Total human chorionic gonadotropin is a more suitable diagnostic marker of gestational trophoblastic diseases than the free -subunit of human chorionic gonadotropin

Objectives: Human chorionic gonadotropin (hCG) levels are essential for the management of trophoblastic diseases. This study aimed to compare the sensitivities and relationships of two hCG measurement methods (total hCG and the free beta-subunit of hCG) in managing gestational trophoblastic disease (GTD). Design and Methods: We analyzed data from patients treated for GTD at Chiba University Hospital between 2008 and 2019. We focused on cases where both total hCG (mIU/mL) and the free beta-subunit of hCG (ng/mL) were measured on the same day. Results: Out of 80 patients (mean age 38.9 +/- 11.7 years) and 158 measurements, 26 had values below the sensitivity threshold for both tests. Fifty-nine measurements were positive for total hCG but below the sensitivity threshold for the free beta-subunit of hCG, whereas only two showed the opposite. Seventy-one measurements were positive for both total hCG and the free beta-subunit of hCG. There was a significant correlation between total hCG and the free beta-subunit of hCG with both positive values, (r = 0.94, p < 0.001; Spearman's correlation test). Of the 85 measurements with undetectable free beta-subunit levels, 26 also had undetectable total hCG levels. However, total hCG was detectable in 59 patients from these cases, with a median value (interquartile range) of 2.9 (1.75-4.9) mIU/mL. Conclusions: In the management of GTD, the use of the free beta-subunit system alone cannot be recommended.