Sectioning Spots Malignancy After Salpingo-Oophorectomy

NEW YORK JAN 27, 2005 (Reuters Health) - Use of a rigorous operative and pathological protocol in BRCA mutation carriers who undergo bilateral risk-reducing salpingo-oophorectomy (RRSO) increases the rate of occult ovarian malignancy detection, according to the results of a small study reported in the January 1st issue of the Journal of Clinical Oncology.

Dr. John L. Ziegler of the University of California San Francisco Comprehensive Cancer Center, and colleagues note that women with deleterious mutation of BRCA1 or BRCA2 genes are at increased risk of ovarian cancer and after childbearing may elect to undergo RRSO.

Recent studies have reported occult malignancy in 2.5% of such women. To increase the detection rate, the researchers adopted a protocol that included complete removal and serial sectioning of both ovaries and fallopian tubes, as well as biopsies and cytological examination of peritoneal washings.

In 41 women who underwent RRSO, the protocol was followed completely or partially and revealed seven occult malignancies (17%), of which six were microscopic. All were found due to protocol-associated procedures, not standard procedures.

Moreover, other factors such as age, parity, mutation type and surgery "did not alter the strong effect of the protocol on cancer detection," the researchers report.

Should these results be confirmed, they conclude, "additional staging, chemotherapy, and follow-up may be necessary in affected women."

SOURCE:

• Journal of Clinical Oncology 2005;23:127-132.