Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy.
OBJECTIVE
Women who carry deleterious mutations of BRCA1 or BRCA2 genes have up to a 54% lifetime risk of developing ovarian cancer. After childbearing, women at high risk increasingly choose bilateral risk-reducing salpingo-oophorectomy (RRSO). Two recent studies of BRCA mutation carriers reported occult malignancy in 2.5% of women undergoing RRSO. This study aimed to increase this detection rate using a protocol.


METHODS
In 1996, the University of California San Francisco Gynecologic Oncology Program instituted a surgical-pathologic RRSO protocol that was composed of complete removal and serial sectioning of both ovaries and fallopian tubes, peritoneal and omental biopsies, and collection of peritoneal washings for cytology. We report the pathologic findings in 67 BRCA mutation carriers according to the degree of adherence to this protocol.


RESULTS
Of the 67 procedures, the protocol was followed completely or partially in 41 (61%). Seven occult malignancies were discovered, four in the fallopian tube and three in the ovaries. Six of these were microscopic, and all seven (17%) were found in specimens from complete or partial protocol procedures as opposed to standard procedures (P = .026). Other variables such as age, parity, BRCA1 or BRCA2 mutation, or type of surgery did not alter the strong effect of protocol procedure on the cancer detection rate.


CONCLUSIONS
A rigorous operative and pathologic protocol for RRSO increases the detection rate of occult ovarian malignancy in BRCA mutation carriers nearly seven-fold. If confirmed, this finding will alter postoperative management because additional staging, chemotherapy, and follow-up may be necessary in affected women.
Powell
C Bethan
CB
Gynecologic Oncology Program and Cancer Risk Program, University of California San Francisco Comprehensive Cancer Center, 2340 Sutter Street, Room N424, San Francisco, CA 94143, USA.
Kenley
Eric
E
Chen
Lee-May
LM
Crawford
Beth
B
McLennan
Jane
J
Zaloudek
Charles
C
Komaromy
Miriam
M
Beattie
Mary
M
Ziegler
John
J
D000328:Adult; D005185:Fallopian Tube Neoplasms / Q000473:pathology*; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000473:pathology*; D010052:Ovariectomy; D010534:Peritoneal Neoplasms / Q000473:pathology