Consensus based recommendations for the diagnosis of serous tubal intraepithelial carcinoma: an international Delphi study

Abstract

Aim: Reliably diagnosing or safely excluding serous tubal intraepithelial carcinoma (STIC), a precursor lesion of tubo-ovarian high-grade serous carcinoma (HGSC), is crucial for individual patient care, for better understanding the oncogenesis of HGSC, and for safely investigating novel strategies to prevent tuboovarian carcinoma. To optimize STIC diagnosis and increase its reproducibility, we set up a three-round Delphi study. Methods and results: In round 1, an international expert panel of 34 gynecologic pathologists, from 11 countries, was assembled to provide input regarding STIC diagnosis, which was used to develop a set of statements. In round 2, the panel rated their level of agreement with those statements on a 9-point Likert scale. In round 3, statements without previous consensus were rated again by the panel while anonymously disclosing the responses of the other panel members. Finally, each expert was asked to approve or disapprove the complete set of consensus statements. The panel indicated their level of agreement with 64 statements. A total of 27 statements (42%) reached consensus after three rounds. These statements reflect the entire diagnostic work-up for pathologists, regarding processing and macroscopy (three statements); microscopy (eight statements); immunohistochemistry (nine statements); interpretation and reporting (four statements); and miscellaneous (three statements). The final set of consensus statements was approved by 85%. Conclusion:This study provides an overview of current clinical practice regarding STIC diagnosis amongst expert gynecopathologists. The experts' consensus statements form the basis for a set of recommendations, which may help towards more consistent STIC diagnosis.

Risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer in women with an increased inherited risk: insights into an alternative strategy

“…Current practice when diagnosing an isolated STIC after salpingectomy is removal of the ovaries [46]. However, there are no guidelines for management after isolated STIC diagnosis after RRSO [47], partly due to the low prevalence which hinders research with a sufficient sample size [48].…”

“…Diagnosing a STIC has been proven difficult for several reasons: the small size of a STIC, its low prevalence, and the absence of standardized diagnostic criteria [48]. Aspects that could contribute to the low prevalence are: (1) underdiagnosing STIC because of sampling error due to the small size of the lesions, (2) overgrowth of cancer in the fallopian tubes in advanced stage EOC, (3) reporting bias, since there are no clinical consequences when a STIC is detected simultaneously with HGSC, (4) some early serous proliferations may skip the stage of STIC and function as a direct precursor of HGSC, the 'precursor escape model' [49].…”

“…To further optimize preventive care for women with an increased inherited risk, it is of the utmost importance to face the challenges regarding diagnosis and follow-up of STIC [48]. More research is necessary to take the next step in understanding the pathophysiology, create standardized diagnostic criteria, and discover its long-term consequences.…”

Morphologic and Molecular Heterogeneity of High-grade Serous Carcinoma Precursor Lesions

“…STICs are of microscopic size and are detected on the mucosal surface of the fallopian tube, commonly at the fimbriated ends. Classic morphologic features of STICs include nuclear atypia, prominent nucleoli, epithelial stratification, and occasional mitotic figures and/or apoptotic bodies 10–12 . STICs can be found with or without concurrent HGSC, and isolated STICs detected incidentally, in the absence of HGSC, arguably provide the ideal tissue sources for studying the pathogenesis of HGSC.…”