Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study

Minig, Lucas; Cabrera, Sílvia; Oliver, R T; Couso, Aldina; Rubio, María Jesús; Iacoponi, Sara; Martin-Salamanca, M B; Carballo‐Rastrilla, Sonia; Cádenas-Rebollo, J M; Garcia, Ana Luís; Gil-Ibáñez, Blanca; Juan-Fita, María José; Patrono, María Guadalupe

doi:10.1007/s12094-018-1865-9

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…It also needs to be mentioned that their pathologic findings were all in women with pathogenic variants in BRCA1. Minig et al [10] diagnosed STIC in 0.8 % and simultaneous STIC and OC in 1.7 %. They also noticed a statistically significant higher risk for BRCA1 mutation carriers for the detection of occult neoplasia in RRSO.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, they did additional immunohistochemistry, which revealed a p53 and ki67 positive intraepithelial carcinoma in histological review. In the study of Minig et al [10] one woman with positive pelvic washing underwent surgical staging including hysterectomy, omentectomy and lymphonodectomy without any proof of disease or further treatment. Until today, there is no standardized clinical management for patients with isolated positive pelvic washing or isolated STIC.…”

Section: Discussionmentioning

confidence: 99%

“…The wide range might be explicable through different study populations especially in age and mutation spectrum. Furthermore, different intraoperative and pathological protocols add to variations in study outcome 3 , 10 . It is already known that BRCA1 carriers have the highest risk of occult neoplasia at RRSO and that the frequency of incidental discoveries increases with age 11 .…”

Section: Objectivementioning

confidence: 99%

“…However, only a few of the women with atypical cells in pelvic washings develop carcinoma on the long run. Not only the clinical relevance of positive pelvic washings but also therapeutic consequences such as chemotherapy therefore remain unclear 9 , 10 . To date, there is no proof for the benefit of peritoneal washings nor peritoneal biopsies in the context of RRSO.…”

Section: Objectivementioning

confidence: 99%

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Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

Pross

Karsten

Blohmer

et al. 2021

Geburtshilfe Frauenheilkd

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Objective The objective of this retrospective study was to assess the role of routine peritoneal biopsies during risk reducing salpingo-oophorectomy (RRSO). Methods Data of 204 women who underwent RRSO between January 1, 2014 and February 20, 2020 at Charité – Universitätsmedizin Berlin, Campus Mitte were retrospectively analyzed. RRSO was done according to the standard operating procedures of the German Consortium Hereditary Breast and Ovarian Cancer (GC-HBOC) with peritoneal washing and several peritoneal biopsies. Specimen collected during RRSO were analyzed using the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Perioperative complications were classified using the Clavien-Dindo-Classification. Results 147 women who underwent RRSO had peritoneal biopsies and pelvic washing, 44 women had none of that. 123 patients (64.4%) carried a pathologic variant in gBRCA1, 53 (27.7%) carried a pathologic variant in gBRCA2. Histopathological evaluation identified four patients (2.1%) with pathological findings. Neither peritoneal biopsies nor pelvic washings revealed additional information after histological examination. There was no statistically significant difference in complication rate between the two groups. The mean surgery time for RRSO without peritoneal biopsies was 64.3 minutes compared to 77.8 minutes with peritoneal biopsies. That shows a statistically significant prolongation of 16% (13.5 minutes, p = 0.0383). Conclusions The routine use of peritoneal biopsies during RRSO does not improve detection of occult ovarian cancer or STIC but prolongs the operation time significantly. By omitting peritoneal biopsies in RRSO not only perioperative risks are diminished but also costs could be reduced by shortening of surgery time as well as decreased number of pathological samples.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

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Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

Pross

Karsten

Blohmer

et al. 2021

Geburtshilfe Frauenheilkd

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“…An incidental carcinoma involving the ovary, fallopian tube or peritoneum is detected during surgery or in the surgical specimen in 2-14% of patients undergoing risk-reducing procedures among multiple large studies. The frequency, however, in several studies is 3-5%, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] although it could be argued that there may be publication bias in the rates of positivity in the literature with the possibility of lower rates in current practice due to a shift to surgery in younger patients.…”

Section: Incidental Detection Of Stic In the Setting Of Prophylactic ...mentioning

confidence: 99%

Serous tubal intra‐epithelial carcinoma: what do we really know at this point?

Vang

Shih

2022

Histopathology

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Serous tubal intra‐epithelial carcinoma (STIC) is the earliest morphologically recognisable step in the development of invasive high‐grade serous carcinoma of the fallopian tube. Lesions occurring prior to STIC within the carcinogenic sequence for the pathogenesis of invasive high‐grade serous carcinoma include the p53 signature and secretory cell outgrowth (SCOUT). Variable histological criteria have been used for diagnosing STIC, but a combination of morphology and immunohistochemistry for p53/Ki‐67 improves interobserver agreement. Half of all carcinomas identified in risk‐reducing salpingo‐oophorectomy specimens are in the form of STIC; however, STIC also may be incidentally found on occasion in specimens from women at low or average risk of ovarian/tubal/peritoneal carcinoma. TP53 mutation is the earliest known DNA sequence alteration in STIC and almost all invasive high‐grade serous carcinomas of the ovary and peritoneum. Data on the clinical behaviour of STIC are limited. While the short‐term follow‐up in the prior literature suggests a low risk of malignant progression, a more recent meta‐analysis indicates a 10‐year risk of 28%. STIC probably should be best regarded as a lesion with uncertain malignant potential at present, and future molecular analysis will help to classify those with higher risk of dissemination. This review provides an update on the current knowledge of STIC and related issues.

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Recommendations for diagnosing STIC: a systematic review and meta-analysis

et al. 2021

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Our understanding of the oncogenesis of high-grade serous cancer of the ovary and its precursor lesions, such as serous tubal intraepithelial carcinoma (STIC), has significantly increased over the last decades. Adequate and reproducible diagnosis of these precursor lesions is important. Diagnosing STIC can have prognostic consequences and is an absolute requirement for safely offering alternative risk reducing strategies, such as risk reducing salpingectomy with delayed oophorectomy. However, diagnosing STIC is a challenging task, possessing only moderate reproducibility. In this review and meta-analysis, we look at how pathologists come to a diagnosis of STIC. We performed a literature search identifying 39 studies on risk reducing salpingo-oophorectomy in women with a known BRCA1/2 PV, collectively reporting on 6833 patients. We found a pooled estimated proportion of STIC of 2.8% (95% CI, 2.0–3.7). We focused on reported grossing protocols, morphological criteria, level of pathologist training, and the use of immunohistochemistry. The most commonly mentioned morphological characteristics of STIC are (1) loss of cell polarity, (2) nuclear pleomorphism, (3) high nuclear to cytoplasmic ratio, (4) mitotic activity, (5) pseudostratification, and (6) prominent nucleoli. The difference in reported incidence of STIC between studies who totally embedded all specimens and those who did not was 3.2% (95% CI, 2.3–4.2) versus 1.7% (95% CI, 0.0–6.2) (p 0.24). We provide an overview of diagnostic features and present a framework for arriving at an adequate diagnosis, consisting of the use of the SEE-FIM grossing protocol, evaluation by a subspecialized gynecopathologist, rational use of immunohistochemical staining, and obtaining a second opinion from a colleague.

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Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study

Abstract: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery.

Cited by 15 publications

References 20 publications

Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

Serous tubal intra‐epithelial carcinoma: what do we really know at this point?

Recommendations for diagnosing STIC: a systematic review and meta-analysis

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