Predictors of occult neoplasia in women undergoing risk-reducing salpingo-oophorectomy.
OBJECTIVE
The purpose of this study was to define the rate of neoplasia in prophylactic surgical specimens with the use of a careful surgical and pathologic protocol in a prospective study of high-risk women who were undergoing risk-reducing salpingo-oophorectomy. Outcomes of interest were neoplasia that was identified in surgical specimens and clinical outcomes of women who were undergoing risk-reducing salpingo-oophorectomy. We hypothesized that older age and having a BRCA1 mutation would be predictors for tubal or ovarian neoplasia and that a careful surgical and pathologic protocol would lead to a low rate of subsequent primary peritoneal cancer.


METHODS
A prospective tissue and research database enrolled patients who underwent risk-reducing salpingo-oophorectomy for prevention of ovarian cancer. Clinical and pathologic data were extracted for those patients after the initiation of a defined surgical and pathologic protocol in 1999.


RESULTS
One hundred thirteen women met the high-risk criteria; 40 of the women (45%) who were tested had a deleterious mutation in BRCA1, and 22 women (25%) had a mutation in BRCA2. Seven women had ovarian or tubal neoplasia (6.2%). One woman had occult endometrial cancer. Age > or =45 years and having a BRCA1 or BRCA2 mutation were significant predictors of occult neoplasia. Two patients with neoplasia that was identified at risk-reducing salpingo-oophorectomy experienced recurrence. Three patients with BRCA1 mutations have subsequent new diagnoses of breast cancer. No patients had primary peritoneal cancer after risk-reducing salpingo-oophorectomy.


CONCLUSIONS
Age > or =45 years and mutations in BRCA1 or BRCA2 predict occult neoplasia in women who undergo risk-reducing salpingo-oophorectomy. A thorough pathologic and surgical protocol at the time of risk-reducing salpingo-oophorectomy may improve the risk of subsequent primary peritoneal cancer.
Lamb
Julie D
JD
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195-6460, USA.
Garcia
Rochelle L
RL
Goff
Barbara A
BA
Paley
Pamela J
PJ
Swisher
Elizabeth M
EM
D000328:Adult; D000368:Aged; D000375:Aging; D003949:Diagnostic Techniques, Surgical; D016889:Endometrial Neoplasms / Q000235:genetics; D005185:Fallopian Tube Neoplasms / Q000235:genetics; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D016147:Genes, Tumor Suppressor; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009154:Mutation; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy; D011446:Prospective Studies