Population Frequency of Serous Tubal Intraepithelial Carcinoma (STIC) in Clinical Practice Using SEE-Fim Protocol

Samimi, Goli; Trabert, Britton; Geczik, Ashley M.; Duggan, Máire A.; Sherman, Mark E.

doi:10.1093/jncics/pky061

Cited by 26 publications

(23 citation statements)

References 30 publications

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“…Additionally, a careful consideration of the global changes in the fallopian tube with STIC lesions could simplify the current protocol for pathologic examination of fallopian tubes. Since early cancer lesions are typically microscopic, entire fallopian tubes are cut into thin sections using the SEE-FIM (sectioning and extensive examination of the fimbria) dissection protocol with the distal fimbriae cut sagittally at 1 mm intervals ( 21 ). This can yield a large number of slides that need to be reviewed by a pathologist to potentially identify one section with an early cancer lesion.…”

Section: Discussionmentioning

confidence: 99%

Focal Serous Tubal Intra-Epithelial Carcinoma Lesions Are Associated With Global Changes in the Fallopian Tube Epithelia and Stroma

Raz

Recouvreux

et al. 2022

Front. Oncol.

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ObjectiveSerous tubal intra-epithelial carcinoma (STIC) lesions are thought to be precursors to high-grade serous ovarian cancer (HGSOC), but HGSOC is not always accompanied by STIC. Our study was designed to determine if there are global visual and subvisual microenvironmental differences between fallopian tubes with and without STIC lesions.MethodsComputational image analyses were used to identify potential morphometric and topologic differences in stromal and epithelial cells in samples from three age-matched groups of fallopian tubes. The Benign group comprised normal fallopian tubes from women with benign conditions while the STIC and NoSTIC groups consisted of fallopian tubes from women with HGSOC, with and without STIC lesions, respectively. For the morphometric feature extraction and analysis of the stromal architecture, the image tiles in the STIC group were further divided into the stroma away from the STIC (AwaySTIC) and the stroma near the STIC (NearSTIC). QuPath software was used to identify and quantitate secretory and ciliated epithelial cells. A secretory cell expansion (SCE) or a ciliated cell expansion (CCE) was defined as a monolayered contiguous run of >10 secretory or ciliated cells uninterrupted by the other cell type.ResultsImage analyses of the tubal stroma revealed gradual architectural differences from the Benign to NoSTIC to AwaySTIC to NearSTIC groups. In the epithelial topology analysis, the relative number of SCE and the average number of cells within SCE were higher in the STIC group than in the Benign and NoSTIC groups. In addition, aging was associated with an increased relative number of SCE and a decreased relative number of CCE. ROC analysis determined that an average of 15 cells within SCE was the optimal cutoff value indicating the presence of a STIC lesion in the tubal epithelium.ConclusionsOur findings suggest that global stromal alterations and age-associated reorganization of tubal secretory and ciliated cells are associated with STIC lesions. Further studies will need to determine if these alterations precede STIC lesions and provide permissible conditions for the formation of STIC.

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Section: Discussionmentioning

confidence: 99%

Focal Serous Tubal Intra-Epithelial Carcinoma Lesions Are Associated With Global Changes in the Fallopian Tube Epithelia and Stroma

Raz

Recouvreux

et al. 2022

Front. Oncol.

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“…The present study was not set up to assess the prevalence of STIC lesions or cancer, and a SEE‐FIM protocol is not used routinely for grossly normal tubes removed from women with no increased risk of ovarian cancer (as opposed to specimens from women with a BRCA mutation). A recent Canadian study that used the SEE‐FIM protocol found STIC in eight of 9392 women (less than 0·1 per cent) with benign diagnoses who had a normal risk of ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy

Tomasch

Lemmerer

Oswald

et al. 2020

British Journal of Surgery

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Background Most serous ovarian cancers are now understood to originate in the fallopian tubes. Removing the tubes (salpingectomy) likely reduces the risk of developing high‐grade serous ovarian cancer. Numerous gynaecological societies now recommend prophylactic (or opportunistic) salpingectomy at the time of gynaecological surgery in appropriate women, and this is widely done. Salpingectomy at the time of non‐gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer. Methods This study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. Outcome measures were rate of accomplishment of salpingectomy, time and procedural steps needed for salpingectomy, and complications. Results A total of 105 patients were included in the study. The rate of acceptance of salpingectomy was approximately 60 per cent. Salpingectomy was performed in 98 of 105 laparoscopic cholecystectomies (93·3 per cent) and not accomplished because of poor visibility or adhesions in seven (6·7 per cent). Median additional operating time was 13 (range 4–45) min. There were no complications attributable to salpingectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re‐evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma. Conclusion Prophylactic salpingectomy can be done during elective laparoscopic cholecystectomy.

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“…Indeed, of the 31 older patients, 1 was diagnosed with a stage 2 malignancy and 2 were diagnosed with STIC lesions (6.5%), which is a higher rate than 1%-2% reported STIC identification during RRSO. 15,16 Arguably, the one malignancy that may have been prevented with earlier participation in a screening program.…”

Section: Practice Implications and Research Recommendationsmentioning

confidence: 99%

Impact of a Structured Early Detection Program on Adherence to Guidelines for Risk-Reducing Surgery in BRCA1/2 Carriers

Guo

Cowan

Pyrzak

et al. 2020

Journal of Gynecologic Surgery

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Objective: To determine the proportion of women with BRCA1/BRCA2 mutations participating in an ovarian cancer screening program who adhere to National Comprehensive Cancer Network (NCCN) guidelines for riskreducing bilateral salpingo-oophorectomy (BRCA1 = 40 years, BRCA2 = 45 years). Design: Retrospective cohort study. Materials and Methods: Records were reviewed of all patients with BRCA1/BRCA2 mutations who were screened in Northwestern University's Ovarian Cancer Early Detection and Protection Program from 2002 to 2016. Exclusion criteria included a prior ovarian cancer diagnosis, oophorectomy before screening, or if visits were not recorded in the prospectively collected database. The primary endpoint was age at ovarian removal. Results: Of 134 patients identified (BRCA1, n = 83; BRCA2, n = 51), 46 patients underwent risk-reducing salpingooophorectomy (RRSO). Most surgeries (38/46, 83%) were performed by the upper limit of the mutation-specific recommended age. Of the 86 patients who have not undergone surgery, 49 patients are not yet at the recommended age for RRSO, 4 chose to continue screening, and 33 transferred care or were lost to follow-up. Patients were more likely to have prophylactic surgery by guideline-recommended age if they identified racially as white compared with non-white (odds ratio 7.5, 95% confidence interval 1.5-36.2, p = 0.02). Conclusion: More than 80% of BRCA patients in our program who obtained RRSO did so by the NCCN recommended ages. Indeed, most patients with BRCA1/BRCA2 who have not undergone surgery are still participating in the program. As more malignancy-related genes are discovered and evolving technologies developed for both genetic testing and cancer detection, screening programs may yet find a place in the management of high-risk patients. (J GYNECOL SURG 00:000).

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Population Frequency of Serous Tubal Intraepithelial Carcinoma (STIC) in Clinical Practice Using SEE-Fim Protocol

Cited by 26 publications

References 30 publications

Focal Serous Tubal Intra-Epithelial Carcinoma Lesions Are Associated With Global Changes in the Fallopian Tube Epithelia and Stroma

Focal Serous Tubal Intra-Epithelial Carcinoma Lesions Are Associated With Global Changes in the Fallopian Tube Epithelia and Stroma

Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy

Impact of a Structured Early Detection Program on Adherence to Guidelines for Risk-Reducing Surgery in BRCA1/2 Carriers

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