Support of the 'fallopian tube hypothesis' in a prospective series of risk-reducing salpingo-oophorectomy specimens

Welmoed Reitsma, Geertruida H. de Bock, Jan C. Oosterwijk, Joost Bart, Harry Hollema, Marian J. E. Mourits*

*Corresponding author for this work

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Abstract

Objective: To determine the prevalence, localisation and type of occult (non) invasive cancer in risk-reducing salpingo-oophorectomy (RRSO) specimens in BRCA-mutation carriers and high-risk women from BRCA-negative families.

Methods: A consecutive series of RRSO specimens of asymptomatic, screen-negative high-risk women were prospectively collected in our tertiary multidisciplinary cancer clinic from January 2000 until March 2012. All high-risk women in this study underwent genetic testing on BRCA-mutations. The surgico-pathological protocol comprised complete resection of ovaries and fallopian tubes, transverse sectioning at 2-3 mm (sectioning and extensively examining the fimbrial end [SEE-FIM] protocol from 2006) and double independent pathology review of morphologically deviant sections.

Results: Three hundred and sixty RRSOs were performed in 188 BRCA1-carriers, 115 BRCA2-carriers and 57 BRCA-negative women at a median age of 44.0 years. Four occult invasive cancers were detected in BRCA-carriers (1.3%, 95%-confidence interval (CI) 0.03-2.61), all in BRCA1-carriers >40 years of age. All cancers, of which two tubal and two ovarian cancers, were FIGO-stage I/II. Three non-invasive serous intraepithelial carcinomas (STICs) were detected in BRCA-carriers (1.0%, 95%-CI 0.00-2.10). In BRCA-negative women one STIC was found (1.8%, 95%-CI 0.00-5.16), however she carried an unclassified variant in BRCA2. Total follow-up after RRSO was 1691 woman-years, in which one BRCA1-carrier developed peritoneal cancer (0.3%, 95%-CI 0.00-0.82).

Conclusions: A low prevalence of occult invasive cancer (1.1%) was found in young asymptomatic, screen-negative women at increased ovarian cancer risk undergoing RRSO. This study adds to the advice to perform RRSO in BRCA1-carriers before the age of 40. Our findings support the hypothesis of the fallopian tube as the primary site of origin of pelvic high-grade serous cancer. (C) 2012 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)132-141
Number of pages10
JournalEuropean Journal of Cancer
Volume49
Issue number1
DOIs
Publication statusPublished - Jan-2013

Keywords

  • Risk-reducing salpingo-oophorectomy
  • BRCA
  • Occult carcinoma
  • Serous tubal intraepithelial carcinoma
  • BRCA1/2 MUTATION CARRIERS
  • GERM-LINE MUTATION
  • OVARIAN-CANCER
  • PROPHYLACTIC OOPHORECTOMY
  • INTRAEPITHELIAL CARCINOMA
  • FAMILY-HISTORY
  • WOMEN
  • SURGERY
  • METAANALYSIS
  • REDUCTION

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