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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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2
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Lymph Node Involvement in Recurrent Serous Borderline Ovarian Tumors: Current Evidence, Controversies, and a Review of the Literature. Cancers (Basel) 2023; 15:cancers15030890. [PMID: 36765848 PMCID: PMC9913328 DOI: 10.3390/cancers15030890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Borderline ovarian tumors (BOTs) account for 10-20% of epithelial ovarian neoplasms. They are characterized by their lack of destructive stromal invasion. In comparison to invasive ovarian cancers, BOTs occur in younger patients and have better outcome. Serous borderline ovarian tumor (SBOT) represents the most common subtype of BOT. Complete surgical staging is the current standard management but fertility-sparing surgery is an option for SBOT patients who are at reproductive age. While most cases of SBOTs have an indolent course with favorable prognosis, late recurrence and malignant transformation can occur, usually in the form of low-grade serous carcinoma (LGSC). Thus, assessment of the recurrence risk is essential for the management of those patients. SBOTs can be associated with lymph node involvement (LNI) in up to 30% of patients who undergo lymph node dissection at diagnosis, and whether LNI affects prognosis is controversial. The present review suggests that recurrent SBOTs with LNI have poorer oncological outcomes and highlights the biases due to the scarcity of reports in the literature. Preventing SBOTs from recurring and becoming invasive overtime and a more profound understanding of the underlying mechanisms at play are necessary.
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Lazurko C, Feigenberg T, Murphy J, Pulman K, Lennox G, Dube V, Zigras T. Identifying Borderline Ovarian Tumor Recurrence Using Routine Ultrasound Follow-Up. Cancers (Basel) 2022; 15:cancers15010073. [PMID: 36612070 PMCID: PMC9817930 DOI: 10.3390/cancers15010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Borderline ovarian tumors (BOTs) are non-invasive tumors frequently diagnosed in young patients. Surgical removal of the uterus, fallopian tubes, ovaries, and omentum is considered definitive management, however fertility-sparing approach is a recognized option. Surveillance is important due to known recurrence, but there is controversy over the effectiveness of follow-up modalities. The objective is to determine the efficacy of ultrasound screening in identifying tumor recurrence. This retrospective chart review evaluated all patients consulted and/or treated surgically at our institution from January 2015 to June 2020 diagnosed with BOT. Patients were excluded if concurrently diagnosed with another gynecologic malignancy, did not have yearly ultrasound follow-up, or were lost to follow-up. This study included 56 patients, 17 of whom underwent fertility preserving surgery. The overall rate of recurrence was 10.7%; with recurrence rates of 23.5% for the fertility preserving surgery population and 5.1% for the definitive surgery population. Ultrasound first identified 5 of the 6 (83.3%) recurrences. Overall time to recurrence was 51.5 months. In conclusion, recurrences were identified on routine ultrasound screening prior to symptom onset or detection via physical exam in 83.3% of cases. While the best modality of follow-up remains controversial, this review provides evidence supporting the use of routine ultrasound follow-up for early detection of BOT recurrence.
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Affiliation(s)
- Caitlin Lazurko
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tomer Feigenberg
- Division of Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Joan Murphy
- Division of Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
| | - Kate Pulman
- Division of Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Genevieve Lennox
- Division of Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Valerie Dube
- Department of Pathology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
| | - Tiffany Zigras
- Division of Gynecologic Oncology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON L5M 2N1, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1E2, Canada
- Correspondence: ; Tel.: +1-905-813-4024
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Gaballa K, Abdelkhalek M, Fathi A, Refky B, Belal K, elaraby M, Zuhdy M. Management of borderline ovarian tumors: A tertiary referral center experience in Egypt. Front Surg 2022; 9:962820. [PMID: 36117821 PMCID: PMC9478369 DOI: 10.3389/fsurg.2022.962820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn this retrospective study, we discuss our experience as a large tertiary referral center in Egypt in the management and follow-up of borderline tumorsPatients and methodsThis is a retrospective cohort study where all patients diagnosed with a borderline ovarian tumor at Oncology Center Mansoura University from November 2014 to June 2020 were included. Demographics, preoperative, operative, postoperative, pathologic, and oncologic follow-up data were retrieved from a prospectively maintained electronic database. The included patients were followed until April 2022.ResultsWe included 27 patients with borderline ovarian tumors. The mean age of the study patients was 47.67 ± 16.39 years. The median CA 125 was 33 (6–304 U/ml). Frozen section examination was utilized in 13 patients (48.14%), where a diagnosis of borderline ovarian tumors was revealed in 8 patients. Recurrence was reported in one patient with serous type after approximately 26 months. The most common pathological type in our cohort was the mucinous borderline type reported in 14 patients (51.9%), followed by the serous type reported in 11 patients (40.7%), and the seromucinous type in 1 patient only. Patients with mucinous borderline type were significantly younger (40.083 ± 18.47 vs. 53.73 ± 11.91 years, p = 0.028). Interestingly, Cancer Antigen 125 levels were significantly higher in mucinous than serous and seromucinous types [67(16–304) vs. 20(6–294.6) U/ml, p = 0.027]. On the other hand, the radiological tumor size of serous and seromucinous types was larger than that of the mucinous type [23(19–31) cm vs. 8(5–20) cm, p = 0.001]. Over a median follow-up period of 58.66 (54.16–63.16) months, only one postoperative mortality was reported, while only one recurrence was reported.ConclusionBorderline ovarian tumors still represent a dilemma either in diagnosis or management. A frozen section examination could help to reach a preliminary diagnosis. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are the cornerstone of surgical management; however, fertility-sparing surgery could be a valid option for women desiring fertility.
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Affiliation(s)
- Khaled Gaballa
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
- Correspondence: Khaled Gaballa
| | - Mohamed Abdelkhalek
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Basel Refky
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Khaled Belal
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Moustafa elaraby
- Ministry of Health, Consultant of Obstetrics and Gynecology, Mansoura, Egypt
| | - Mohammad Zuhdy
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
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Capozzi V, Cianci S, Scarpelli E, Monfardini L, Cianciolo A, Barresi G, Ceccaroni M, Sozzi G, Mandato V, Uccella S, Franchi M, Chinatera V, Berretta R. Predictive features of borderline ovarian tumor recurrence in patients with childbearing potential undergoing conservative treatment. Mol Clin Oncol 2022; 17:121. [DOI: 10.3892/mco.2022.2554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/17/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vito Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
| | - Stefano Cianci
- Department of Gynecological Oncology and Minimally‑Invasive Gynecological Surgery, Università Degli Studi di Messina, Policlinico G. Martino, I‑98125 Messina, Italy
| | - Elisa Scarpelli
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
| | - Luciano Monfardini
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
| | - Alessadra Cianciolo
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
| | - Giuseppe Barresi
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecological Oncology and Minimally‑Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS ʻSacro Cuore‑Don Calabriaʼ Hospital, I‑37024 Verona, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, I‑90127 Palermo, Italy
| | - Vincenzo Mandato
- Unit of Obstetrics and Gynecology, Azienda USL‑IRCCS di Reggio Emilia, I‑42124 Reggio Emilia, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, I‑37134 Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, I‑37134 Verona, Italy
| | - Vito Chinatera
- Department of Gynecologic Oncology, University of Palermo, I‑90127 Palermo, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University Hospital of Parma, I‑43125 Parma, Italy
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6
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Carbonnel M, Layoun L, Poulain M, Tourne M, Murtada R, Grynberg M, Feki A, Ayoubi JM. Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women. J Clin Med 2021; 10:jcm10184233. [PMID: 34575343 PMCID: PMC8467795 DOI: 10.3390/jcm10184233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
Borderline ovarian tumors (BOT) represent about 10 to 20 percent of all epithelial tumors of the ovary. They constitute intermediate lesions between benign ovarian cysts and invasive carcinomas. They often occur in young women of reproductive age, and, albeit with a favorable prognosis, it may recur on the ipsilateral or contralateral ovary. Controversies surround the diagnostic criteria used for their assessment, and the optimal management to minimize their risk of recurrence and/or transformation into malignant carcinoma. Fertility preservation (FP) is considered a priority in the management of these patients, and studies aim at finding the safest and most effective way to help women with BOT history conceive with minimal risk. We present the experience of a single institution in managing three cases of serous BOT in young nulliparous women, followed by a thorough review of the existing literature, highlighting controversies and exploring the possible FP techniques for these women.
