Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation

J Gynecol Obstet Hum Reprod. 2023 Oct;52(8):102642. doi: 10.1016/j.jogoh.2023.102642. Epub 2023 Aug 11.

Abstract

Objective: Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients.

Material and methods: We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022.

Inclusion criteria: BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination.

Exclusion criteria: patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer.

Results: A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation.

Conclusion: The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.

Keywords: BRCA 1/2; Ovarian carcinoma; Risk reducing salpingo-oophorectomy; Serous tubal intraepithelial carcinoma.

MeSH terms

  • BRCA1 Protein / genetics
  • BRCA2 Protein / genetics
  • Clinical Relevance
  • Cystadenocarcinoma, Serous* / genetics
  • Cystadenocarcinoma, Serous* / pathology
  • Fallopian Tube Neoplasms* / genetics
  • Fallopian Tube Neoplasms* / pathology
  • Fallopian Tube Neoplasms* / surgery
  • Female
  • Humans
  • Mutation
  • Peritoneal Neoplasms* / prevention & control
  • Retrospective Studies
  • Salpingo-oophorectomy

Substances

  • BRCA1 protein, human
  • BRCA1 Protein
  • BRCA2 protein, human
  • BRCA2 Protein