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abstract
Accumulating recent evidence suggests that the majority
of extrauterine high-grade serous carcinomas (HGSCs) do not arise from
the ovary as historically accepted but from the distal, fimbrial end of
the fallopian tube from a precursor known as serous tubal
intraepithelial carcinoma. There has been variable acceptance of this
evidence among pathologists and clinicians dealing with "ovarian" cancer
and this has resulted in wide variation in the assignment of primary
site between different institutions when HGSC involves >1 anatomic
site. This has obvious implications for cancer epidemiology,
registration, and entry into clinical trials. We undertook a survey of
members of several national and international gynecologic pathology and
clinical cancer societies with a view to ascertaining the degree of
acceptance of the fallopian tube origin of extrauterine HGSC and to
explore various aspects regarding site assignment, pathologic sampling,
diagnosis, FIGO staging, and reporting of these neoplasms. The results
indicate wide acceptance among both pathologists and clinicians of the
fallopian tube theory of origin of HGSC (86% pathologists, 92%
clinicians), although there is significant variation regarding the
perceived importance of assigning a primary site given the limited
prognostic and therapeutic significance. Interestingly, clinicians feel
it is more important to assign a primary site than pathologists (71% vs.
49%). The survey also indicates widespread acceptance of recently
proposed criteria for site assignment in extrauterine HGSC.
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