Sectioning and extensively examining the fimbriated end (SEE-FIM) of the fallopian tube in routine practices, is it worth the effort?

Abstract

Aim: To determine the prevalence of fallopian tube high-grade serous carcinoma (HGSC) and to analyze the benefit of the sectioning and extensively examining the fimbriated end (SEE-FIM) protocol.

Methods: Fallopian tubes from 450 patients with risk-reducing salpingo-oophorectomy, or tumor of the ovary, endometrium, fallopian tube or peritoneum were examined using the SEE-FIM protocol. Microscopic tubal pathology and the number of paraffin blocks used were evaluated. Immunostaining for p53 was performed to confirm TP53 mutation. Cost effectiveness was determined by equation of incremental cost-effectiveness ratio.

Results: Tubal HGSC were detected in 25 out of 70 cases of pelvic extrauterine HGSC, in 1 case of endometrioid carcinoma, and 4 cases of uterine serous carcinoma out of 250 cases of endometrial neoplasm. The mean number of tissue blocks per case was 6. The incremental cost for detecting one case of coexisting fallopian tube HGSC in the study population was 94 Thai baht/3 USD per case.

Conclusion: The SEE-FIM protocol facilitates identification of lesions that are not distinguishable by classical sampling protocol, and this results in more accurate tumor staging and a better understanding of the carcinogenesis. The benefit of the SEE-FIM protocol was demonstrated, especially in cases at high risk for coexisting fallopian tube carcinoma.

Keywords: fallopian tube; sectioning and extensively examining the fimbriated end; serous carcinoma; serous tubal intraepithelial carcinoma; serous tubal intraepithelial lesion.