Introduction/Background Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is currently the most effective method for reducing ovarian cancer risk in patients with strong family history or BRCA mutation. Lynch syndrome patients are offered hysterectomy with bilateral salpingo-oophorectomy due to a 40–60% lifetime risk for endometrial cancer and 10–12% lifetime risk for ovarian carcinoma.

Methodology For this retrospective study at our institute, the pathology database was searched for patients that underwent RRBSO with or without hysterectomy between 2009 and 2019, with no clinical suspicion of malignancy. The ovaries and fallopian tubes were examined by sectioning and extensively examining the fimbrial end (SEE-FIM protocol). The endometrium of the hysterectomy specimens was examined in its entirety.

Results 92 patients fit the study criteria and had an age range from 35 to 77 years. 24 patients had BRCA 1 mutation, 32 had BRCA 2 mutations,1 had both BRCA1 and 2 mutations, 7 had Lynch syndrome (LS) and 28 had strong family history. We found carcinoma in 2 patients (2.2%): 1 high grade serous carcinoma and 1 endometrial endometrioid carcinoma.

There were 5 serous tubal intraepithelial carcinomas (STIC), 3 showed p53 signature and 1 non-atypical endometrial hyperplasia. Benign findings were seen in 22 patients.

Conclusion In our study, 8 patients (8.7%) had (pre)malignancy. Our data is consistent with the literature that reports an incidence of 2–10% (pre)malignancy in risk reducing surgeries. 35–45 years is deemed an appropriate age for women to be considered for risk reducing surgery but our study had a wider age range.

With lack of effective screening modality for high risk ovarian and endometrial carcinoma, our study highlights the importance of risk reducing surgery.

The SEE-FIM protocol is effective and should be routinely used. We also want to raise awareness of importance of embedding the entire endometrium in patients with increased risk of endometrial carcinoma.

Disclosure Nothing to disclose