abstract:
Incidence and Characteristics of Unsuspected Neoplasia Discovered in High-Risk Women Undergoing Risk Reductive Bilateral Salpingooophorectomy
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.
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