Mahe Etienne, Tang Shangguo, Deb Pratima, Sur Monalisa, Lytwyn Alice, Daya Dean
Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Int J Gynecol Pathol. 2013 Jul;32(4):353-7. doi: 10.1097/PGP.0b013e318264ae09.
Studies have suggested serous tubal intraepithelial carcinoma (STIC) of the fallopian tube to be a putative precursor to ovarian and peritoneal serous carcinoma. It has been recommended that resected fallopian tube specimens should be rigorously examined for STIC, especially in women at high risk of serous carcinoma, such as those with BRCA mutations or with a strong family history. The SEE-FIM protocol allows for the greatest surface area of the tube to be histologically assessed. There have been suggestions that multiple deeper sections should be examined if the initial hematoxylin and eosin (H&E) sections are negative; however, whether this identifies more cases of STIC has not rigorously examined. We examined deeper sections from 56 cases of pelvic carcinoma in which the initial H&E sections of the fallopian tubes were negative for STIC. All initial and deeper sections underwent consensus review by panel of experts in gynecologic pathology. These cases are part of a larger study in which we had examined 300 consecutive bilateral salpingectomies using the SEE-FIM protocol and a single-H&E section per block and had identified 68 cases of pelvic serous carcinoma, of which 12 were associated with STIC. We calculated the sensitivity of a single-H&E section to detect STIC, as compared with examination of multiple deeper sections, and reevaluated the clinicopathologic data of the parent study in light of the additional cases of STIC. In the 56 cases initially negative for STIC, 4 cases of STIC were identified after examination of multiple deeper sections of the fallopian tubes. The single-H&E section SEE-FIM approach therefore detected only 75% (95% confidence interval, 51%-90%) of STIC that was present. Three of these new cases were associated with primary ovarian serous carcinoma and 1 with primary peritoneal serous carcinoma. All 3 new cases associated with ovarian carcinoma were noted in women without neoadjuvant chemotherapy. In considering the data from the parent study, we calculated a statistically significant lower incidence of STIC in women with ovarian serous carcinoma who received neoadjuvant chemotherapy as compared with those who did not (P=0.042). Our study demonstrated that additional cases of STIC can be detected if deeper sections are examined. These additional cases also highlighted a statistically significant difference in the incidence of STIC associated with ovarian serous carcinoma who received neoadjuvant chemotherapy relative to those who did not. Consideration to this should be given in future studies of the prevalence of STIC and to routine examination of salpingectomy specimens from women at high risk for pelvic serous carcinoma.
研究表明，输卵管浆液性上皮内癌（STIC）可能是卵巢和腹膜浆液性癌的前体。建议对切除的输卵管标本进行严格检查以查找STIC，特别是在浆液性癌高危女性中，例如那些携带BRCA突变或有强烈家族病史的女性。SEE-FIM方案能够对输卵管最大表面积进行组织学评估。有人提出，如果最初的苏木精和伊红（H&E）切片为阴性，则应检查多个更深的切片；然而，这是否能发现更多STIC病例尚未经过严格检验。我们检查了56例盆腔癌病例的更深切片，这些病例的输卵管最初H&E切片未发现STIC。所有最初和更深的切片均由妇科病理学专家小组进行共识审查。这些病例是一项更大研究的一部分，在该研究中，我们使用SEE-FIM方案和每个组织块一张H&E切片检查了300例连续的双侧输卵管切除术，并识别出68例盆腔浆液性癌，其中12例与STIC相关。我们计算了与检查多个更深切片相比，单张H&E切片检测STIC的敏感性，并根据新增的STIC病例重新评估了母研究的临床病理数据。在最初STIC为阴性的56例病例中，在对输卵管多个更深切片进行检查后发现了4例STIC。因此，单张H&E切片SEE-FIM方法仅检测到了存在的STIC的75%（95%置信区间，51%-90%）。这些新增病例中的3例与原发性卵巢浆液性癌相关，1例与原发性腹膜浆液性癌相关。所有3例与卵巢癌相关的新增病例均见于未接受新辅助化疗的女性。在考虑母研究的数据时，我们计算得出，接受新辅助化疗的卵巢浆液性癌女性中STIC的发生率与未接受新辅助化疗的女性相比有统计学意义的降低（P=0.042）。我们的研究表明，如果检查更深的切片，可以发现更多STIC病例。这些新增病例还突出显示了接受新辅助化疗的卵巢浆液性癌患者与未接受新辅助化疗的患者相比，STIC发生率存在统计学意义的差异。在未来关于STIC患病率的研究以及对盆腔浆液性癌高危女性输卵管切除标本的常规检查中应考虑到这一点。
