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The role of peritoneal cytology at risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of familial ovarian/tubal cancer

2011; Elsevier BV; Volume: 124; Issue: 2 Linguagem: Inglês

10.1016/j.ygyno.2011.10.017

1095-6859

Ranjit Manchanda, Ronny Drapkin, Ian Jacobs, Usha Menon,

Prenatal Screening and Diagnostics

Risk-reducing salpingo-oophorectomy (RRSO) is the mainstay of managing women at increased risk of familial ovarian cancer and use of strict surgical protocols with serial sectioning of the specimen is increasingly the norm. The role of cytology obtained from peritoneal washings has received less attention, with even commentaries by some authoritative experts omitting to remark on this point [ [1] Domchek S.M. Rebbeck T.R. Prophylactic oophorectomy in women at increased cancer risk. Curr Opin Obstet Gynecol. 2007; 19: 27-30 Crossref PubMed Scopus (52) Google Scholar ]. As a result, practice varies among surgeons and institutions, with some published series reporting cytological findings at RRSO [ 2 Manchanda R. Abdelraheim A. Johnson M. Rosenthal A. Benjamin E. Brunell C. et al. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG. 2011; 118: 814-824 Crossref PubMed Scopus (100) Google Scholar , 3 Callahan M.J. Crum C.P. Medeiros F. Kindelberger D.W. Elvin J.A. Garber J.E. et al. Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction. J Clin Oncol. 2007; 25: 3985-3990 Crossref PubMed Scopus (422) Google Scholar , 4 Powell C.B. Kenley E. Chen L.M. Crawford B. McLennan J. Zaloudek C. et al. Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy. J Clin Oncol. 2005; 23: 127-132 Crossref PubMed Scopus (335) Google Scholar ], a number omitting to mention this [ 5 Finch A. Beiner M. Lubinski J. Lynch H.T. Moller P. Rosen B. et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA. 2006; 296: 185-192 Crossref PubMed Scopus (518) Google Scholar , 6 Rebbeck T.R. Lynch H.T. Neuhausen S.L. Narod S.A. Van't Veer L. Garber J.E. et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002; 346: 1616-1622 Crossref PubMed Scopus (1335) Google Scholar ], and recently one suggesting it is not necessary [ [7] Haldar K. Giamougiannis P. Crawford R. Utility of peritoneal lavage cytology during laparoscopic salpingo-oophorectomy: a retrospective analysis. BJOG. 2011; 118: 28-33 Crossref PubMed Scopus (11) Google Scholar ]. This is an important issue for clinical practice which requires addressing. Cytology is likely to impact management decisions if early stage or pre-invasive disease is discovered at RRSO. We present a summary of the current literature (Table 1, Table 2, Table 3), and put forward the rationale for cytology to be included as routine in RRSO protocols. Table 1Occult Stage 1 invasive cancers (with or without concomitant STIC) a Includes those cases with histology reports of invasive ovarian and fallopian tube cancer (with or without concomitant STIC). detected at RRSO. Author Series Pos cases Histology (gross) Histology (microscopic) Cytology Staging surgery Stage Mutation status Chemotherapy 2nd Look Follow-up data Stratton 1999 n=48 Case 1 NA Ovary ca (microinvasive serous adenoca) NA NA 1 BRCA NA NA Colonic ca—2 yrs Deligdisch 1999 n=52 Case 1 NA Ovary ca (microinvasive mod diff serous) NA NA 1 BRCA1 NA NA NA Hartley 2000 Case report Case 1 Normal FTC (fimbrial) Neg Yes, Neg (TAH BSO followed by omentectomy+PA node dissection) 1a BRCA1 P+C No NA Paley 2001 2 case reports Case 2 Small nodule lt. FT infundibulum FTC (7 mm) Pos Incomplete (TAH, BSO, appendicectomy) 1c BRCA1 P+C (6 cycles) Neg NA Leeper 2002 n=30 Case 3 Normal FTC (8 mm) Pos Yes (post chemotherapy7 mth after TAH BSO, at 2nd look