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Open Access 01-04-2022 | Salpingo-Oophorectomy | Review and Perspectives

Recommendations for diagnosing STIC: a systematic review and meta-analysis

Authors: Joep M. A. Bogaerts, Miranda P. Steenbeek, Majke H. D. van Bommel, Johan Bulten, Jeroen A. W. M. van der Laak, Joanne A. de Hullu, Michiel Simons

Published in: Virchows Archiv | Issue 4/2022

Abstract

Our understanding of the oncogenesis of high-grade serous cancer of the ovary and its precursor lesions, such as serous tubal intraepithelial carcinoma (STIC), has significantly increased over the last decades. Adequate and reproducible diagnosis of these precursor lesions is important. Diagnosing STIC can have prognostic consequences and is an absolute requirement for safely offering alternative risk reducing strategies, such as risk reducing salpingectomy with delayed oophorectomy. However, diagnosing STIC is a challenging task, possessing only moderate reproducibility. In this review and meta-analysis, we look at how pathologists come to a diagnosis of STIC. We performed a literature search identifying 39 studies on risk reducing salpingo-oophorectomy in women with a known BRCA1/2 PV, collectively reporting on 6833 patients. We found a pooled estimated proportion of STIC of 2.8% (95% CI, 2.0–3.7). We focused on reported grossing protocols, morphological criteria, level of pathologist training, and the use of immunohistochemistry. The most commonly mentioned morphological characteristics of STIC are (1) loss of cell polarity, (2) nuclear pleomorphism, (3) high nuclear to cytoplasmic ratio, (4) mitotic activity, (5) pseudostratification, and (6) prominent nucleoli. The difference in reported incidence of STIC between studies who totally embedded all specimens and those who did not was 3.2% (95% CI, 2.3–4.2) versus 1.7% (95% CI, 0.0–6.2) (p 0.24). We provide an overview of diagnostic features and present a framework for arriving at an adequate diagnosis, consisting of the use of the SEE-FIM grossing protocol, evaluation by a subspecialized gynecopathologist, rational use of immunohistochemical staining, and obtaining a second opinion from a colleague.

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Title: Recommendations for diagnosing STIC: a systematic review and meta-analysis
Authors: Joep M. A. Bogaerts
Miranda P. Steenbeek
Majke H. D. van Bommel
Johan Bulten
Jeroen A. W. M. van der Laak
Joanne A. de Hullu
Michiel Simons
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Salpingo-Oophorectomy
Salpingectomy
Ovarian Cancer
Ovarian Cancer
Published in: Virchows Archiv / Issue 4/2022
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-021-03244-w

At a glance: The STEP trials

Springer Medicine

Recommendations for diagnosing STIC: a systematic review and meta-analysis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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