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Intra‐operative evaluation of prophylactic hysterectomy and salpingo‐oophorectomy specimens in hereditary gynaecological cancer syndromes
Author(s) -
Wong Serena,
Ratner Elena,
Buza Natalia
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13503
Subject(s) - hysterectomy , medicine , oophorectomy , gynecology , gynaecological cancer , ovarian cancer , cancer , general surgery , surgery
Aims Prophylactic total hysterectomy ( TH ) and bilateral salpingo‐oophorectomy ( BSO ) have become routine procedures in women at genetic risk for gynaecological malignancies. Intra‐operative pathology diagnosis of an occult malignancy provides the opportunity for immediate surgical staging and helps to avoid a second surgery. However, no standard guidelines exist for optimal intra‐operative evaluation ( IOE ) of these specimens. We performed a retrospective analysis of prophylactic TH and BSO cases to assess the presence of gross findings, frozen and permanent section sampling practices, frozen section diagnoses and diagnostic discrepancies. Methods and results All prophylactic TH and BSO cases between 1990 and 2017 were retrieved from our departmental archives. A total of 413 cases were included in the study: 27 with Lynch syndrome ( LS ), 222 with germline BRCA 1 or 2 mutations and 164 cases with strong family or personal history (non‐Lynch/non‐ BRCA ). Only fewer than half of all cases (159 of 413; 38.5%) were sent for IOE , 15 of 27 (56%) LS cases, 93 of 222 (42%) BRCA cases and 51 of 164 (31%) non‐Lynch/non‐ BRCA cases. A total of 19 patients (4.6% of patients combining all three groups) had a final diagnosis of malignancy or premalignancy on permanent sections. Of these 19 cases, eight had a corresponding gross lesion (42%) and could have been diagnosed on frozen section; however, only one of them underwent IOE . Conclusions Our results highlight the potential benefits and challenges of IOE in this setting and may provide a basis for future practice recommendations.