Practical Value of Systematic and Complete Examination of Fallopian Tubes in Unselected Women Undergoing Salpingectomy for Benign Indications: Results of a Prospective Study
Karuna Garg, Joseph T Rabban. University of California, San Francisco, CA
Background: Recent studies implicate the fallopian tube (FT) as one of the earliest sites of cancer development in women with hereditary risk for pelvic serous carcinoma. Clinically occult serous tubal intraepithelial carcinoma (STIC) can be found in about 10% of risk reducing salpingo-oophorectomy (RRSO) specimens in BRCA mutation carriers, if a systematic and complete pathologic evaluation is performed. This study prospectively tested a protocol of systematic and complete evaluation of FTs from unselected women undergoing GYN surgery for benign indications. The aims were to define the incidence of occult tubal carcinoma in this patient population and to quantify the additional labor and burden from diagnostic work up of problematic findings using this protocol.
Design: All cases where the entire FTs were examined for benign indications from 2009 to 2012 were included. Lesions that met morphologic and immunohistochemicaL criteria for STIC or invasive tubal carcinoma (ITC) were considered malignant. Lesions that were morphologically atypical but fell short of STIC were coded as atypical for this study.
Results: A total of 396 patients with benign surgical indications were evaluated by this protocol. Primary surgical indications included cystic pelvic/adnexal mass (clinical/radiologic impression of benign, benign diagnosis confirmed by pathology) (263), fibroids (64), hormonal suppression for breast carcinoma (17), prolapse (16), pelvic pain (11), endometriosis (10), abnormal bleeding (8),hydrosalpinx (3), torsion (3), hemoperitoneum (1). The average number of tissue blocks per fallopian tube was 4. A total of 2 cases of STIC (0.5%) and 0 cases of ITC were identified. Both STICs were located in the fimbriae. 3 cases had morphological atypia prompting further workup. Patients with STIC were 46 and 83 years old who underwent surgery for ovarian dermoid cyst and serous cystadenoma respectively.
Conclusions: Systematic microscopic examination of the fallopian tubes in patients presenting for benign indications may identify rare early cancers, all of which are found in the fimbriae in our study. This comes with a cost of additional labor and the cost of detecting lesions of uncertain significance. Inclusion of the non-fimbriated tube in this protocol does not appear to be of value. These results may contribute to the discussion of whether this practice is justified as a routine screening tool in unselected women.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 1:15 PM
Proffered Papers: Section B, Tuesday Afternoon