Thompson Claire, McCormick Ciara, Kamran Waseem, O'Riain Ciaran, Norris Lucy, Gallagher David, Gleeson Noreen
Gynaecological Oncology Department, St James's Hospital, Dublin, Ireland.
Histopathology Department, St James's Hospital, Dublin, Ireland.
Ir J Med Sci. 2018 Aug;187(3):789-794. doi: 10.1007/s11845-017-1717-6. Epub 2018 Jan 3.
High-grade serous carcinoma (HGSC) is the most common tubo-ovarian cancer. The fallopian tube harbours the precursor lesion: serous tubal intraepithelial carcinoma (STIC). Bilateral salpingo-oophorectomy is an effective risk-reducing surgical (RRS) strategy for breast cancer susceptibility gene mutation carriers (BRCAm). The value of RRS in those without defined genetic risk is unknown but these women represent a substantial cohort in prophylactic surgical practice.
This is a retrospective review of RRS at an Irish university teaching hospital.
One hundred and thirty women underwent RRS; group 1 = 46 BRCAm; group 2 = 19 BRCAm negative/65 genetic status unknown. Group 1 had one occult HGSC. Group 2 had no STIC or cancers and were older and more likely to have hysterectomy and benign pathology. Other pathologies included serous tubal intraepithelial lesions (STIL) (2), p53 signatures (2), endometriosis (6), fibroids/adenomyosis (4) and atypical endometrial hyperplasia (1).
More than 60% of women undergoing RRS were BRCAm negative or untested. Counselling of high-risk women without defined germline mutations remains a challenge for gynaecologists because the likelihood of removing STIC lesions or occult invasive cancer is low. Removal of coincidental pathology may give added value to RRS in these women.
高级别浆液性癌（HGSC）是最常见的输卵管卵巢癌。输卵管中存在前驱病变：浆液性输卵管上皮内癌（STIC）。双侧输卵管卵巢切除术是一种针对乳腺癌易感基因突变携带者（BRCAm）的有效的降低风险手术（RRS）策略。对于没有明确遗传风险的女性，RRS的价值尚不清楚，但这些女性在预防性手术实践中占相当大的比例。
这是对爱尔兰一家大学教学医院的RRS进行的回顾性研究。
130名女性接受了RRS；第1组 = 46名BRCAm携带者；第2组 = 19名BRCAm阴性/65名基因状态未知。第1组有1例隐匿性HGSC。第2组没有STIC或癌症，年龄更大，更有可能进行子宫切除术且病理结果为良性。其他病理情况包括浆液性输卵管上皮内病变（STIL）（2例）、p53特征（2例）、子宫内膜异位症（6例）、肌瘤/子宫腺肌病（4例）和非典型子宫内膜增生（1例）。
接受RRS的女性中超过60%为BRCAm阴性或未检测。对于没有明确种系突变的高危女性进行咨询，仍然是妇科医生面临的一项挑战，因为切除STIC病变或隐匿性浸润癌的可能性较低。切除合并的病理情况可能会为这些女性的RRS带来额外价值。
