Risk-reducing Salpingo–Oophorectomy in Women at Higher Risk of Ovarian and Breast Cancer: A Single Institution Prospective Series

Ricciardi, Enzo; Tomao, Federica; Aletti, Giovanni; Bazzurini, Luca; Bocciolone, Luca; Boveri, Sara; Landoni, Fabio; Lapresa, Maria Teresa; Maruccio, Matteo; Parma, Gabriella; Peccatori, Fedro Alessandro; Petrella, Maria Cristina; Zanagnolo, Vanna; Colombo, Nicoletta; Maggioni, Angelo

doi:10.21873/anticanres.11948

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…According to the available literature, the prevalence of occult cancer found after RRSO varies from 2% to 17%. [13][14][15][16][17][18][19][20][21][22]28 In our study, the prevalence of occult cancer in BRCA1/2 positive women was 5.5%, which is similar to what Conner et al have found. 29 We detected fewer occult cancers than Powell et al who reported a rate of 7.9% and more than Reitsma et al (2.2%) and Finch et al (4.2%).…”

Section: Discussionsupporting

confidence: 91%

“…Occult cancers have been reported to occur between 2% and 17% and STICs between 3% and 12%, respectively. [13][14][15][16][17][18][19][20][21][22] The occult cancer detection is probably influenced by the age at RRSO, gynaecological screening prior to RRSO, extent of the surgical removal of specimens and the accuracy of tubal pathohistological assessment. It is known that the protocol for sectioning and extensively examining the fimbriated end of the Fallopian tube (SEE-FIM) enables a more exact histopathological examination of the distal tube with its fimbrial part.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients – Slovenian population based study

Gornjec

Merlo

Novaković

et al. 2020

Radiology and Oncology

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BackgroundWe assessed the prevalence, localization, type and outcome of occult cancer at risk-reducing salpingo-oophorectomy or salpingectomy (RRSO) in asymptomatic carriers of pathogenic or likely pathogenic BRCA1/2 variants and high-risk BRCA1/2 negative women.Patients and methodsA retrospective analysis of all consecutive gynaecologic preventive surgeries from January 2009 to December 2015 was performed. Participants underwent genetic counselling and BRCA1/2 testing before the procedure. Data on clinical parameters, adjuvant treatment and follow-up were collected and analysed.ResultsOne hundred and fifty-five RRSO were performed in 110 BRCA1, 35 BRCA2 carriers of pathogenic or likely pathogenic variants and 10 high-risk BRCA1/2 negative women, at the mean age of 48.3 years. Nine occult cancers (9/155, 5.8%) were identified; eight in BRCA1 positive women and one in high-risk BRCA1/2 negative woman. We identified four non-invasive serous intraepithelial tubal carcinomas (3 in BRCA1 carriers and 1 in a high-risk BRCA1/2 negative woman) and five invasive tubo-ovarian high grade serous cancers (all detected in BRCA1 carriers). Only one out of nine patients (11.1%) with occult cancer had a slightly elevated CA-125 value preoperatively.ConclusionsA 5.8% prevalence of occult invasive and noninvasive tubo-ovarian serous cancer after RRSO was found in high risk asymptomatic and screen negative women. We conclude that RRSO should be performed in BRCA1/2 carriers and in high-risk BRCA1/2 negative women. Age of preventive gynaecologic surgery should be carefully planned, taking into account the completion of childbearing age and type of mutation. The results favour the tubal hypothesis of tubal origin of high grade serous ovarian and peritoneal cancer. Cytology result of peritoneal cavity washing was important for the decision making process in determining treatment. Cytology examination should be performed in all cases of RRSO. CA-125 assay did not prove to be an effective screening tool for early cancer detection in our patients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients – Slovenian population based study

Gornjec

Merlo

Novaković

et al. 2020

Radiology and Oncology

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“…Nonetheless, all the biopsies we performed in patients diagnosed with STIC as well as invasive cancers were negative for the presence of neoplastic cells, suggesting that peritoneal staging might be a surgical overtreatment. It should be underlined that we found a low rate of STIC compared with other previously reported [20] albeit the Sectioning and Extensively Examining the Fimbriated End Protocol was applied [21], but other papers describe the same percentage [15,16,20]; additionally, the median age of our study population is lower than that reported in those cases with higher STIC rates.…”

Section: Discussioncontrasting

confidence: 66%

“…Nonetheless, the incidence of occult malignancies or STIC reported in the literature is highly variable and is influenced by several factors, including patients' age at surgery, adequacy of preoperative work-up and accuracy of histopathological examination [15,16]. Moreover, there is heterogeneity in study design: most of them are retrospective and without standardization of the surgical and pathological procedures [17,18]; furthermore, some studies include both BRCA mutation carriers and wild-type BRCA patients at high risk based on family or personal history.…”

Section: Introductionmentioning

confidence: 99%

Risk reducing surgery with peritoneal staging in BRCA1-2 mutation carriers. A prospective study

Marchetti

Arcieri

Vertechy

et al. 2022

European Journal of Surgical Oncology

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“…P53 signatures are reported on by six studies, with an estimated incidence of 16.2% (95% CI, 2.2-39.7) [16,20,25,27,40,47]. Finally, STIL was reported on by six studies and has an estimated incidence of 1.6% (95% CI, 0.3-3.8) [16,26,27,44,47,55].…”

Section: Study Characteristicsmentioning

confidence: 98%

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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Risk-reducing Salpingo–Oophorectomy in Women at Higher Risk of Ovarian and Breast Cancer: A Single Institution Prospective Series

Cited by 9 publications

References 26 publications

The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients – Slovenian population based study

The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients – Slovenian population based study

Risk reducing surgery with peritoneal staging in BRCA1-2 mutation carriers. A prospective study

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

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