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Poster and E-Posters
09. Prevention of gynaecologic cancer
1341 Long-term evaluation of lynch syndrome endometrial surveillance: 16 year experience at a specialist centre
  1. Malcolm Scott1,
  2. Ertan Saridogan2,
  3. Usha Menon3,
  4. Ranjit Manchanda4,5,6,
  5. Guldzhan Vorona7,
  6. Zoe Moatti8,
  7. Rupali Arora9,
  8. Nafisa Wilkinson9 and
  9. Adam N Rosenthal1,10
  1. 1Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
  2. 2Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3MRC Clinical Trials Unit at UCL, Institute of Institute of Clinical Trials and Methodology, University College London, London, UK
  4. 4Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
  5. 5Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
  6. 6Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  7. 7Whittington Health NHS Trust, London, UK
  8. 8Guys and St Thomas’ NHS Foundation Trust, London, UK
  9. 9Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
  10. 10Familial Cancer Clinic, University College London Hospitals NHS Foundation Trust, London, UK

Abstract

Introduction/Background ESMO guidance1 (2016) recommends offering annual endometrial biopsy (EB) and transvaginal ultrasound (TVS) to Lynch Syndrome (LS) women, whereas the Manchester International Consensus2 (2019) doesn’t recommend invasive testing due to a lack of evidence of benefit. A meta-analysis3 (2022) found no interval endometrial cancers (EC) with hysteroscopy and EB. University College London Hospital (UCLH) offers LS patients annual TVS, hysteroscopy, EB, and serum CA125.

Methodology Data were collected on all LS surveillance patients 1.1.2007–30.11.2023.

Results 136 women underwent 472 women screen years (WSY); mean 3.5 years/woman.

(Fig1. Table of Results)

15 asymptomatic women had screen detected pathology. 3 of 6 screen-detected EH had worse pathology in hysterectomy specimen; 1 EC, 2 AEH. Two EH didn’t undergo hysterectomy; one declined, and one was lost to follow-up. One EH and one AEH resolved prior to hysterectomy, spontaneously and with Mirena coil, respectively. An additional patient had polyps on TVS and opted for hysterectomy, with AEH in final specimen.

Eight women developed pathology <1yr of normal screen; 3 ECs had unscheduled bleeding, 5 had occult pathology in risk-reducing hysterectomy specimens.

Median intervals from normal screen to EH/AEH and EC were 3 months (range 2–6) and 9 months (range 3–11), respectively.

Overall sensitivity for pathology was 69.6% (CI 47.1–86.8%), with a negative predictive value = 98.2 (CI 96.3–99.3%). All EC were stage 1a, grade 1 endometrioid adenocarcinomas, irrespective of mode of diagnosis.

Conclusion This large study indicates:

  1. Annual hysteroscopy and EB can detect pre-cancerous lesions, sparing women a cancer diagnosis.

  2. EH in LS is associated with a high risk of concurrent worse pathology.

  3. Interval cancers occur despite annual hysteroscopy, indicating the need to develop better/less invasive surveillance tests (e.g. DNA methylation-based).

References

  1. Paluch-Shimon S, Cardoso F, Sessa C, et al. Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening [published correction appears in Ann Oncol. 2017 Jul 1;28(suppl_4):iv167-iv168]. Ann Oncol. 2016;27(suppl 5):v103-v110. doi:10.1093/annonc/mdw327.

  2. Crosbie EJ, Ryan NAJ, Arends MJ, et al. The Manchester international consensus group recommendations for the management of gynecological cancers in lynch syndrome. Genet Med. 2019;21(10):2390–2400. doi:10.1038/s41436-019-0489-y.

  3. Lim N, Hickey M, Young GP, Macrae FA, Kelly C. Screening and risk reducing surgery for endometrial or ovarian cancers in lynch syndrome: a systematic review. Int J Gynecol Cancer. 2022;32(5):646–655. Published 2022 May 3. doi:10.1136/ijgc-2021-003132.

View this table:
Abstract 1341 Table 1

https://doi.org/10.1136/ijgc-2024-ESGO.924

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