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Incidence and Characteristics of Unsuspected Neoplasia Discovered in High-Risk Women Undergoing Risk Reductive Bilateral Salpingooophorectomy
  1. Carolin Poon, MBBS, BMedSci, MRANZCOG,
  2. Simon Hyde, MBBS, FRCOG, FRANZCOG, CGO,
  3. Peter Grant, MBBS, FRANZCOG, CGO, FRCS,
  4. Marsali Newman, MBBS, BMedSci, FRCPA and
  5. Kerryn Ireland Jenkin, MBBS, FRCPA, MIAC, GAICD
  1. * Department of Gynaecology Oncology, Mercy Hospital for Women; and
  2. Department of Anatomical Pathology, Austin Hospital, Melbourne, Australia.
  1. Address correspondence and reprint requests to Carolin Poon, MBBS, BMedSci, MRANZCOG, Department of Gynaecology Oncology, The Mercy Hospital for Women, 163 Studley Road, Heidelberg 3084, Australia. E-mail: Carolin.poon{at}gmail.com.

Abstract

Objective Risk reducing salpingooophorectomy is recommended to women with a BReast CAncer susceptibility gene (BRCA) 1 or 2 germline mutation to reduce the risk of ovarian cancer. The incidence of unsuspected neoplasia varies in the literature. The purpose of this study was to identify the rate of unsuspected neoplasia in a high-risk Australian population, discuss their management, and assess the clinical outcome.

Method This is a retrospective review of all women undergoing risk reductive salpingooophorectomy between January 2006 and December 2014. The medical, operative, and pathology results were reviewed. The specimens were assessed using the Sectioning and Extensively Examining the Fimbriated End protocol to the fallopian tube, and the ovary was also examined using 2 to 3 mm sectioning.

Results During the study period, 138 patients underwent risk-reducing salpingooophorectomy for a known BRCA 1 or 2 germline mutation or a high-risk personal or family history of ovarian cancer. Five patients with neoplasia were identified, 2 with invasive tubal carcinoma and 3 with serous tubal intraepithelial carcinoma (STIC), giving an overall incidence of 3.62%. Invasive tubal carcinoma occurred in 1 woman with a BRCA 1 mutation and 1 woman with a BRCA 2 mutation. The incidence of carcinoma in women with either a BRCA 1 or 2 germline mutation was subsequently 2.78%. STIC occurred in 2 women with a BRCA 1 germline mutation and 1 woman carrying a BRCA 2 germline mutation. The incidence of STIC in women with either a BRCA 1 or 2 germline mutation was subsequently 4.17%. Of the patients with STIC, all 3 remain disease free at an average follow-up period of 79.33 months.

Conclusions In this retrospective review, we found the incidence of neoplasia within a high-risk Australian population undergoing risk-reducing bilateral salpingo-oophorectomy to be 3.62%. The incidence of STIC was 2.17%. During our follow-up period, all patients with STIC remained disease free.

  • Risk reductive bilateral salpingooophorectomy
  • BRCA 1
  • BRCA 2
  • Ovarian carcinoma
  • Fallopian tube carcinoma
  • Serous tubal intraepithelial carcinoma

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Footnotes

  • The authors declare no conflicts of interest.

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