Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study
To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO.
Materials and methods
BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals.
A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3–92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1).
The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery.
KeywordsBRCA Risk reduction salpingo-oophorectomy Serous tubal intraepithelial carcinoma Ovarian cancer Primary peritoneal carcinoma
The authors want to thank Lara Vargas, MD (Gynecology Department, Sanatorio Allende, Córdoba, Argentina) for her contribution in the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that there are no conflicts of interest.
The study was previously approved by the Internal Review Board in accordance with the ethical standards of the Helsinki Declaration of 1975, revised in 1983.
For this type of study formal consent was not required.
- 8.National Comprehensive Cancer Network (NCCN). Genetic/familial high-risk assessment: breast and ovarian. https://www.nccn.org/store/login/login.aspx?. https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed Jan 2018.
- 10.College of American Pathologists. Protocol for the examination of specimens from patients with carcinoma of the fallopian tube. http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/fallopiantube-15protocol-3102.pdf. Accessed 10 March 2018.
- 16.Rebbeck TR, Friebel T, Wagner T, Lynch HT, Garber JE, Daly MB, et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2005;23(31):7804–10.CrossRefPubMedGoogle Scholar
- 23.Powell CB, Chen LM, McLennan J, Crawford B, Zaloudek C, Rabban JT, et al. Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer. 2011;21(5):846–51.CrossRefPubMedGoogle Scholar
- 24.The Pelvic-Ovarian Cancer Interception (POINT) Project. http://www.bwhpathology.org/POINT/point_purpose.aspx. Accessed Jan 2018.