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Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics Gynecology and Reproductive Medicine, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France; (L.L.); (M.P.); (R.M.); (J.M.A.)
- Correspondence:
| | - Laetitia Layoun
- Department of Obstetrics Gynecology and Reproductive Medicine, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France; (L.L.); (M.P.); (R.M.); (J.M.A.)
| | - Marine Poulain
- Department of Obstetrics Gynecology and Reproductive Medicine, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France; (L.L.); (M.P.); (R.M.); (J.M.A.)
| | - Morgan Tourne
- Department of Pathology, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France;
| | - Rouba Murtada
- Department of Obstetrics Gynecology and Reproductive Medicine, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France; (L.L.); (M.P.); (R.M.); (J.M.A.)
| | - Michael Grynberg
- Center of Reproductive Medicine and Biology, Hospital Antoine Béclère, University Paris-Sud, 91400 Orsay, France;
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR Fribourg Hopital Cantonal, 1708 Fribourg, Switzerland;
| | - Jean Marc Ayoubi
- Department of Obstetrics Gynecology and Reproductive Medicine, Hospital Foch, Suresnes and University Versailles, 78180 Versailles, France; (L.L.); (M.P.); (R.M.); (J.M.A.)
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7
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Ande E, Jain S, Rouabhi S, Yoong W. Unexpected borderline ovarian tumours (BOT) in late pregnancy: challenges in management and review of literature. BMJ Case Rep 2020; 13:13/12/e237970. [PMID: 33318250 PMCID: PMC7737075 DOI: 10.1136/bcr-2020-237970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This case report describes a right-sided borderline ovarian tumour diagnosed unexpectedly following suspected torsion in the third trimester of pregnancy. The patient had had a right mucinous cystadenoma and left serous cystadenoma in her previous pregnancy and underwent bilateral ovarian cystectomy at the time of her first elective caesarean section. The management of borderline ovarian tumours is generally difficult in younger women of reproductive age and is made more complex by pregnancy. The authors share the challenges of managing this condition in pregnancy together with a review of the literature.
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Affiliation(s)
- Elizabeth Ande
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Silky Jain
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Schahrazed Rouabhi
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
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8
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Rosati A, Gueli Alletti S, Capozzi VA, Mirandola M, Vargiu V, Fedele C, Uccella S, Vascone C. Role of ultrasound in the detection of recurrent ovarian cancer: a review of the literature. Gland Surg 2020; 9:1092-1101. [PMID: 32953624 DOI: 10.21037/gs-20-357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nowadays, no standard approaches for follow up in ovarian cancer (OC) patients exist. While the role of ultrasound (US) is well defined in primary diagnosis of OC, it is still controversial during follow-up of surgically treated OC. The aim of this narrative review is to evaluate the role described in literature of US imaging in the early detection of OC recurrences. A review of the English literature present in PubMed and SCOPUS of the past 30 years regarding the use of US in recurrent ovarian cancer (ROC) has been performed. The following keywords were searched: "ultrasound and recurrent ovarian cancer" and "intraoperative ultrasound and recurrent ovarian cancer". A total of 15 articles were selected. US was mainly adopted in the detection of recurrent pelvic disease after debulking surgery, after fertility sparing surgery (FSS) and as an intraoperative tool for localization of OC recurrences. If introduced as a standard follow-up procedure, US may have a central role in the early detection of pelvic OC recurrence, in ovarian localization of relapses of borderline ovarian tumor (BOT) and early stages disease treated with FSS; it may also play an important role in the intraoperative localization of previously suspected secondary lesions.
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Affiliation(s)
- Andrea Rosati
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mariateresa Mirandola
- Departmentof Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Virginia Vargiu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Ospedale degli infermi, Biella, Italy
| | - Carmine Vascone
- Department of Obstetrics and Gynecology, Pineta Grande Hospital, Castel Volturno, CE, Italy
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9
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Plett H, Ricciardi E, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Dataset on patients with Recurrent Borderline Ovarian Tumors and Table with Review of Literature on Fertility and Oncologic Outcomes of patients with Borderline Ovarian Tumors. Data Brief 2020; 30:105653. [PMID: 32395597 PMCID: PMC7206201 DOI: 10.1016/j.dib.2020.105653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
The data presented here is related to the research article entitled "FERTILITY-SPARING SURGERY AND REPRODUCTIVE-OUTCOMES IN PATIENTS WITH BORDERLINE OVARIAN TUMORS" by Plett et al. in Journal of Gynecologic Oncology [1] and is analysed and discussed in detail. 18 Patients with Recurrent Borderline Ovarian Tumors (BOT) were identified and listed in Table 1. All patients underwent treatment for primary BOT either per radical surgery (RS) or fertility sparing surgery (FSS) by the same team in Horst Schmidt Klinik (HSK) in Wiesbaden and the Department of Gynecology and Gynecologic Oncology at Kliniken Essen-Mitte between January 2000 and December 2018 and were followed up closely. Details on patients` and surgical characteristics are given as well as management of character of recurrent disease. In Table 2 important publications from the last 20 years are listed in order to visualize better the oncologic outcomes (invasive and non-invasive relapses) and calculated risks of recurrence with the purpose to understand better the important findings of the related article cited above.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Enzo Ricciardi
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F. Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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10
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Maramai M, Barra F, Menada MV, Stigliani S, Moioli M, Costantini S, Ferrero S. Borderline ovarian tumours: management in the era of fertility-sparing surgery. Ecancermedicalscience 2020; 14:1031. [PMID: 32419843 PMCID: PMC7221127 DOI: 10.3332/ecancer.2020.1031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 11/29/2022] Open
Abstract
Borderline ovarian tumours (BOTs) are ovarian neoplasms characterised by epithelial proliferation, variable nuclear atypia and no evidence of destructive stromal invasion. BOTs account for approximately 15% of all epithelial ovarian cancers. Due to the fact that the majority of BOTs occur in women under 40 years of age, their surgical management often has to consider fertility-sparing approaches. The aim of this mini-review is to discuss the state of the art of fertility-sparing surgery for BOTs with a specific focus on the extent of surgery, post-operative management and fertility.
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Affiliation(s)
- Mattia Maramai
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mario Valenzano Menada
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Stigliani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Melita Moioli
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sergio Costantini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Plett H, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol 2020; 157:411-417. [PMID: 32115229 DOI: 10.1016/j.ygyno.2020.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility sparing surgery (FSS) is an important issue. With this study we aimed to evaluate risk factors for relapses and fertility of patients after FSS. METHODS Patients diagnosed with BOT and treated between 2000 and 2018 were included. External pathological review was done in all patients. FSS was performed after individual discussion and a complete surgical staging according to FIGO, without lymphadenectomy and with a waiver for preservation of uterus and one ovary. RESULTS Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients (5.1%) relapsed and 4 cases of malignant transformation were reported (1.1%). One patient of the latter died, all others have no evidence of disease. The overall recurrence-rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV (HR = 27; 95%-CI 7.7-95; p ≤.001). 95 patients underwent FSS. Thirteen (13.7%) of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV (HR = 27; 95%-CI: 8.1-102; p ≤.001) and FSS (HR = 12; 95%-CI: 2.9-47; p = .001) remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported. CONCLUSION FSS in stage I is a safe procedure and life-birth-rates after FSS are high. More advanced FIGO stages have to be discussed individually and relapse rates have to be weighed against FSS. A central review of pathology, as we performed routinely, is mandatory and may have contributed to our low rate of invasive relapses.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany.