but details NA) 1c BRCA1 P+C (6 cycles) Neg Rec 13 mth (post 2nd look) Rebbeck 2002 n=259 Case 1 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Case 2 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Case 3 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Case 4 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Case 5 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Case 6 NA Ovary ca NA NA 1 BRCA 1 NA NA NA Agoff 2002, 2004 n=7 case reports Case 1 Normal FT focal CIS+FTC 7 mm+(same tube) Pos TAH BSO at primary surgery (not formally staged) 1c BRCA1 P+C (6 cycles) Neg 7 mth (pelvic and PA nodes Neg) Rec 17 mth—T+C (vag dis-alive 30 mth) Case 4 18 cm ov cyst FT CIS+FTC(fimbria)+(ov cystadenoma) Neg TAH BSO at primary surgery (not formally staged) 1a Unknown Not given 30 mth dis free Case 5 Normal FTC (fimbria) 9 mm Not done at pri surgery. Neg at staging TAH BSO at primary surgery. Staging laparotomy 1mth later (details NA) 1a Unknown Not Given 9 yrs (brst ca-5 yr, 7 yr) Olivier 2004 n=90 Case 1 Normal FTC (endometrioid adenoca) 2.5 mm NA Yes (details of procedure NA) 1a BRCA 1 NA 46 mth dis free Case 4 Normal Ovary ca (pap serous adenoca) NA Yes (details of procedure NA) 1c BRCA 1 NA 35 mth dis free Case 5 Normal Ovary ca (pap serous adenoca) NA Yes (details of procedure NA) 1a BRCA 1 NA 11 mth dis free McEwen 2004 Case report Case 1 Normal FTC (3 mm) with FT CIS Neg Not reported 1a BRCA2 None NA 3 mth dis free Meeuwissen 2005 n=133 Case 1 FTC NA Yes (TAH, BSO, omentectomy. No lymphadenectmoy reported) 1a BRCA1 NA NA Powell 2005 n=67 Case 1 Normal FT CIS 2.7 mm+FTC (1.7 mm, same FT) Neg Omental bx Neg (details of any formal staging not reported) 1a BRCA2 Not known Individual case FU not known. Cohort FU median 3 years Case 3 Normal FT CIS+FTC (2.2 mm, same FT) Pos Omental bx Neg (details of any formal staging not reported) 1c BRCA1 Not known Case 5 Normal Ovary ca (Rt ovary adenoca, 0.9 mm) Neg Omental bx Neg (details of any formal staging not reported) 1a? BRCA1 Not known Case6 Normal Ovary ca (serous, high grade) Neg Omental bx Neg (details of any formal staging not reported) 1a? BRCA1 Not known Case 7 Normal Ovary ca (Lt ovary 3 small foci adenoca) Neg No omental bx (details of any formal staging not reported) 1a? BRCA1 Not known Schmeler 2006 n=65 Case 1 Normal Ovary ca (1 mm) ?Neg TAH BSO primary surgery (no further staging) 1a BRCA None 24 mths dis free Finch 2006 JAMA n=490 Case 5 NA FTC Unclear NA 1a BRCA2 NA NA 1 yr (alive) Case 7 NA Ovary ca Unclear NA 1a BRCA 1 NA NA 4 yrs (deceased) Case 8 NA FTC Unclear NA 1a BRCA2 NA NA alive at 6 yr Finch 2006 Gynecol Oncol n=159 Case 2 Normal Ovary ca (serous) 1 mm (high grade) Pos NA 1c BRCA 1 NA NA NA Case 5 1.5 cm fim nodule FTC-fimbria Neg NA 1b BRCA 1 NA NA NA Medeiros 2006 n=13 Case 1 NA FT STIC, FTC fimbria (serous) 1.2 mm; multifocal Unclear Yes (at FU, details NA. upstaged to stage 3)) 1a BRCA2 NA NA NA Case 2 NA FTC (7 mm-endometrioid adenoca fimbria) Unclear Yes (details NA) 1a BRCA 1 NA NA NA Laki 2007 n=89 Case 1 NA FTC Neg Unclear 1a BRCA 1 NA NA 12 mth (deceased, breast ca rec) Case 3 NA FTC Neg Unclear 1a BRCA 1 NA NA 38 mth Dis free Callahan 2007 n=122 Case 5 Normal FTC-endometrioid (fimbrial) Neg Yes (following BSO, operative details NA) 1a BRCA1 P+C (1 cycle, stopped due to toxicity) NA NA Case 6 Normal FT CIS+FTC (fimbrial, tubal serosal) Neg Yes (RAH, BSO, omentectomy) 1c BRCA1 P+C NA NA Domchek 2010 n=647 Case 2 NA Serous ca ovary NA NA 1 BRCA1 NA NA NA Case 3 NA Ovary ca NA NA 1 BRCA1 NA NA NA Case 4 NA Ovary NA NA 1 BRCA1 NA NA NA Case 5 NA Ovary ca or FTC (unclear) NA NA 1 BRCA1 NA NA NA Case 6 NA Ovary ca or FTC (unclear) NA NA 1 BRCA1 NA NA NA Case 7 NA Ovary ca or FTC (unclear) NA NA 1 BRCA1 NA NA NA Manchandab Follow-up data previously unpublished (personal communication). 2011 n=308 Case 3 Normal FTC- serous (Grade 2) Neg Yes (hysterectomy, omentectomy) 1a BRCA1 NA NA NA Case 7 Normal Ovary ca (Serous 5 mm, incl cyst lining,Gr 3) Neg Yes (Following BSO- hysterectomy, omentectomy, lymphadenectomy) 1a BRCA 2 None No NA Case 8 Ovary ca—(Pap serous, Gr 2, 9 mm lesion 4 mm invasion & extracapsular extension) Neg Yes (following BSO- TLH, omentectomy, lymphadenectomy) 1c BRCA2 C (6 cycles) No 24 mth dis free BSO—bilateral salpingo-oophorectomy, C—Carboplatin, ca—cancer, CIS—carcinoma in situ, dis—disease, FU—follow up, FTC—fallopian tube cancer, mth—months, NA—not available, Neg—negative, Pos—positive, P—Paclitaxel, rec—recurrence, RAH—radical abdominal hysterectomy, STIC Serous tubal carcinoma in situ, TAH—total abdominal hysterectomy, TLH—total laparoscopic hysterectomy, T—Taxotere. (unable to provide reference links for all above studies in the reference section given journal guidelines). a Includes those cases with histology reports of invasive ovarian and fallopian tube cancer (with or without concomitant STIC). b Follow-up data previously unpublished (personal communication). Open table in a new tab Table 2Occult carcinoma in situ (CIS) / serous tubal in situ carcinoma (STIC) lesions a Includes cases where the final histological diagnosis is STIC without concomitant invasive cancer. (without concomitant invasion) detected at RRSO. Author Series Pos cases Histology (gross) Histology (microscopic) Cytology Staging surgery Stage Mutation status Chemotherapy 2nd Look Follow up Paley 2001 2 case reports Case 1 Normal FT CIS 8 mm Pos Yes (LAVH, BSO primary surgery. Staging completed at 2nd look but details NA) 1c BRCA1 P+C (6 cycles) Negative (completion of staging, details NA) NA Colgan 2002 n=35 Case 2 Normal FT CIS Pos Unknown 1c? BRCA1 None – 1 year dis free Leeper 2002 n=30 Case 2 Normal FT CIS 7 mm Pos Yes (LAVH, BSO primary surgery. Staging completed at 2nd look but details NA) 1c BRCA1 P+C (6 cycles) Negative (7 mth after primary surgery) 17 mths dis free Case 4 Normal FT CIS 14 mths dis free Agoff 2002, 2004 n=7 case reports Case 2 Normal FT CIS 8 mm Pos TAH BSO primary surgey (no formal staging) 1c BRCA1 P+C (6 cycles) Neg 6mth (biopsies taken but details NA) 48 mths dis free Case 3 Normal FT CIS 2 mm Neg TAH BSO primary surgey (no formal staging) 1a BRCA2 P+C (3 cycles) Not done 36 mths dis free Powell 2005 n=67 Case 2 Intraluminal lesion FT CIS (+12 mm luminal lesion) Neg Omental bx Neg. (details of any formal staging not reported) 0 BRCA2 Not known Individual case FU not known. Cohort FU median 3 yrs Case 4 Normal FT CIS (b/l multifocal) Not done No omental bx. (details of any formal staging not reported) 0 BRCA1 Not known Finch 2006 Gynecol Oncol n=159 Case 4 Normal FT CIS Neg NA 0 BRCA 1 NA NA NA Lamb2006 n=113 Case 2 FT CIS Pos ?Undertaken at 2nd look (details NA) 0 BRCA 1 P+C (6 cycles) Neg (details NA) Dis free Case 4 FT CIS Neg Not done 0 BRCA2 P+C (3 cycles) NA Dis free Case 6 FT CIS Neg Not done 0 BRCA 1 None NA Dis free Case 7 FT CIS Neg Not done 0 BRCA 1 None NA Dis free Medeiros 2006 n=13 Case 3 FT STIC (fimbria,serous,2 mm) Neg Yes (at FU, details NA) 0 BRCA2 NA NA NA Case 4 FT STIC (fimbria, serous, 1 mm) Pos Yes (at FU, details NA) ?1c BRCA2 NA NA NA Case 5 FT STIC (ampulla, serous, 1 mm) Neg Yes (at initial surgery, details NA) 0 BRCA 1 NA NA NA Carcangiu 2006 n=50 Case 4 FT CIS NA Not reported 0 BRCA 1 None NA Dis free 87 mths Case 5 FT CIS Neg Not reported 0 BRCA 1 None NA Dis free 38 mths Case 6 FT CIS Neg Not reported 0 BRCA 1 None NA Dis free 7 mths Callahan 2007 n=122 Case 1 Normal FT CIS (fimbrial) Pos Yes (following BSO, operative details NA) 1c? BRCA2 P+C NA NA Case 2 Normal FT CIS (ampullary) Neg Yes (following BSO, operative details NA) 0 BRCA2 P+C NA NA Case 4 Normal FT CIS (fimbrial) Neg TAH at primary surgery (formal staging not reported) 0 BRCA1 P+C NA NA Manchandab Follow-up data previously unpublished (personal communication). 