- •Survey to assess processing protocols of gynecologic surgical pathology specimens
- •Majority of pathology labs perform SEE-Fim on risk-reducing specimens.
- •Most labs perform SEE-Fim on benign specimens if first sections are suspicious.
- •Results suggest detailed processing of fallopian tubes pathology specimens.
Many high-grade serous carcinomas initiate in fallopian tubes as serous tubal intraepithelial carcinoma (STIC), a microscopic lesion identified with specimen processing according to the Sectioning and Extensive Examination of the Fimbria protocol (SEE-Fim). Given that the tubal origin of these cancers was recently recognized, we conducted a survey of pathology practices to assess processing protocols that are applied to gynecologic surgical pathology specimens in clinical contexts in which finding STIC might have different implications.
We distributed a survey electronically to the American Society for Clinical Pathology list-serve to determine practice patterns and compared results between practice types by chi-square (χ2) tests for categorical variables. Free text comments were qualitatively reviewed.
Survey responses were received from 159 laboratories (72 academic, 87 non-academic), which reported diverse specimen volumes and percentage of gynecologic samples. Overall, 74.1% of laboratories reported performing SEE-Fim for risk-reducing surgical specimens (82.5% academic versus 65.7% non-academic, p < 0.05). In specimens from surgery for benign indications in which initial microscopic sections showed an unanticipated suspicious finding, 75.9% of laboratories reported using SEE-Fim to process the remainder of the specimen (94.8% academic versus 76.4% non-academic, p < 0.01), and 84.6% submitted the entire fimbriae.
Changes in the theories of pathogenesis of high-grade serous carcinoma have led to implementation of pathology specimen processing protocols that include detailed analysis of the fallopian tubes. These results have implications for interpreting trends in cancer incidence data and considering the feasibility of developing a bank of gynecologic tissues containing STIC or early cancer precursors.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Gynecologic Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The dualistic model of ovarian carcinogenesis: revisited, revised, and expanded.Am. J. Pathol. 2016; 186: 733-747
- Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship.Am. J. Surg. Pathol. 2007; 31: 161-169
- Serous tubal intraepithelial carcinoma associated with extraovarian metastases.Int. J. Gynecol. Cancer. 2017; 27: 444-451
- Diagnosis of serous tubal intraepithelial carcinoma based on morphologic and immunohistochemical features: a reproducibility study.Am. J. Surg. Pathol. 2011; 35: 1766-1775
- Serous tubal intraepithelial carcinoma and the dominant ovarian mass: clues to serous tumor origin?.Am. J. Surg. Pathol. 2009; 33: 376-383
- Frequency of serous tubal intraepithelial carcinoma in various gynecologic malignancies: a study of 300 consecutive cases.Int. J. Gynecol. Pathol. 2012; 31: 103-110
- Risk reducing salpingo-oophorectomy for BRCA mutation carriers: twenty years later.Gynecol. Oncol. 2014; 132: 261-263
- Serous tubal intraepithelial carcinomas associated with high-grade serous ovarian carcinomas: a systematic review.BJOG. 2017; 124: 872-878
- Molecular analysis of high-grade serous ovarian carcinoma with and without associated serous tubal intra-epithelial carcinoma.Nat. Commun. 2017; 8: 990
- The fallopian tube origin and primary site assignment in extrauterine high-grade serous carcinoma: findings of a survey of pathologists and clinicians.Int. J. Gynecol. Pathol. 2017; 36: 230-239
- The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome.Am. J. Surg. Pathol. 2006; 30: 230-236
- Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR).Mod. Pathol. 2015; 28: 1101-1122
- Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention.J. Clin. Oncol. 2008; 26: 4160-4165
- Multistep level sections to detect occult fallopian tube carcinoma in risk-reducing salpingo-oophorectomies from women with BRCA mutations: implications for defining an optimal specimen dissection protocol.Am. J. Surg. Pathol. 2009; 33: 1878-1885
- Reported incidence and survival of fallopian tube carcinomas: a population-based analysis from the north American Association of Central Cancer Registries.J. Natl. Cancer Inst. 2017;
- Precancerous lesions of ovarian cancer-a US perspective.J. Natl. Cancer Inst. 2018; 110djx269
- Growth in salpingectomy rates in the United States since 2000.Am. J. Obstet. Gynecol. 2016; 215: 666-667
- Management of Preinvasive Lesions.Clin. Obstet. Gynecol. 2017; 60: 771-779
- Serous tubal intraepithelial carcinoma: an incidental finding at the time of prophylactic bilateral salpingo-oophorectomy.Case Rep. Obstet. Gynecol. 2015; 2015
- Serous tubal intraepithelial carcinoma (STIC) - clinical impact and management.Expert. Rev. Anticancer. Ther. 2016; 16: 1311-1321
- “Primary peritoneal” high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer.Gynecol. Oncol. 2011; 120: 470-473
- Are all pelvic (nonuterine) serous carcinomas of tubal origin?.Am. J. Surg. Pathol. 2010; 34: 1407-1416
- Early salpingectomy (TUbectomy) with delayed oophorectomy to improve quality of life as alternative for risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a prospective non-randomised multicentre study.BMC Cancer. 2015; 15
- Adamo M.B. Johnson C.H. Ruhl J.L. Dickie L.A. SEER Program Coding and Staging Manual. National Cancer Institute, NIH, Bethesda, MD2012
- Grading ovarian serous carcinoma using a two-tier system.Am. J. Surg. Pathol. 2004; 28: 496-504
- The diagnostic and biological implications of laminin expression in serous tubal intraepithelial carcinoma.Am. J. Surg. Pathol. 2012; 36: 1826-1834
- HMGA2: a potential biomarker complement to P53 for detection of early-stage high-grade papillary serous carcinoma in fallopian tubes.Am. J. Surg. Pathol. 2010; 34: 18-26
- Serous tubal intraepithelial carcinoma or not? Metastases to fallopian tube mucosa can masquerade as in situ lesions.Arch. Pathol. Lab. Med. 2017; 141: 1313-1315
- Next-generation sequencing of tubal intraepithelial carcinomas.JAMA Oncol. 2015; 1: 1128-1132
- Genomics of ovarian cancer progression reveals diverse metastatic trajectories including intraepithelial metastasis to the fallopian tube.Cancer Discov. 2016; 6: 1342-1351
- Do deeper sections increase the frequency of detection of serous tubal intraepithelial carcinoma (STIC) in the “sectioning and extensively examining the FIMbriated end” (SEE-FIM) protocol?.Int. J. Gynecol. Pathol. 2013; 32: 353-357
- Rationale for developing a specimen bank to study the pathogenesis of high-grade serous carcinoma: a review of the evidence.Cancer Prev. Res. (Phila.). 2016; 9: 713-720
- Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol.Int. J. Gynecol. Cancer. 2011; 21: 846-851
- Early detection of high-grade tubal serous carcinoma in women at low risk for hereditary breast and ovarian cancer syndrome by systematic examination of fallopian tubes incidentally removed during benign surgery.Am. J. Surg. Pathol. 2014; 38: 729-742
Published online: February 03, 2018
Accepted: January 15, 2018
Received in revised form: January 12, 2018
Received: December 20, 2017
Published by Elsevier Inc.