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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12
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[Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Diagnosis and Management of Recurrent Borderline Ovarian Tumours]. ACTA ACUST UNITED AC 2020; 48:314-321. [PMID: 32004781 DOI: 10.1016/j.gofs.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide recommendations for the diagnosis and management of the recurrence of Borderline Ovarian Tumour (BOT). METHODS Literature review by consulting Pubmed, Medline and Cochrane databases. RESULTS In the case of BOT, most of recurrences are a new BOT without invasive contingent (LE2). In the case of bilateral BOT, bilateral cystectomy is associated with a shorter recurrence time compared to unilateral oophorectomy and contralateral cystectomy (LE2). In recurrent serous BOT, cysts are usually fluid thin-walled with vegetation, corresponding in the IOTA classification to a solid unilocular cyst (LE2). A size of the cyst less than 20mm is not a sufficient to eliminate the diagnosis of recurrent serous BOT (LE2). Recurrence of mucinous BOT predominantly appears as multilocular or as solid multilocular cysts (LE4). In the case of ovarian preservation, recurrences are most often observed on the preserved ovary(s) (LE2). Non-invasive peritoneal recurrence after initial radical treatment including bilateral hysterectomy and adnexectomy is possible, mainly in patients initially diagnosed with stage II or III BOT with non-invasive peritoneal implant (LE3). Most BOT recurrences are asymptomatic, but clinical examination may allow diagnosis of recurrence (LE2). The normality of the CA 125 dosage does not rule out the diagnosis of recurrent BOT (LE2). A second conservative treatment in the event of recurrence of BOT entails the risk of new recurrence (LE2) with no impact on survival (LE4). Totalization of the adnexectomy in case of recurrence of BOT reduces the risk of new recurrence (LE2). Conservative treatment does not increase the risk of recurrence with non-invasive peritoneal implants (LE4). Conservative treatment may be offered after a first non-invasive recurrence in young women who wish to preserve their fertility (gradeC). In the absence of infiltrating tumor, chemotherapy is not indicated. The only cases for which chemotherapy can be considered are those for which there is an infiltrative component in addition to TFO.
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13
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Margueritte F, Sallee C, Lacorre A, Gauroy E, Larouzee E, Chereau E, De La Motte Rouge T, Koskas M, Gauthier T. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiology and Risk Factors of Relapse, Follow-up and Interest of a Completion Surgery]. ACTA ACUST UNITED AC 2020; 48:248-259. [PMID: 32004784 DOI: 10.1016/j.gofs.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) based on the best evidence available, concerning epidemiology of recurrence, the risk or relapse and the follow-up in case of borderline ovarian tumor after primary management, and evaluation of completion surgery after fertility sparing surgery. MATERIAL AND METHODS English and French review of literature from 2000 to 2019 based on publications from PubMed, Medline, Cochrane, with keywords borderline ovarian tumor, low malignant potential, recurrence, relapse, follow-up, completion surgery. From 2000 up to this day, 448 references have been found, from which only 175 were screened for this work. RESULTS AND CONCLUSION Overall risk of recurrence with Borderline Ovarian Tumour (BOT) may vary from 2 to 24% with a 10-years overall survival>94% and risk of invasive recurrence between 0.5 to 3.8%. Age<40 years (level of evidence 3), advanced initial FIGO stage (LE3), fertility sparing surgery (LE2), residual disease after initial surgery for serous BOT (LE2), implants (invasive or not) (LE2) are risk factors of recurrence. In case of conservative treatment, serous BOT had a higher risk of relapse than mucinous BOT (LE2). Lymphatic involvement (LE3) and use of mini invasive surgery (LE2) are not associated with a higher risk of recurrence. Scores or Nomograms could be useful to assess the risk of recurrence and then to inform patients about this risk (gradeC). In case of serous BOT, completion surgery is not recommended, after conservative treatment and fulfillment of parental project (grade B). It isn't possible to suggest a recommendation about completion surgery for mucinous BOT. There is not any data to advise a frequency of follow-up and use of paraclinic tools in general case of BOT. Follow-up of treated BOT must be achieved beyond 5 years (grade B). A systematic clinical examination is recommended during follow-up (grade B), after treatment of BOT. In case of elevation of CA-125 at diagnosis use of CA-125 serum level is recommended during follow-up of treated BOT (grade B). When a conservative treatment (preservation of ovarian pieces and uterus) of BOT is performed, endovaginal and transabdominal ultrasonography is recommended during follow-up (grade B). There isn't any sufficient data to advise a frequency of these examinations (clinical examination, ultrasound and CA-125) in case of treated BOT. CONCLUSION Risk of relapse after surgical treatment of BOT depends on patients' characteristics, type of BOT (histological features) and modalities of initial treatment. Scores and nomogram are useful tools to assess risk of relapse. Follow-up must be performed beyond 5 years and in case of peculiar situations, use of paraclinic evaluations is recommended.
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Affiliation(s)
- F Margueritte
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - C Sallee
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - A Lacorre
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - E Gauroy
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Larouzee
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - E Chereau
- Service de gynécologie-obstétrique, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - T De La Motte Rouge
- Département d'oncologie médicale, centre Eugène Marquis, avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87000 Limoges, France.
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14
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Raimond E, Bourdel N. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Surgical Management of Advanced Stages of Borderline Ovarian Tumours]. ACTA ACUST UNITED AC 2020; 48:304-313. [PMID: 32004785 DOI: 10.1016/j.gofs.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the surgical management of borderline ovarian tumors (BOT) in the framework of recommendations for clinical practice made by the National College of Obstetricians and Gynecologists (CNGOF) METHODS: This is a comprehensive review of the literature on the advanced stages of BOT. Bibliographic selection was conducted in PubMed from 2007 to 2019 inclusive, selecting publications in English and French. Articles were selected on the basis of the title, then the abstract and finally the full article. The levels of evidence of the studies were defined according to the scale proposed by the High Authority of Health (HAS). RESULTS By analogy with epithelial ovarian cancer, in case of preoperative suspicion or after a postoperative diagnosis of advanced BOT, the patient must be referred to an expert centre in ovarian cancer (gradeC). There is no data from the literature to conclude that a hysterectomy should be performed routinely, however, the goal in the advanced stages of BOT is no tumor residue (gradeC). In advanced stages of BOT, systematic lymphadenectomy is not recommended, but excision of suspected lymph node on preoperative and intraoperative evaluation, for curative purposes, may be discussed to obtain no residual disease (gradeC). It is recommended to describe peritoneal carcinomatosis before any excision as well as tumor residues at the end of surgery (grade B). The use of a peritoneal carcinomatosis score to evaluate tumor burden such as the "Peritoneal Carcinosis Index" (PCI) is recommended (gradeC). For advanced stages of BOT, a conservative treatment with at least the preservation of the uterus and an ovarian fragment in a patient wishing a pregnancy may be proposed after Multidisciplinary Concertation Meeting (GradeC). Contralateral ovary biopsy is not recommended in advanced stage BOT (GradeC) but restaging surgery associated with removal of all tumor lesions is recommended when not performed initially (GradeC). It is not possible to make a recommendation on chemotherapy indication in advanced stages even with invasive implants. CONCLUSION The weakness of the literature and the retrospective nature of BOT advanced stage studies limit the grade of the recommendations.
