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Diathermy-Induced Injury May Affect Detection of Occult Tubal Lesions at Risk-Reducing Salpingo-Oophorectomy
  1. Ranjit Manchanda, MD, MRCOG*,
  2. Anna Silvanto, MBBS, BSc,
  3. Ahmed Abdelraheim, MRCOG,§,
  4. Matthew Burnell, PhD*,
  5. Michelle Johnson, MSc*,
  6. Ertan Saridogan, FRCOG,
  7. Adam N. Rosenthal, MRCOG, PhD*,,
  8. Carol Brunell, MD,
  9. Naaila Aslam, MRCOG,
  10. Arvind Vashisht, MRCOG,
  11. George Pandis, MRCOG,
  12. Ian Jacobs, FRCOG, MD*,#,
  13. Usha Menon, FRCOG, MD* and
  14. Elizabeth Benjamin, MD
  1. *Department of Gynaecological Oncology, EGA Institute for Women’s Health, and
  2. Department of Pathology, Cancer Institute, University College London;
  3. Barts Cancer Institute, Barts and the London School of Medicine and Dentistry;
  4. §Department of Obstetrics and Gynaecology, ElMinia University Hospitals, El Minia, Egypt; Departments of
  5. Gynaecology and
  6. Radiology University College London Hospital, London; and
  7. #Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
  1. Address correspondence and reprint requests to Ranjit Manchanda, MD, MRCOG, Gynaecological Cancer Research Centre, EGA Institute for Women’s Health, University College London, First floor, Maple House, 149 Tottenham Court Road, London W1T 7NF. E-mail: r.manchanda@ucl.ac.uk.

Abstract

Background Electrosurgery-induced tubal thermal injury obscures cellular detail and hampers histomorphological assessment for occult pathology.

Objective The objectives of this study were to report on diathermy-related thermal injuries to the fallopian tube observed at RRSO and explore its potential impact on the detection of occult tubal epithelial lesions.

Design This study was composed of high-risk women from breast and/or ovarian cancer families attending a tertiary high-risk familial gynecologic cancer clinic. This was a retrospective case-control analysis of high-risk women who underwent RRSO. Cases were all women detected to have occult lesions (tubal atypia/carcinoma in situ/cancer) between January 2005 and December 2010. Control subjects were all women with normal tubal/ovarian histology between August 2006 and December 2007.

Methods Two pathologists performed histopathologic assessment for grade of thermal injury. Tubal diathermy injury rates were compared between cases and controls. Statistical analysis was undertaken using SPSS version 18. The Mann-Whitney U test compared age distributions; χ2/Fisher tests, the difference between proportions, and γ test, the difference in ordinal variables between the groups.

Results A novel tubal thermal index to describe the severity of injury is reported. Lack of fimbrial thermal injury is twice as likely (odds ratio, 2.04; 95% confidence interval, 1.06–3.92) to be associated with detection of occult tubal pathology, whereas isthmic injury does not affect detection rate (P = 0.744). The groups were comparable with respect to age at RRSO (P = 0.531) and the presence of BRCA mutations (P = 0.192).

Conclusions This report highlights the potential impact of electrosurgical thermal injury on detection of occult tubal pathology following RRSO. It is important for surgeons to avoid thermal injury to the distal end of the tube.

  • Risk-reducing salpingo-oophorectomy
  • Diathermy
  • Electrosurgery
  • Thermal injury
  • Tubal injury
  • Occult pathology
  • Fallopian tube
  • BRCA
  • Fimbrial

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Footnotes

  • R.M., and A.S., U.M., and E.B. contributed equally to this work.

  • I.J. has consultancy arrangements with Becton Dickinson, who have an interest in tumor markers and ovarian cancer. I.J. and U.M. have a financial interest in Abcodia, Ltd, a company formed to develop academic and commercial development of biomarkers for screening and risk prediction. I.J. is a member of the board of Abcodia Ltd and Women’s Health Specialists Ltd. A.N.R. has received honoraria from Fujirebio Diagnostics for giving lectures and attending meetings on the use of biomarkers in ovarian cancer management, but none were directly related to this work. E.S. received honoraria from Ethicon for provision of training to health care professionals; this was not related to this work. The other authors declare no conflict of interest.

  • R.M., A.S., and A.A. were involved in initial data collection. R.M. and U.M. were involved in analysis, drafting, and writing of the paper. A.S. and E.B. reviewed the histological specimens and contributed to the histopathologic sections described in the manuscript. R.M. and M.B. performed the statistical analysis and contributed to writing the statistical sections of the manuscript. I.J., A.N.R., E.S., A.A., M.J., C.B., G.P., N.A., and A.V. contributed to writing of the manuscript. U.M., I.J., A.N.R., R.M., C.B., E.S., G.P., N.A., and A.V. were responsible for the clinical care of the patients. The final draft was prepared by R.M. and U.M. and approved by the others.

  • The project was referred to the Chair of the Research Ethics committee (National Hospital for Neurology and Neurosurgery & institute of Neurology Joint REC, reference no. 07L 173). Under the Research Governance Framework, the project was deemed to be a clinical audit, and permission for data analysis and submission for publication was given.

  • This work has not been directly funded by any commercial organization, charity, or other sources. A large portion of this work was done at University College London Hospital/University College London within the “women’s health theme” of the NIHR University College London Hospital/University College London Comprehensive Biomedical Research Centre supported by the Department of Health.

  • This work is original and not under consideration for publication anywhere else, either whole or in part (except in abbreviated form as a communication or abstract). All the authors have contributed substantially to this article and have approved the final version of the manuscript. The corresponding author of this article has the right to grant on behalf of all authors and does grant on behalf of all authors a license to the International Journal of Gynecological Cancer and its licensees, to permit this article (if accepted) to be published in the International Journal of Gynecological Cancer.

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