete hydatidiform mole. Placenta 2018, 62:28-3 doi:10.1016/j.placen-
ta.2017.12.008. Epub 2017 Dec 16.).
Some points need to be better explained in methods:
1, all cases are in the first trimester. How many were in early first trimester (until 8 weeks) sincethe hydropic feature in molar pregnancy at ultrasonography begins around 9 weeks? ( Jauniaux E,Memtsa M, Johns J, Ross JA, Jurkovic D. New insights in the pathophysiology of completehydatidiform mole. Placenta 2018, 62:28-3 doi:10.1016/j.placenta.2017.12.008. Epub 2017 Dec16.2. how were the criteria to match the 2398 gestation women with non-molar missed abortion? Wasthe gestational age took in account?3. what was the essay used to measure the hCG?4. How long was the interval between the hCG measurement and the uterine evacuation?5. Who performed the naked eye examination of uterine specimen? A senior physician?6. Who performed the ultrasonography? A senior physician? What type of equipment was used?7. were the partial mole confirmed with p57 immunohistochemical exam? It helps differentiateearly complete mole and partial hydatidiform mole avoiding misdiagnosis. (Hui P, Buza N,Murphy KM, et al. Hydatidiform moles: genetic basis and precision diagnosis. Annu Rev Pathol2017; 12: 449-485. DOI: 10.1016/j.placenta.2017.12.008)
P10 lines 7 to 12 ... in our current study we found that the sensivity of diagnosis of two subtypes of
hydatidiform mole by pre-evacuation ultrasound examination was not different... (it is possiblethat some cases classified as partial mole could be early complete mole)
P11 lines 2 to 5 and 51 to 54: "our finding may suggest there is less clinical significance in the
levels of hCG in the prediction of hydatidiform mole in missed abortion. In addition, levels ofhCG may not have clinical significance to predict hydatidiform mole in missed abortion." I thinkthat this conclusion could be modified to: in missed abortion the hCG value was higher inhydatidiform mole than in non-molar, although there is an overlaping among them.
P11 lines 44 to 52: you suggest to perform histopathological examination in missed abortion,
particularly in non-developed countries. What do you suggest to patients who had spontaneousmissed abortion elimination, without available specimen to be examined? I suggest to read:Fisher RA, Tommasi A, Short D, Kaur B, Seckl MJ, Sebire NJ. Clinical utility of selectivemolecular genotyping for diagnosis of partial hydatidiform mole; a retrospective study from aregional trophoblastic disease unit. J Clin Pathol 2014 Nov;67(11):980-4. In summary, in thisarticle, the authors suggest a pragmatic management approach of human chorionic gonadotrophinsurveillance in cases in which the differential diagnosis between partial mole and non-molarabortion is not possible by histopathological examination. Similarly, I think that the hCGmeasurement, at least once around 30 to 40 days after the pregnancy termination represents anapproppriate approach to rule out molar pregnancy in cases without available specimen.
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