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Affiliation(s)
- E Raimond
- Département de gynécologie-obstétrique, CHU de Reims, université de Reims Champagne-Ardennes, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - N Bourdel
- Département de chirurgie gynécologique, CHU d'Estaing, 1, rue Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
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15
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Vo TM, Duong KA, Tran LTH, Bui TC. Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam. J Obstet Gynaecol Res 2019; 45:2055-2061. [PMID: 31368150 DOI: 10.1111/jog.14072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to determine the recurrence rate and related risk factors of borderline ovarian tumors (BOT). METHODS We conducted a retrospective cohort study with 433 patients who were surgically treated for primary BOT at Tu Du Hospital from 11/2008 to 09/2015. We used the life table method to estimate the cumulative recurrence rate. We used the log-rank test and Cox proportional hazard model to determine recurrence-associated factors. RESULTS Median follow-up time was 43 months (range: 3-105 months). Eighteen patients developed recurrence. The cumulative BOT recurrence rates at year 1, 2, 3 and 4 were 1.2% (95% confidence interval [CI] = 0.5-2.8), 3.0% (95% CI = 1.7-5.2), 4.6% (95% CI = 2.9-7.4), and 5.1% (95% CI = 3.2-8.0), respectively. In the final multivariate model, a higher recurrence rate was significantly associated with primary tumor stages (stage I vs stages II and III, hazards ratio [HR] = 4.44, 95% CI = 1.60-12.38), pre-operative tumor's capsule rupture (HR = 4.14, 95% CI = 1.78-9.64), and cystectomy (HR = 5.33, 95% CI = 1.43-19.91). CONCLUSION The overall BOT recurrence rate in women in southern Vietnam was moderate. Primary tumor stage, capsule rupture, and cystectomy were main factors associated with BOT recurrence. Appropriate follow-up strategies for patients with high-risk factors are needed for early detection and management of recurrence.
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Affiliation(s)
- Tuan M Vo
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kim A Duong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ly T-H Tran
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Thanh C Bui
- Stephenson Cancer Center, Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Borderline Ovarian Tumors: Fifteen Years' Experience at a Scottish Tertiary Cancer Center. Int J Gynecol Cancer 2019; 28:1683-1691. [PMID: 30365457 DOI: 10.1097/igc.0000000000001364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Since the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence. METHODS This retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation. RESULTS Two hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0-136 months). CONCLUSIONS To our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.
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De Decker K, ter Brugge HG, Bart J, Kruitwagen RF, Nijman HW, Kruse AJ. Borderline tumours of the ovary: Common practice in the Netherlands. Gynecol Oncol Rep 2018; 27:25-30. [PMID: 30581952 PMCID: PMC6297066 DOI: 10.1016/j.gore.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Discordance between frozen section diagnosis and the definite histopathological diagnosis and the fact that the frozen section result is not always unambiguous, may contribute to differences in clinical practice regarding perioperative treatment and follow-up of borderline ovarian tumours (BOTs) patients amongst gynaecologic oncologists, which may lead to over- and undertreatment. The aim of the study was to map the Dutch gynaecologists' preferred treatment and follow-up strategy in case of BOTs. Methods A questionnaire was sent to all Dutch gynaecologists involved in ovarian surgery with perioperative frozen section analysis, and the outcomes were assessed using descriptive statistics. Results Nearly half of the respondents (41.0%) would not perform a staging procedure in case of a BOT. In case of an ambiguous frozen section diagnosis, tending towards invasive carcinoma, a considerable number (sBOT 56.4%; mBOT 30.8%) would perform a lymph node sampling as part of the staging procedure. A relaparotomy/relaparoscopy, to perform a lymph node sampling in case of a serous or mucinous carcinoma after a BOT frozen section diagnosis, would be performed by 97.4% and 48.7% of the respondents, respectively. Conclusions A considerable number of gynaecologists would perform a staging procedure that is recommended for ovarian cancer in case of an ambiguous BOT frozen section diagnosis, especially for serous tumours. In addition, nearly all gynaecologists would perform a second procedure including a lymph node sampling in case of a serous invasive carcinoma after a BOT frozen section diagnosis, which applies to half of the gynaecologists in case of a mucinous carcinoma. In case of an unambiguous frozen section BOT diagnosis, a staging procedure is omitted by nearly half of the gynaecologists. When the frozen section BOT diagnosis is ambiguous, a full ovarian cancer staging procedure is frequently performed. Most gynaecologists perform a second procedure to complete staging when definitive diagnosis shows invasive ovarian cancer. Full staging is performed more frequently in case of serous histopathology, when compared to mucinous tumours.
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Affiliation(s)
- Koen De Decker
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
- Corresponding author at: Isala Clinics, Department of Obstetrics and Gynaecology, PO Box 10400, 8000 GK Zwolle, the Netherlands.
| | - Henk G. ter Brugge
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
| | - Joost Bart
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
| | - Roy F.P.M. Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hans W. Nijman
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
| | - Arnold-Jan Kruse
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
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Zhang W, Jia S, Xiang Y, Yang J, Jia C, Leng J. Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumor. J Int Med Res 2018; 47:96-104. [PMID: 30198356 PMCID: PMC6384450 DOI: 10.1177/0300060518795582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This study was performed to investigate the diagnostic accuracy of frozen section (FS) of mucinous borderline ovarian tumors (mBOTs) and the diagnostic value of various risk factors for misdiagnosis. Methods Patients with either an FS or permanent pathologic diagnosis of mBOT were included. Optimum cut-off values for serum tumor markers and maximal tumor diameter were determined, and risk factors for underdiagnosis of mucinous malignant ovarian tumors (mMOTs) were evaluated. The sensitivity, specificity, Youden’s index, and diagnostic odds ratio of the risk factors were assessed to determine their diagnostic value for mMOTs. Results Of 121 included patients, 97 were diagnosed with mBOTs by FS. Relatively abnormal cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) levels; bilateral tumors; and specific pathological features showed significant associations with underdiagnosis of mMOTs in the univariate analysis. The presence of specific pathological features was the only significant risk factor in the multivariate analysis. The CA125, CA19-9, and CEA levels and specific pathological features demonstrated certain diagnostic value in detecting malignant cases among FS-diagnosed mBOTs. Conclusions In patients with FS-diagnosed mBOT, significant predictors of malignancy were relatively higher CA125, CA19-9, and CEA levels; bilateral tumors; and tumors with specific pathological features.
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Affiliation(s)
- Wen Zhang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Shuangzheng Jia
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yang Xiang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Junjun Yang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Congwei Jia
- 2 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jinhua Leng
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
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Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies. Int J Gynecol Cancer 2018; 27:1833-1841. [PMID: 28816706 DOI: 10.1097/igc.0000000000001092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to find the unfavorable prognostic factors for recurrence after fertility-preserving surgery (FPS) in patients with borderline ovarian tumors (BOTs). METHODS To perform a meta-analysis to compare the recurrence rates of BOT patients after FPS according to different prognostic factors, we searched PubMed, EMBASE, and Cochrane for observational studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a fixed-effects model. RESULTS We analyzed 32 studies that included 2691 BOT patients who underwent FPS, 383 patients of whom had a relapse in the follow-up. In meta-analysis, risks associated with recurrence in patients with unilateral cystectomy (OR, 2.49; 95% CI, 1.86-3.33) or serous borderline ovarian tumors (OR, 3.15; 95% CI, 1.97-5.02) were significantly increased, and there was no significantly increased OR for patients with laparoscopy compared with those with laparotomy (OR, 0.96; 95% CI, 0.57-1.60). CONCLUSIONS Unilateral cystectomy (19.4%) and serous BOTs (19.2%) are significantly associated with higher recurrence rates, and no negative impact of laparoscopy on recurrence can be demonstrated when compared with laparotomy in the meta-analysis.
