From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center; and the Department of Urology, New York University Langone Health.
Plast Reconstr Surg. 2021 Jan 1;147(1):194-198. doi: 10.1097/PRS.0000000000007452.
Gender-affirming surgery is becoming increasingly more common. Procedures including chest masculinization, breast augmentation, vaginoplasty, metoidioplasty, and phalloplasty routinely generate discarded tissue. The incidence of finding an occult malignancy or premalignant lesion in specimens from gender-affirming surgery is unknown. The authors therefore conducted a retrospective review of all transgender patients at their institution who underwent gender-affirming surgery to determine the incidence of precancerous and malignant lesions found incidentally.
A retrospective review of transgender patients who underwent gender-affirming surgery at the authors' institution between 2017 and 2018 performed by a single plastic surgeon and a single reconstructive urologic surgeon was conducted. Only transgender patients who underwent gender-affirming surgery that led to routine pathologic review of discarded tissue (mastectomy, vaginoplasty, vaginectomy as part of phalloplasty) were included. Charts were reviewed and patient demographics, duration of hormonal therapy, medical comorbidities, genetic risk factors for cancer, medications (including steroids or other immunosuppressants), pathology reports, and cancer management were recorded.
Between 2017 and 2018, 295 transgender patients underwent gender-affirming surgery that generated discarded tissue sent for pathologic evaluation. During this period, 193 bilateral mastectomies, 94 vaginoplasties with orchiectomies, and eight vaginectomies were performed; 6.4 percent of all patients had an atypical lesion found on routine pathologic evaluation.
Gender-affirming surgery is increasingly more common given the increase in access to care. The authors' review of routine pathologic specimens generated from gender-affirming surgery yielded a 6.4 percent rate of finding atypical lesions requiring further evaluation. The authors advocate that all specimens be sent for pathologic evaluation.
性别肯定手术变得越来越普遍。包括胸部男性化、乳房增大、阴道成形术、阴蒂成形术和阴茎成形术在内的手术通常会产生废弃组织。在性别肯定手术的标本中发现隐匿性恶性肿瘤或癌前病变的发生率尚不清楚。因此，作者对他们机构中所有接受性别肯定手术的跨性别患者进行了回顾性研究，以确定偶然发现的癌前和恶性病变的发生率。
作者对 2017 年至 2018 年间在他们机构接受由一位整形外科医生和一位重建泌尿科医生进行的性别肯定手术的跨性别患者进行了回顾性研究。仅包括接受性别肯定手术导致废弃组织常规病理检查的跨性别患者（乳房切除术、阴道成形术、阴茎成形术的阴道切除术）。回顾了图表，并记录了患者的人口统计学数据、激素治疗的持续时间、医疗合并症、癌症遗传风险因素、药物（包括类固醇或其他免疫抑制剂）、病理报告和癌症管理。
2017 年至 2018 年间，295 名跨性别患者接受了性别肯定手术，产生了废弃组织进行病理评估。在此期间，进行了 193 例双侧乳房切除术、94 例伴有睾丸切除术的阴道成形术和 8 例阴道切除术；6.4%的患者在常规病理评估中发现了非典型病变。
由于获得护理的机会增加，性别肯定手术变得越来越普遍。作者对性别肯定手术产生的常规病理标本进行的回顾性分析显示，有 6.4%的标本发现需要进一步评估的非典型病变。作者主张所有标本均应进行病理评估。
