Prevalence of Occult Ovarian Cancer and Metastatic Breast Cancer in Ovarian Ablation Specimens of Patients With Hormone Receptor-Positive Breast Cancer: Implications for Tissue Sampling Strategies, Early Ovarian Cancer Detection and Resource Utilization - PubMed (original) (raw)

. 2025 Mar 1;44(2):174-181.

doi: 10.1097/PGP.0000000000001055. Epub 2024 Jun 26.

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Prevalence of Occult Ovarian Cancer and Metastatic Breast Cancer in Ovarian Ablation Specimens of Patients With Hormone Receptor-Positive Breast Cancer: Implications for Tissue Sampling Strategies, Early Ovarian Cancer Detection and Resource Utilization

Anjali Walia et al. Int J Gynecol Pathol. 2025.

Abstract

Bilateral oophorectomy is one method of hormone suppression for premenopausal patients with hormone receptor-positive breast cancer. Such specimens could, in theory, harbor occult early ovarian cancer and/or metastatic breast cancer but guidelines for tissue sampling for pathologic examination remain to be addressed. Therefore, we evaluated oophorectomy specimens from 166 patients who underwent ovarian ablation for hormone receptor-positive breast cancer. Results of germline genetic testing were documented by the surgeon in only 31.3% of the pathology specimen requisition forms, whereas that information was available for 81.3% of patients elsewhere in the electronic medical records. All but 5.2% tested negative for a hereditary ovarian cancer gene pathogenic variant before oophorectomy. Complete tissue sampling was performed in 77.1% of the cases and representative sampling in the remainder. No cases of ovarian cancer were observed. Ovarian metastasis of breast cancer was identified in 9.6% of patients, all of whom were already known to have advanced-stage disease. The number of tissue cassettes per ovary required for complete tissue submission was on average three times higher than that for representative tissue sampling ( P < 0.01) and ranged up to 20 cassettes per ovary when multiple follicle cysts were present. We propose that guidelines for tissue sampling in this context be defined by a combination of hereditary risk and macroscopic examination; representative sampling is reasonable for macroscopically normal ovaries in hormone receptor-positive breast cancer patients whose germline genetic testing is negative. Positive genetic test results merit complete tissue submission even if macroscopically normal. This strategy balances the goals of early ovarian cancer detection and optimal resource utilization. However, it depends on clear documentation of genetic test results. Our study demonstrates that many opportunities remain to close gaps in the communication of genetic test results by clinicians submitting oophorectomy specimens for pathologic evaluation.

Copyright © 2024 by the International Society of Gynecological Pathologists.

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Conflict of interest statement

J.T.R. reports that his spouse receives salary and stock options from Merck & Co. The remaining authors declare no conflict of interest.

References

    1. Grossman DC, Curry SJ, Owens DK, et alForce USPST. Screening for ovarian cancer: US Preventive Services Task Force recommendation statement. JAMA 2018;319:588–594.
    1. College of American Pathologists Cancer Committee. Protocol for the Examination of Specimens from Patients with Primary Tumors of the Ovary, Fallopian Tube, or Peritoneum. Version 1.4.0.0, Protocol posting date March 2023. Accessed December 10, 2023. www.cap.org
    1. WHO Classification of Tumours Editorial Board. Female genital tumours, 5th edn. Lyon, France: International Agency for Research on Cancer; 2020.
    1. Medeiros F, Muto MG, Lee Y, et al. 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.
    1. Rabban JT, Mackey A, Powell CB, et al. Correlation of macroscopic and microscopic pathology in risk-reducing salpingo-oophorectomy: implications for intraoperative specimen evaluation. Gynecol Oncol 2011;121:466–471.

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