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Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol 2017; 41:49-59. [DOI: 10.1016/j.bpobgyn.2016.09.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
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Malignant and borderline epithelial ovarian tumors in the pediatric and adolescent population. Maturitas 2017; 96:45-50. [DOI: 10.1016/j.maturitas.2016.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/01/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
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22
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Ultrasonographic diagnosis and longitudinal follow-up of recurrences after conservative surgery for borderline ovarian tumors. Am J Obstet Gynecol 2016; 215:756.e1-756.e9. [PMID: 27443811 DOI: 10.1016/j.ajog.2016.07.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Borderline ovarian tumors are generally diagnosed in young women. Because of the young age of patients at first diagnosis and at recurrence, and given the good prognosis of borderline ovarian tumors, a conservative surgical approach in those women who wish to preserve their fertility is advised. In this scenario, transvaginal ultrasound examination plays a key role in the detection of borderline ovarian tumor recurrence, and in assessment of amount of normal functioning parenchyma remaining. To date, no data are available about the natural history of borderline ovarian tumor recurrence. OBJECTIVE The aim of the study was to determine growth rate of recurrent ovarian cysts by a scheduled follow-up by ultrasound examination, in women previously treated with fertility-sparing surgery due to borderline ovarian tumors. STUDY DESIGN In this prospective observational study, we collected data from 34 patients previously treated with fertility-sparing surgery due to borderline ovarian tumors, who had a suspicious recurrent lesion. The patients underwent transvaginal ultrasonographic examination every 3 months, until the clinical setting recommended proceeding with surgery. According to cyst size at study entry, they were categorized into 3 groups: ≤10 mm, 10-20 mm, and >20 mm. Summary statistics for cyst size, growth rate, and the probability of remaining within the same dimension category at first ultrasound during the follow-up were also obtained. For each cyst the growth rate was calculated as the slope of the linear interpolation between 2 consecutive measurements. RESULTS Follow-up timing (P < .001), cyst size (P < .001), and micropapillary pattern (P < .001) were factors significantly affecting the cyst growth both in univariate and multivariate analysis. According to size category at first ultrasound, growth rate ranges from a minimum of 0.06 mm/mo for cysts <10 mm up to 1.92 mm/mo for cysts >20 mm. The final histology of all recurrent lesions confirmed the same histotype of primary borderline ovarian tumors. CONCLUSION This article represents the first observational study that describes the trend in the growth rate of borderline ovarian tumor recurrence in relation to their size detected at the first ultrasound examination. The findings of this study seem to confirm, in selected patients, that a thorough ultrasonographic follow-up of borderline ovarian tumor recurrence has proven to be safe and feasible. The final goal of such management is to maximize the impact on fertility potential of these young women without worsening their prognosis.
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Gaurilcikas A, Gedgaudaite M, Strolyte D, Celkiene I, Paskauskas S, Vaitkiene D. Evaluation of a transvaginal ultrasound report quality in cases of borderline ovarian tumours: a retrospective study. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Outcome of patients with advanced-stage borderline ovarian tumors after a first peritoneal noninvasive recurrence: impact on further management. Int J Gynecol Cancer 2016; 25:830-6. [PMID: 25828751 DOI: 10.1097/igc.0000000000000437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to report the outcome of patients with advanced-stage serous borderline ovarian tumors (SBOT) after a first noninvasive recurrence and the impact of conservative treatment in that context and to define the best management for those patients. STUDY DESIGN From 1973 to 2006, 168 patients were treated at or referred to our institution for an SBOT with peritoneal implants. Their slides were reviewed by the same expert pathologist. Selection criteria were as follows: advanced stage (International Federation of Gynecology and Obstetrics ≥ II), with at least 1 recurrence (only noninvasive ones) and more than 5 years of follow-up. RESULTS Twenty patients met the inclusion criteria. The median duration of follow-up was 12 years (range, 6-23 years). Median age was 26 years (14-61 years). Initial surgical management was conservative for 14 patients and radical for 6. In the study population, 4 patients recurred, all with invasive disease. Time to invasive recurrence was at least 3 years for 3 of 4 patients. None of those 4 patients had a second-look surgery initially or after the first recurrence. Two patients had small-sized residual disease after initial management; only 1 of these 4 patients is currently alive and disease-free. There was no significant difference between conservative and radical treatment of the risk of second recurrence. CONCLUSIONS This study emphasizes the need for a long follow-up after recurrence of advanced-stage SBOT and the risk of a new invasive recurrence after a first noninvasive peritoneal recurrence. Conservative treatment does not seem as a risk factor and is still justified after a first noninvasive recurrence for young patients who desire to preserve fertility.
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Seckin KD, Karslı MF, Yucel B, Bestel M, Yıldırım D, Canaz E, Akbayır O. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol 2015; 196:60-3. [PMID: 26683535 DOI: 10.1016/j.ejogrb.2015.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT). STUDY DESIGN Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy. RESULTS A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p>0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p<0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p<0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively). CONCLUSIONS In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.
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Affiliation(s)
- Kerem Doga Seckin
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Fatih Karslı
- Obstetrics and Gynecology Department, Sami Ulus Women and Children Health Training and Research Hospital, Ankara, Turkey
| | - Burak Yucel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Melih Bestel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Yıldırım
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Emel Canaz
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akbayır
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Abstract
ObjectiveThe main purpose of this article is to explore the current practice for follow-up of gynecological cancer, pointing out the different procedures, to determine the most clinically and cost-effective surveillance strategies after the primary treatment.Materials and MethodsWe analyzed the follow up strategies for ovarian, endometrial, and cervical cancer. All of the topics discussed below arose from the “ESGO State of Art Conference—Follow-up in gynaecological malignancies” in Turin, (September 11–13, 2014;http://torino2014.esgo.org/).ResultsPhysical but these practices should be integrated with biomarkers or imaging strategies. Currently, most recommendations about follow-up are based on retrospective studies and expert opinion, and there is some disagreement on surveillance strategies due to lack of evidence-based knowledge.ConclusionsAll surveillance procedures should be evidence-based with a clearly defined purpose: there is a need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival, detection of recurrence, quality of life (QoL), and costs as outcomes.
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Vasconcelos I, de Sousa Mendes M. Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer 2015; 51:620-31. [PMID: 25661104 DOI: 10.1016/j.ejca.2015.01.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent reports have stirred the debate regarding the optimal conservative treatment for both serous and mucinous borderline ovarian tumour (BOT). The aim of this study is to examine the optimal oncological approach of conservative surgery in unilateral BOT (cystectomy (C) versus unilateral salpingo-oophorectomy (USO)) and in bilateral BOT (bilateral C (BC) versus USO+contralateral C (CC)), as well as fertility outcomes. MATERIALS AND METHODS The PubMed database and Cochrane Library were searched using the search terms (((Borderline) OR (low malignant potential)) AND (ovarian)) AND ((tumour) OR (cancer)) AND (((fertility sparing) OR (conservative)) AND surgery). RESULTS We analysed 39 studies that included 5105 women (2624 patients with serous-, 2120 patients with mucinous- and the remaining with other types of BOT), 2752 of which underwent conservative surgery (817 underwent C, 89 BC, 1686 USO and 118 USO+CC). Eight studies included only stage I patients, in 14 studies more than 90% of patients were stage I and five studies included only late-stage patients. Seven studies included only patients with serous borderline ovarian tumour (sBOT) and two only mucinous borderline ovarian tumour (mBOT). A total of 296 patients with non-invasive-, 76 patients with invasive- and 50 patients with unspecified implants were pooled. Of the patients undergoing C, BC, USO and USO+CC the pooled recurrence estimates were respectively 25.3%, 25.6%, 12.5% and 26.1%. In meta-analysis, USO was significantly favored over C with an OR for recurrence reduction=2200, 95% CI=0.793-2.841 and p<0.0001. The pooled recurrence estimate as invasive ovarian cancer was 15.4% and the pooled 95% CI was 0.120-0.196. The cumulative pregnancy rate was 55.7% with 45.4% for USO and 40.3.0% for C. CONCLUSION Cystectomy in unilateral serous BOT is significantly associated with a higher recurrence rate, albeit no impact on survival can be demonstrated. Whether this is related to the duration of follow-up, remains to be proven. Nonetheless, recent data seem to suggest that USO is advisable in the case of mucinous BOT. On the contrary, a more conservative approach (BC) should be definitively favored in bilateral BOT, which is almost always serous, because no significant difference is seen in terms of recurrence rate when compared to USO+CC.
