title: Diathermy-induced injury may affect detection of occult tubal lesions at risk-reducing salpingo-oophorectomy.
abstract: BACKGROUND
  Electrosurgery-induced tubal thermal injury obscures cellular detail and hampers histomorphological assessment for occult pathology.
  
  
  OBJECTIVE
  The objectives of this study were to report on diathermy-related thermal injuries to the fallopian tube observed at RRSO and explore its potential impact on the detection of occult tubal epithelial lesions.
  
  
  METHODS
  This study was composed of high-risk women from breast and/or ovarian cancer families attending a tertiary high-risk familial gynecologic cancer clinic. This was a retrospective case-control analysis of high-risk women who underwent RRSO. Cases were all women detected to have occult lesions (tubal atypia/carcinoma in situ/cancer) between January 2005 and December 2010. Control subjects were all women with normal tubal/ovarian histology between August 2006 and December 2007.
  
  
  METHODS
  Two pathologists performed histopathologic assessment for grade of thermal injury. Tubal diathermy injury rates were compared between cases and controls. Statistical analysis was undertaken using SPSS version 18. The Mann-Whitney U test compared age distributions; χ/Fisher tests, the difference between proportions, and γ test, the difference in ordinal variables between the groups.
  
  
  RESULTS
  A novel tubal thermal index to describe the severity of injury is reported. Lack of fimbrial thermal injury is twice as likely (odds ratio, 2.04; 95% confidence interval, 1.06-3.92) to be associated with detection of occult tubal pathology, whereas isthmic injury does not affect detection rate (P = 0.744). The groups were comparable with respect to age at RRSO (P = 0.531) and the presence of BRCA mutations (P = 0.192).
  
  
  CONCLUSIONS
  This report highlights the potential impact of electrosurgical thermal injury on detection of occult tubal pathology following RRSO. It is important for surgeons to avoid thermal injury to the distal end of the tube.
authors.affiliation: Department of Gynaecological Oncology, EGA Institute for Women's Health, Cancer Institute, University College London, London. r.manchanda@ucl.ac.uk
authors.forename: Ranjit
authors.initials: R
authors.lastname: Manchanda
authors.forename: Anna
authors.initials: A
authors.lastname: Silvanto
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelraheim
authors.forename: Matthew
authors.initials: M
authors.lastname: Burnell
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
authors.forename: Ertan
authors.initials: E
authors.lastname: Saridogan
authors.forename: Adam N
authors.initials: AN
authors.lastname: Rosenthal
authors.forename: Carol
authors.initials: C
authors.lastname: Brunell
authors.forename: Naaila
authors.initials: N
authors.lastname: Aslam
authors.forename: Arvind
authors.initials: A
authors.lastname: Vashisht
authors.forename: George
authors.initials: G
authors.lastname: Pandis
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000601:surgery*; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D003972:Diathermy / Q000009:adverse effects*; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000235:genetics / Q000601:surgery*; D010052:Ovariectomy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors