Multiple Deep Level Sections of Tubal Fimbriae Blocks in Risk Reducing Salpingo-Oophorectomy from Women with BRCA Mutations: Do Levels Increase Detection of Occult Cancer?
EF Krasik, CB Powell, LM Chen, B Crawford, CJ Zaloudek, JT Rabban. UCSF, San Francisco, CA
Background: Occult cancer can be found in a small subset of risk reducing salpingo-oophorectomies (RRSO) from women with BRCA mutations. Most occult cancer involves the tubal fimbriae and may be as small as 1 millimeter. Pathologic detection of occult cancer depends completely on the thoroughness of tissue examination. A special dissection protocol of embedding thinly sliced sections of the entire tube and ovary is required. We hypothesized that enhanced examination of tubal fimbriae via multiple deep level sections could uncover occult cancer not present on the original slides. The diagnostic value of automatically perfoming level sections in RRSO has not been formally tested.
Design: RRSO slides from 79 women with BRCA mutations were retrospectively studied. All cases were dissected by a special protocol to maximize visible tissue: tubes and ovaries were sectioned at 2-3 mm intervals and entirely embedded. Tubal fimbriae were sectioned parallel to the fimbriae length. For this study, we identified all blocks containing fimbriae and obtained 3 deeper level sections on each one for standard hematoxylin and eosin (H&E) staining. A single experienced histotechnologist performed all the levels, which were cut down to a depth of more than 75% of the remaining tissue block. Levels were reviewed without knowledge of the original diagnosis and without reviewing the original H&E slide.
Results: The original diagnoses identified 9 cases of occult carcinoma: 4 in tubal fimbriae; 1 in tubal isthmus; 2 in ovary; 2 in both tubal fimbriae and ovary. Size of tubal carcinomas ranged from 1 to 11 mm. All but one tubal serous carcinoma were non-invasive. Total number of blocks containing fimbriae ranged from 1 to 3 per adnexa. Review of level sections did not reveal any additional cases of occult cancer. Non-neoplastic findings in tubal fimbriae included tubal epithelial hyperplasia (15%), transitional cell metaplasia of fimbriae (32%), endometriosis (9%), paratubal cysts (62%), and serous micro-adenofibromas (1%).
Conclusions: In RRSO specimens from BRCA positive women that have been thinly dissected and totally embedded, performance of routine multiple deep level sections of tubal fimbriae tissue blocks does not improve detection of occult carcinoma.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 178, Tuesday Afternoon