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Affiliation(s)
- Inês Vasconcelos
- Charité, Gynecology Department, Charitéplatz 1, 10117 Berlin, Germany
| | - Miguel de Sousa Mendes
- Vivantes Neukolln Clinic, Obstetrics Department, Rudower Straße 48, 12351 Berlin, Germany
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Bendifallah S, Ballester M, Uzan C, Fauvet R, Morice P, Darai E. Nomogram to predict recurrence in patients with early- and advanced-stage mucinous and serous borderline ovarian tumors. Am J Obstet Gynecol 2014; 211:637.e1-6. [PMID: 24949545 DOI: 10.1016/j.ajog.2014.06.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/15/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recurrence prediction is a cornerstone of patient management for borderline ovarian tumors. This study aimed to develop a nomogram predicting the recurrence probability in individual patients who had received primary surgical treatment. STUDY DESIGN This retrospective multicenter study included 186 patients with borderline ovarian tumor diagnosed from January 1980 through December 2008. A multivariate logistic regression analysis of selected prognostic features was performed and a nomogram to predict recurrence was constructed. The nomogram was internally validated. RESULTS The overall recurrence rate was 34.4% (64/186), with noninvasive and invasive forms in 29% (54/186) and 5.4% (10/186) of cases, respectively. International Federation of Gynecology and Obstetrics stage, age at diagnosis, histologic subtype, completeness of surgery, and type of surgery (radical vs fertility sparing) were associated with an increased risk of recurrence and were included in the nomogram. The predictive model had a concordance index of 0.78 (95% confidence interval, 0.76-0.80) and 0.77 (95% confidence interval, 0.75-0.79) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed good calibration. CONCLUSION Our results support the use of the present nomogram based on 5 clinical and pathological characteristics to predict recurrence probability with a high concordance, hence to inform patients on surgical management. External validation is required to recommend this nomogram in routine practice.
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Affiliation(s)
- Sofiane Bendifallah
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 707, "Epidemiology, Information Systems, Modeling", Université Pierre et Marie Curie, Paris, France.
| | - Marcos Ballester
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Paris, France; INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France
| | - Catherine Uzan
- Department of Gynecologic Surgery and INSERM U 10-30, Institut Gustave Roussy, Villejuif, and Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Raffaele Fauvet
- Department of Obstetrics and Gynecology, Centre hospitalier Universitaire and INSERM ERI-12, Université de Picardie Jules Vernes, Amiens, France
| | - Philippe Morice
- Department of Gynecologic Surgery and INSERM U 10-30, Institut Gustave Roussy, Villejuif, and Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Emile Darai
- Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Institut Universitaire de Cancérologie, Paris, France; INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France
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Park JM, Kim MK. Hereditary risk evaluation for borderline ovarian tumors based on immunohistochemistry. J Menopausal Med 2014; 20:14-20. [PMID: 25371887 PMCID: PMC4217565 DOI: 10.6118/jmm.2014.20.1.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives Borderline ovarian tumors (BOT) are premalignant lesions. Approximately 10% of all epithelial ovarian cancers are known to be hereditary with hereditary breast and ovarian cancer (HBOC) accounting for approximately 90% of cases; the remaining 10% are attributable to Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC). The aim of our study is to estimate this risk based on screening immunohistochemistry (IHC). Methods Thirty-four patients diagnosed with BOT were identified. Family history, clinical characteristics, and IHC data (breast cancer 1, early onset [BRCA1], breast cancer 2, early onset [BRCA2], mutS homolog 2 [MSH2], mutL homolog 1 [MLH1]) were collected for all cases from the patients' medical charts. Nuclear staining of the tumor was scored as negative and positive. Results Among 32 patients, 14 (44%) had serous type and 18 (56%) had mucinous type. The mean patient age was 44 years (range 19-86).The number of patients with weak IHC staining for MSH2 and BRCA2 was 1 (3%) and 6 (19%) respectively. The median follow up was 21.8 months. Conclusion According to the results, we discovered that 3% and 19% of patients with BOT had a risk of hereditary cancer based on IHC analysis respectively. This pilot study may help clinician to counsel effectively for confirmative tests.
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Affiliation(s)
- Jung Min Park
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyu Kim
- Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Patrono MG, Minig L, Diaz-Padilla I, Romero N, Rodriguez Moreno JF, Garcia-Donas J. Borderline tumours of the ovary, current controversies regarding their diagnosis and treatment. Ecancermedicalscience 2013; 7:379. [PMID: 24386008 PMCID: PMC3869475 DOI: 10.3332/ecancer.2013.379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Indexed: 12/02/2022] Open
Abstract
Borderline ovarian tumours generally affect women of reproductive age. The positive prognosis is related to the fact that over 80% of cases are diagnosed at an early stage of the disease. Although radical surgery is the standard of care for this disease, fertility-sparing surgery can be performed in selected cases. Since it was first described in 1929, the knowledge of the molecular and histologic characteristics has been significantly improved. In this review, advances in the clinical behaviour, pathologic characteristics, prognostics factors, and different strategies of treatment are discussed.
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Affiliation(s)
- María Guadalupe Patrono
- Gynaecology Oncology Programme, Clara Campal Comprehensive Cancer Centre, HM Hospitals, Madrid 28050, Spain
| | - Lucas Minig
- Gynaecology Oncology Programme, Clara Campal Comprehensive Cancer Centre, HM Hospitals, Madrid 28050, Spain
| | - Ivan Diaz-Padilla
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Nuria Romero
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Juan Francisco Rodriguez Moreno
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Jesus Garcia-Donas
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
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Manegold-Brauer G, Bellin AK, Tercanli S, Lapaire O, Heinzelmann-Schwarz V. The special role of ultrasound for screening, staging and surveillance of malignant ovarian tumors: distinction from other methods of diagnostic imaging. Arch Gynecol Obstet 2013; 289:491-8. [PMID: 24253338 DOI: 10.1007/s00404-013-3081-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022]
Abstract
Ovarian cancer is the most aggressive gynecologic malignancy, with a 5-year survival rate ranging around 40%. A crucial factor influencing the prognosis is early detection of a suspicious mass and referral to a gynecologic oncology center for further diagnosis, staging and debulking surgery. Here, we present the different imaging methods ultrasound (US), magnetic resonance imaging, computer tomography (CT) and 18F-fluoro-deoxyglucose positron emission tomography (PET)/CT that are used for the characterization, diagnosis, staging and surveillance of ovarian cancer. In this review, we focus on US and discuss in detail the advantages and the limitations, as well as the appropriate indications for each of the individual imaging techniques.
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Affiliation(s)
- Gwendolin Manegold-Brauer
- Ultrasound Unit, Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland,
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Franchi D, Boveri S, Fruscio R, Fischerova D, Guerriero S, Moruzzi MC, Colombo N, Timmerman D, Valentin L, Testa AC. Imaging in gynecological disease (8): ultrasound characteristics of recurrent borderline ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:452-458. [PMID: 22858859 DOI: 10.1002/uog.12276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe the sonographic characteristics of borderline ovarian tumor (BOT) recurrence. METHODS From the databases of five ultrasound centers, we retrospectively identified 68 patients with histological diagnosis of recurrent BOT who had undergone preoperative ultrasound examination. All recurrences were detected during planned follow-up ultrasound examinations. Recurrent lesions were described using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. RESULTS Sixty-two patients had a serous BOT recurrence and six a mucinous BOT recurrence. All patients except one were premenopausal, 84% of them being < 40 years old. All but one patient were asymptomatic at diagnosis of the recurrence. Fertility-sparing surgery of the recurrent tumor was performed in 57/68 (84%) patients. The most frequent ultrasound feature of recurrent serous BOT was a unilocular solid cyst (49/62, 79%) and almost half of the recurrent serous BOTs (29/62, 47%) had multiple papillary projections. In 89% of the recurrent serous BOTs there was at least one papillation with irregular surface and in 73% there was at least one papillation vascularized at color Doppler examination. Recurrent mucinous BOTs appeared mainly as multilocular or multilocular solid cysts (5/6, 83%). CONCLUSION Sonographic features of recurrent BOT resemble those described by others for different subtypes of primary BOT.
