Ayres Chloe, Ratnayake Gayanie, McNally Orla, Quinn Michael
Departments of *Gynaecological Oncology and †Anatomical Pathology, The Royal Women's Hospital, Parkville, Australia.
Int J Gynecol Cancer. 2017 May;27(4):703-707. doi: 10.1097/IGC.0000000000000954.
Opportunistic bilateral salpingectomy is now promoted for women at the time of hysterectomy for a benign disease, consequent to the fimbrial end of the fallopian tube emerging as the primary site for carcinogenesis in high-grade serous carcinomas. In high-risk women with an identified germ line mutation, bilateral salpingo-oophorectomy offers the greatest risk reduction for ovarian cancer. Currently, no prospective evidence exists with respect to the effectiveness of opportunistic salpingectomy alone in preventing ovarian cancer. Although it is thought that there is no direct connection between the ovary and its adjacent fallopian tube, we often find remnants of the fimbria adherent to the ovary at the time of surgery. If this tubo-ovarian interface is not separate, then practices such as salpingectomy and radical fimbriectomy may be incomplete, and the effectiveness of this technique as a prophylactic strategy may need reconsideration. We aimed to establish whether there might exist a direct attachment of the fimbria to the ovary by examining this interface in surgically removed specimens.
The tubes and ovaries of 20 women undergoing risk-reducing salpingo-oophorectomy were examined using the Sectioning and Extensively Examining the Fimbriated End of the Tubes protocol and p53 immunohistochemistry for lesions suspicious of serous intraepithelial tubal carcinoma.
Three specimens showed fimbria adherent to the ovary at the histopathological analysis. One p53 signature was identified, but there were no occult cancers or serous intraepithelial tubal carcinomas.
Although only a small study, the findings show that microscopic fimbriae are adherent to the ovary. This relationship challenges the recommendation for bilateral salpingectomy alone for risk-reducing surgery because the primary site of carcinogenesis may be left on the ovary to later develop into a high-grade serous carcinoma. A larger study is needed to assess our findings related to the tubo-ovarian interface and its implications for long-term ovarian cancer development. Until then, caution on using this technique alone in the high-risk patient should be adopted.
鉴于输卵管伞端已成为高级别浆液性癌的主要致癌部位，目前提倡在因良性疾病行子宫切除术时对女性进行机会性双侧输卵管切除术。对于已确定存在种系突变的高危女性，双侧输卵管卵巢切除术可最大程度降低卵巢癌风险。目前，尚无关于单纯机会性输卵管切除术预防卵巢癌有效性的前瞻性证据。尽管人们认为卵巢与其相邻的输卵管之间没有直接联系，但我们在手术时经常发现伞端残端附着于卵巢。如果这种输卵管 - 卵巢界面未分离，那么诸如输卵管切除术和根治性伞端切除术等操作可能并不彻底，作为一种预防策略，该技术的有效性可能需要重新考量。我们旨在通过检查手术切除标本中的这个界面，确定伞端与卵巢之间是否可能存在直接附着。
对20例行降低风险的输卵管卵巢切除术的女性的输卵管和卵巢，采用“输卵管伞端切片及广泛检查”方案及p53免疫组织化学方法，检查是否存在可疑浆液性输卵管上皮内癌的病变。
组织病理学分析显示，3个标本的伞端附着于卵巢。发现1个p53特征，但未发现隐匿性癌症或浆液性输卵管上皮内癌。
尽管只是一项小型研究，但结果表明显微镜下可见伞端附着于卵巢。这种关系对仅行双侧输卵管切除术作为降低风险手术的建议提出了挑战，因为致癌的原发部位可能留在卵巢上，随后发展为高级别浆液性癌。需要开展更大规模的研究来评估我们与输卵管 - 卵巢界面相关的研究结果及其对卵巢癌长期发展的影响。在此之前，对于高危患者单独使用该技术应谨慎。
