Intraoperative Evaluation of Prophylactic Hysterectomy and Salpingo-oophorectomy Specimens in Hereditary Gynecologic Cancer Syndromes

Abstract

Aims

Prophylactic total hysterectomy (TH) and bilateral salpingo-oophorectomy (BSO) have become routine procedures in women at genetic risk for gynecologic malignancies. Intraoperative pathology diagnosis of an occult malignancy provides the opportunity for immediate surgical staging and helps avoiding a second surgery. However, no standard guidelines exist for optimal intraoperative 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 1990-2017 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 less than half of all cases (159 of 413; 38.5%) were sent for IOE: fifteen 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 3 groups) had a final diagnosis of malignancy or pre-malignancy on permanent sections. Of these 19 cases, 8 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.

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