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Affiliation(s)
- D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy.
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Borderline ovarian tumors: features and controversial aspects. Eur J Obstet Gynecol Reprod Biol 2013; 167:86-9. [DOI: 10.1016/j.ejogrb.2012.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/08/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022]
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Histopathologic features of ovarian borderline tumors are not predictive of clinical outcome. Gynecol Oncol 2012; 127:516-24. [DOI: 10.1016/j.ygyno.2012.08.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/12/2012] [Accepted: 08/20/2012] [Indexed: 11/21/2022]
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Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist 2012; 17:1515-33. [PMID: 23024155 PMCID: PMC3528384 DOI: 10.1634/theoncologist.2012-0139] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/26/2012] [Indexed: 12/22/2022] Open
Abstract
Borderline ovarian tumors represent a heterogeneous group of noninvasive tumors of uncertain malignant potential with characteristic histology. They occur in younger women, are present at an early stage, and have a favorable prognosis, but symptomatic recurrence and death may be found as long as 20 years after therapy in some patients. The molecular changes in borderline ovarian tumors indicate linkage of this disease to type I ovarian tumors (low-grade ovarian carcinomas). The pathological stage of disease and subclassification of extraovarian disease into invasive and noninvasive implants, together with the presence of postoperative macroscopic residual disease, appear to be the major predictor of recurrence and survival. However, it should be emphasized that the most important negative prognostic factor for recurrence is just the use of conservative surgery, but without any impact on patient survival because most recurrent diseases are of the borderline type-easily curable and with an excellent prognosis. Borderline tumors are difficult masses to correctly preoperatively diagnose using imaging methods because their macroscopic features may overlap with invasive and benign ovarian tumors. Over the past several decades, surgical therapy has shifted from a radical approach to more conservative treatment; however, oncologic safety must always be balanced. Follow-up is essential using routine ultrasound imaging, with special attention paid to the remaining ovary in conservatively treated patients. Current literature on this topic leads to a number of controversies that will be discussed thoroughly in this article, with the aim to provide recommendations for the clinical management of these patients.
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Affiliation(s)
- Daniela Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Apolinaska 18, 120 00 Prague, Czech Republic.
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Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence. Lancet Oncol 2012; 13:e103-15. [PMID: 22381933 DOI: 10.1016/s1470-2045(11)70288-1] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
By comparison with ovarian carcinomas, borderline ovarian tumours are characterised clinically by superior overall survival, even in women with peritoneal spread. In this Review, we aimed to clarify the histological and clinical factors potentially defining a high-risk group in whom disease is likely to evolve to invasive disease. Invasive peritoneal implants (in serous borderline ovarian tumours) and residual disease after surgery were the two factors clearly identified. Other factors are controversial owing to increased risk of invasive recurrence: micropapillary patterns in serous borderline ovarian tumour, intraepithelial carcinoma in mucinous lesions, stromal microinvasion in serous lesions, and use of cystectomy in mucinous borderline ovarian tumours. The pathologist has a pivotal role in assessment of the borderline nature of ovarian tumours and in identification of high-risk criteria, most of which are histological. But, reproducibility of the histological interpretation of some of these potential criteria--eg, classification of peritoneal implants (particularly in desmoplastic subtype), stromal microinvasion, micropapillary patterns, and intraepithelial carcinoma in mucinous borderline ovarian tumours--remains unclear, and should be investigated.
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Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011; 21:951-63. [PMID: 21697684 DOI: 10.1097/igc.0b013e31821bec6b] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease.In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
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Salani R, Backes FJ, Fung MFK, Holschneider CH, Parker LP, Bristow RE, Goff BA. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 2011; 204:466-78. [PMID: 21752752 DOI: 10.1016/j.ajog.2011.03.008] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/08/2011] [Indexed: 11/30/2022]
Abstract
Although gynecologic cancers account for only 10% of all new cancer cases in women, these cancers account for 20% of all female cancer survivors. Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow. Therefore, determining the most cost-effective clinical surveillance for detection of recurrence is critical. Unfortunately, there has been a paucity of research in what are the most cost-effective strategies for surveillance once patients have achieved a complete response. Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of most gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. This article will review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy.
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Affiliation(s)
- Ritu Salani
- The Ohio State University, Columbus, 43210, USA.
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Trillsch F, Mahner S, Ruetzel J, Harter P, Ewald-Riegler N, Jaenicke F, du Bois A. Clinical management of borderline ovarian tumors. Expert Rev Anticancer Ther 2010; 10:1115-24. [PMID: 20645700 DOI: 10.1586/era.10.90] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Borderline ovarian tumors (BOTs) are epithelial tumors of the ovaries characterized by cellular proliferation and nuclear atypia but without an infiltrative growth pattern. As they frequently affect younger patients the clinical management is complicated by considerations such as preserving fertility and reducing postoperative morbidity. Over the past several decades surgical therapy has shifted from a radical approach to more conservative treatment. There are various modes of surgery applied to the patients. All these developments have to be considered from an oncologic standpoint as BOTs represent a potentially malignant disease. Oncologic safety, as well as patients' desires and expectations, have to be balanced to reach the most appropriate treatment for BOTs. For this reason current literature will be discussed in this review to give a thorough overview of this topic and to develop recommendations for the surgical management of these patients. Open questions will be identified to elaborate the need for future surveys and research.
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Affiliation(s)
- F Trillsch
- University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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40
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Poncelet C, Fauvet R, Yazbeck C, Coutant C, Darai E. Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: multivariate analysis of a French multicentre study. Eur J Surg Oncol 2010; 36:1066-72. [PMID: 20817462 DOI: 10.1016/j.ejso.2010.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the contribution of preoperative serum tumor markers to manage borderline ovarian tumors (BOT). STUDY DESIGN Retrospective multicentre study including 317 BOT. Serum tumor marker levels of CA125, CA19-9, CEA, and CA15-3 were determined by radio-immunoassay. RESULTS Among 181 women with serous BOT and 136 women with mucinous BOT, respectively 55 of 114 (48.2%) and 38 of 91 (41.8%) had at least one abnormal value. Women with preoperative tumor marker assays were more likely to have radical treatment (p=0.0001), full staging (p=0.004), and intra-operative histology (p<0.0001). Women with at least one abnormal tumor marker were more likely to undergo laparotomy (p=0.007), to have intra-operative histology (p=0.04) and complete staging (p=0.0008). In multivariate analysis, first-line laparoscopy was associated with abnormal tumor marker levels (OR=9.63; 95%CI=1.40-66.39; p=0.02), while laparotomy was associated with large tumors, bilateral tumors, and ascitis visible on sonography. CONCLUSION Serum tumor marker assays modified both preoperative assessment and surgical management of BOT.
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Affiliation(s)
- C Poncelet
- Hôpital Tenon, AP-HP, CancerEst, Université Pierre et Marie Curie Paris VI, France
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41
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Giorgini M, Marchetti C, Di Donato V, Tesei J, Manci N, Panici PB. Limits of ¹⁸F-fluorodeoxyglucose positron emission tomography in recurrence diagnosis of borderline ovarian tumor. Int J Gynecol Cancer 2010; 20:694-7. [PMID: 20973259 DOI: 10.1111/igc.0b013e3181da2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Most borderline ovarian tumors (BOT) occur in young women and exhibit a low malignant behavior. Nevertheless, an accurate long-term follow-up is required because, frequently, recurrence arises after many years from primary treatment, especially in patients affected by BOT with invasive peritoneal implants, which have a worse prognosis. We report the case of a pelvic recurrence of serous BOT firstly suspected by physical examination but misdiagnosed by ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography and identified only by magnetic resonance imaging, 7 years after primary treatment. We also reviewed the literature concerning the role of ¹⁸F-fluorodeoxyglucose positron emission tomography in the management and follow-up of BOT.