2011 n=308 Case 1 Normal FT CIS Neg No 0 BRCA 1 None None NA Case 2 Normal FT CIS Neg No 0 BRCA1 None None 7 mths dis free Case 4 Normal FT CIS Neg No 0 BRCA1 None None 11 mths dis free Case 6 Normal FT CIS Pos Yes (TLH, BSO, omentectomy) 1c BRCA1 None None 40 mths dis free Case 9 Normal FT CIS, CIS ovary Pos No (No formal staging) ?1c?0 BRCA2 None FU laparoscopy+washings+peritoneal bx+omentectomy Neg 24 mths dis free Case 10 Normal FT CIS Neg No 0 BRCA2 None None 12 mths dis free Case 11 Normal FT CIS Pos Yes (TLH, BSO, omentectomy) 1c Unknown None None 28 mths dis free Case 12 Normal FT CIS Neg No 0 Unknown None None 48 mths dis free Case 13 Normal FT CIS Neg No 0 Unknown None None NA BSO—bilateral salpingo-oophorectomy, bx—biopsy, C—Carboplatin, ca—cancer, CIS—carcinoma in situ, dis—disease, FU—follow up, FTC—fallopian tube cancer, mth—months, NA—not available, Neg—negative, Pos—positive, P—Paclitaxel, rec—recurrence, STIC Serous tubal carcinoma in situ, TAH—total abdominal hysterectomy, T—Taxotere. (unable to provide reference links for all above studies in the reference section given journal guidelines). a Includes cases where the final histological diagnosis is STIC without concomitant invasive cancer. b Follow-up data previously unpublished (personal communication). Open table in a new tab Table 3Cases of normal histology and positive cytology detected at RRSO. Author Series Pos cases Histology (gross) Histology (microscopic) Cytology Staging surgery Stage Mutation status Chemotherapy 2nd Look Follow up Colgan 2002 n=35 Case 3 Normal Normal Pos Yes ? Unknown Yes 10 mths dis free Finch 2006 JAMA n=490 Case 6 NA Normal Pos NA ? BRCA 1 NA NA Alive at 1 yr Schmeler 2006 n=65 Case 2 Normal Normal Pos TAH BSO primary surgery. (Unknown if full staging undertaken at 2nd look) ? BRCA P+C (4 cycles) Yes (details of procedure NA) 60 mths disease free BSO—bilateral salpingo-oophorectomy, C—Carboplatin, dis—disease, mths—months, NA—not available, Pos—positive, P—Paclitaxel, TAH—total abdominal hysterectomy (unable to provide reference links for all above studies in the reference section given journal guidelines). Open table in a new tab BSO—bilateral salpingo-oophorectomy, C—Carboplatin, ca—cancer, CIS—carcinoma in situ, dis—disease, FU—follow up, FTC—fallopian tube cancer, mth—months, NA—not available, Neg—negative, Pos—positive, P—Paclitaxel, rec—recurrence, RAH—radical abdominal hysterectomy, STIC Serous tubal carcinoma in situ, TAH—total abdominal hysterectomy, TLH—total laparoscopic hysterectomy, T—Taxotere. (unable to provide reference links for all above studies in the reference section given journal guidelines). BSO—bilateral salpingo-oophorectomy, bx—biopsy, C—Carboplatin, ca—cancer, CIS—carcinoma in situ, dis—disease, FU—follow up, FTC—fallopian tube cancer, mth—months, NA—not available, Neg—negative, Pos—positive, P—Paclitaxel, rec—recurrence, STIC Serous tubal carcinoma in situ, TAH—total abdominal hysterectomy, T—Taxotere. (unable to provide reference links for all above studies in the reference section given journal guidelines). BSO—bilateral salpingo-oophorectomy, C—Carboplatin, dis—disease, mths—months, NA—not available, Pos—positive, P—Paclitaxel, TAH—total abdominal hysterectomy (unable to provide reference links for all above studies in the reference section given journal guidelines).