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Support of the 'fallopian tube hypothesis' in a prospective series of risk-reducing salpingo-oophorectomy specimens

By Welmoed Reitsma, Geertruida H. de Bock, Jan C. Oosterwijk, Joost Bart, Harry Hollema and Marian J. E. Mourits

Abstract

<p>Objective: To determine the prevalence, localisation and type of occult (non) invasive cancer in risk-reducing salpingo-oophorectomy (RRSO) specimens in BRCA-mutation carriers and high-risk women from BRCA-negative families.</p><p>Methods: A consecutive series of RRSO specimens of asymptomatic, screen-negative high-risk women were prospectively collected in our tertiary multidisciplinary cancer clinic from January 2000 until March 2012. All high-risk women in this study underwent genetic testing on BRCA-mutations. The surgico-pathological protocol comprised complete resection of ovaries and fallopian tubes, transverse sectioning at 2-3 mm (sectioning and extensively examining the fimbrial end [SEE-FIM] protocol from 2006) and double independent pathology review of morphologically deviant sections.</p><p>Results: Three hundred and sixty RRSOs were performed in 188 BRCA1-carriers, 115 BRCA2-carriers and 57 BRCA-negative women at a median age of 44.0 years. Four occult invasive cancers were detected in BRCA-carriers (1.3%, 95%-confidence interval (CI) 0.03-2.61), all in BRCA1-carriers >40 years of age. All cancers, of which two tubal and two ovarian cancers, were FIGO-stage I/II. Three non-invasive serous intraepithelial carcinomas (STICs) were detected in BRCA-carriers (1.0%, 95%-CI 0.00-2.10). In BRCA-negative women one STIC was found (1.8%, 95%-CI 0.00-5.16), however she carried an unclassified variant in BRCA2. Total follow-up after RRSO was 1691 woman-years, in which one BRCA1-carrier developed peritoneal cancer (0.3%, 95%-CI 0.00-0.82).</p><p>Conclusions: A low prevalence of occult invasive cancer (1.1%) was found in young asymptomatic, screen-negative women at increased ovarian cancer risk undergoing RRSO. This study adds to the advice to perform RRSO in BRCA1-carriers before the age of 40. Our findings support the hypothesis of the fallopian tube as the primary site of origin of pelvic high-grade serous cancer. (C) 2012 Elsevier Ltd. All rights reserved.</p>

Topics: Risk-reducing salpingo-oophorectomy, BRCA; Occult carcinoma; Serous tubal intraepithelial carcinoma; BRCA1/2 MUTATION CARRIERS; GERM-LINE MUTATION; OVARIAN-CANCER; PROPHYLACTIC OOPHORECTOMY; INTRAEPITHELIAL CARCINOMA; FAMILY-HISTORY; WOMEN; SURGERY; METAANALYSIS; REDUCTION
Year: 2013
DOI identifier: 10.1016/j.ejca.2012.07.021
OAI identifier: oai:pure.rug.nl:publications/4f3e9a6f-d808-4469-b8e6-5d6321ea06d6
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