Risk reducing surgery with peritoneal staging in BRCA1-2 mutation carriers. A prospective study

Area of Science:

• Gynecologic Oncology
• Cancer Genetics
• Surgical Pathology

Background:

• International guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) for BRCA1/2 mutation carriers to reduce ovarian cancer risk.
• BRCA mutations significantly increase the risk of ovarian and fallopian tube cancers.

Purpose of the Study:

• To prospectively evaluate the incidence of occult malignancies and surgical outcomes in asymptomatic BRCA mutation carriers undergoing RRSO.
• To assess the utility of peritoneal biopsies in detecting incidental cancers during RRSO.

Main Methods:

• Prospective data collection from 132 BRCA1/2 carriers undergoing RRSO between January 2019 and March 2021.
• Procedures included RRSO with peritoneal washing and biopsies (PeS); some patients also had hysterectomy.
• Minimally invasive surgical techniques were predominantly used (99.2%).

Main Results:

• Six occult carcinomas (4.5%) were diagnosed: 3 fallopian tube, 1 ovarian, and 2 serous tubal intraepithelial carcinomas (STICs).
• Peritoneal biopsies (PeS) did not detect any occult malignancies.
• Postoperative complications occurred in 9.1% of patients, primarily in those undergoing concomitant hysterectomy.

Conclusions:

• Occult malignancies were found in 4.5% of BRCA carriers undergoing RRSO, including invasive carcinomas and STICs.
• Routine peritoneal biopsies did not enhance the detection of occult malignancies during RRSO.
• Timely RRSO remains crucial for BRCA1-2 carriers to mitigate cancer risk.