The incidence and clinical outcomes following prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers: a single-center retrospective study

Background: The aim of this study was to determine the incidence of Secretory cell outgrowth (SCOUT), p53 signature, serous tubal intraepithelial lesion (STIL), serous tubal intraepithelial carcinoma (STIC) and occult invasive cancer (OC) in patients with (BReast Cancer 1 BRCA1) and/or (BReast CAncer 2 BRCA2) pathogenic variants and to evaluate clinical outcomes and the risk of developing primary peritoneal carcinoma (PPC) in the follow-up period. Methods: This study is a single center retrospective clinical study. We evaluated 63 patients with BRCA mutations. The treatment approach was prophylactic risk-reducing salpingo-oophorectomy (RRSO) according to Sectioning and Extensively Examining the Fimbriated end of the fallopian tube (SEE-FIM) protocol and immunohistochemical staining. The patients had proven BRCA1-2 variants, but had no personal history of ovarian, peritoneal or fallopian tube cancer and there was no preoperative sign of malignancy. Results: Out of 63 patients, 29 women were identified as carrying a mutation in the BRCA1 gene, while 33 were identified as carrying a mutation in the BRCA2 gene. One patient had both a BRCA1 and BRCA2 mutation. The mean age at surgery was 45.9 years (range, 34 to 71 years). In total, 10 (15.8%) SCOUTs, 4 (6.3%) p53 signatures and 3 (4.7%) STILs were observed. One patient with isolated STIC was detected which was identified in both BRCA1 and BRCA2 mutations and did not undergo restaging surgery or adjuvant chemotherapy. After diagnosis of STIC at RRSO, PPC did not develop during 23 months. Conclusions: The STIC and STIL, which are precancerous lesions, were observed with RRSO by applying SEE-FIM protocol. In addition, the subsequent period did not demonstrate any occurrences of PPC. Further studies are required to investigate the management of these precancerous lesions and OC, due to the rarity of STIC lesions and the low number of case series.

BRCA; Risk-reducing salpingo-oophorectomy; Serous tubal intraepithelial carcinoma

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