Abstract
AIMS:
Evidence
indicates that most non-uterine high-grade serous carcinomas (HGSC)
arise from the fallopian tube, but approaches to primary site assignment
have not evolved to reflect this. This study aimed to assess
application of recently proposed criteria for site assignment.
METHODS AND RESULTS:
151
HGSCs from four centres were reviewed retrospectively. 63/80 (79%)
chemo-naïve (CN) and 45/71 (68%) post-neoadjuvant chemotherapy (NACT)
cases were assigned as fallopian tube (FT) primaries with the new
criteria, while 58/80 (73%) and 45/71 (63%) were considered ovarian
primaries using traditional criteria (p<0.0001). In 111 prospectively
collected HGSC's, with consistent detailed fimbrial examination, 44/53
(83%) CN and 44/58 (76%) NACT cases were assigned as FT primaries.
Reproducibility of site assignment was tested in a subset of 50 cases:
4/4 reviewing pathologists agreed on primary site in 48/50 (96%), and
3/4 in 49/50 (98%) cases. Of the 53 prospectively studied CN cases,
bilateral ovarian involvement (62%) was significantly more frequent than
bilateral tubal involvement (12%, p<0.0001), further supporting
tubal origin and ovarian metastasis in most cases.
CONCLUSIONS:
With
currently accepted protocols, the proposed guidelines are easy to apply
and result in consistent site assignment in non-uterine HGSC. Most
cases of non-uterine HGSC were considered primary FT neoplasms
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