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Affiliation(s)
- Margherita Giorgini
- Department of Obstetrics and Gynecology, University of Rome "Sapienza", Rome, Italy
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42
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Uzan C, Kane A, Rey A, Gouy S, Pautier P, Lhomme C, Duvillard P, Morice P. How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ovary. Ann Oncol 2010; 22:631-635. [PMID: 20713420 DOI: 10.1093/annonc/mdq414] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour. PATIENTS AND METHODS From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed. RESULTS The median follow-up interval was 8.2 years (range 19-286 months). The mode of diagnosis of recurrences was imaging (n = 19), clinical symptoms (n = 8), cancer antigen (CA) 125 elevation (n = 7), secondary surgery (n = 5) and unknown (n = 6). The median time to recurrence was 31 months (range 4-242 month). The type of recurrence was invasive low-grade serous carcinoma in 14 patients. Five patients died of recurrent tumour. Among the 39 patients with a known mode of diagnosis of recurrence, the most frequent diagnostic method for invasive recurrences was blood CA 125 elevation (6 of 13) and the majority of noninvasive recurrences were diagnosed by imaging (16 of 23). CONCLUSIONS This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.
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Affiliation(s)
- C Uzan
- Department of Gynecologic Surgery
| | - A Kane
- Department of Gynecologic Surgery
| | - A Rey
- Department of Biostatistics
| | - S Gouy
- Department of Gynecologic Surgery
| | | | | | - P Duvillard
- Department of Pathology, Institut Gustave Roussy
| | - P Morice
- Department of Gynecologic Surgery; Department of University Paris Sud, Villejuif, France.
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Abstract
OBJECTIVE Borderline ovarian tumors comprise a unique group of noninvasive ovarian neoplasms with characteristic histology and variable tumor biology that typically manifest as low-stage disease in younger women with resultant excellent prognosis. CONCLUSION Borderline tumors are considered to be precursors of low-grade ovarian cancers. Accurate diagnosis and staging facilitate optimal patient management particularly in patients desiring to preserve fertility.
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Kolwijck E, Thomas CM, Bulten J, Massuger LF. Preoperative CA-125 Levels in 123 Patients With Borderline Ovarian Tumors. Int J Gynecol Cancer 2009; 19:1335-8. [DOI: 10.1111/igc.0b013e3181a83e04] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Koskas M, Madelenat P, Yazbeck C. [Ovarian low malignant potential tumor: how to preserve fertility?]. ACTA ACUST UNITED AC 2009; 37:942-50. [PMID: 19819742 DOI: 10.1016/j.gyobfe.2009.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
Abstract
Ovarian low malignant potential tumor account for 10 to 20 percent of ovarian epithelial tumors. They differ from typical ovarian cancers in that they do not grow into the ovarian stroma. Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers tend to affect women at a younger age than the typical ovarian cancers and are less life-threatening than most ovarian cancers. Guidelines for surgical treatment of borderline ovarian tumors are similar to those for ovarian cancer and include hysterectomy with bilateral salpingo-oophorectomy. However, patients with borderline ovarian tumors tend to be younger than women with invasive ovarian cancer. For many of these patients, fertility is an important issue. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Despite infrequent data, this observation has been expanded to include women with advanced-stage disease. Recurrence is noted more often after this type of treatment, but does not seem to have a negative effect on survival. Management of conservative treatment (complete staging, cystectomy or oophorectomy, oophorectomy or adnexectomy) are still under debate since none avoids the malignant transformation risk. Thus, close follow-up is mandatory and the optimal moment for final oophorectomy remains unclear. When ovarian preservation is impossible, oocyte/ovarian cryopreservation or emergency ovarian induction before the surgical procedure to obtain embryos are promising but still under evaluated options.
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Affiliation(s)
- M Koskas
- Service de gynécologie-obstétrique, maternité Aline-de-Crépy, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
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Lenhard MS, Nehring S, Nagel D, Mayr D, Kirschenhofer A, Hertlein L, Friese K, Stieber P, Burges A. Predictive value of CA 125 and CA 72-4 in ovarian borderline tumors. Clin Chem Lab Med 2009; 47:537-42. [PMID: 19317653 DOI: 10.1515/cclm.2009.134] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this study was to assess the prognostic value of cancer antigen (CA) 125 and CA 72-4 in patients with ovarian borderline tumor (BOT). METHODS All women diagnosed and treated for BOT at our institution between 1981 and 2008 were included into this retrospective study (n=101). Preoperatively collected serum samples were analyzed for CA 125 (Architect, Abbott and Elecsys, Roche) and CA 72-4 (Elecsys, Roche) with reference to clinical data and compared to healthy women (n=109) and ovarian cancer patients (n=130). RESULTS With a median of 34.7 U/mL (range 18.1-385.0 U/mL) for CA 125 and 2.3 U/mL (range 0.2-277.0 U/mL) for CA 72-4, serum tumor markers in BOT patients were significantly elevated as compared to healthy women with a median CA 125 of 13.5 U/mL (range 4.0-49.7 U/mL) and median CA 72-4 of 0.8 U/mL (range 0.2-20.6 U/mL). In addition, there was a significant difference compared with ovarian cancer patients who showed a median CA 125 of 401.5 U/mL (range 12.5-35,813 U/mL), but no difference was observed for CA 72-4 (median 3.9 U/mL, range 0.3-10,068 U/mL). Patients with a pT1a tumor stage had significantly lower values of CA 125 but not of CA 72-4 compared with individuals with higher tumor stages (median CA 125 29.9 U/mL for pT1a vs. 50.9 U/mL for >pT1a; p=0.014). There was a trend for increased concentrations of CA 125 but not of CA 72-4 in the presence of ascites, endometriosis or peritoneal implants at primary diagnosis. With respect to the prognostic value of CA 125 or CA 72-4, CA 125 was significantly higher at primary diagnosis in patients who later developed recurrence (251.0 U/mL vs. 34.65 U/mL, p=0.012). CONCLUSIONS Serum CA 125 and CA 72-4 concentrations in BOT patients differ from healthy controls and patients with ovarian cancer. CA 125, but not CA 72-4, at primary diagnosis correlates with tumor stage and tends to be increased in the presence of ascites, endometriosis or peritoneal implants. Moreover, CA 125 at primary diagnosis appears to have prognostic value for recurrence.
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Affiliation(s)
- Miriam S Lenhard
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany.
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47
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Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors. Fertil Steril 2009; 92:736-41. [DOI: 10.1016/j.fertnstert.2008.07.1716] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/11/2008] [Accepted: 07/09/2008] [Indexed: 11/22/2022]
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48
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Gu P, Pan LL, Wu SQ, Sun L, Huang G. CA 125, PET alone, PET–CT, CT and MRI in diagnosing recurrent ovarian carcinoma. Eur J Radiol 2009; 71:164-74. [DOI: 10.1016/j.ejrad.2008.02.019] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/19/2008] [Accepted: 02/20/2008] [Indexed: 12/27/2022]
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49
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Cadron I, Leunen K, Van Gorp T, Amant F, Neven P, Vergote I. Management of borderline ovarian neoplasms. J Clin Oncol 2007; 25:2928-37. [PMID: 17617524 DOI: 10.1200/jco.2007.10.8076] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Over the last decades, the management of borderline ovarian tumors (BOTs) has changed from radical surgery to more conservative therapy as a result of the need for fertility-sparing surgery and the increasing use of laparoscopy. The question is whether this is good clinical practice from an oncologic point of view. Here, recent literature regarding management of borderline ovarian neoplasms is reviewed, and oncologic concerns are discussed with emphasis on the mode of surgery and the possibility of fertility-sparing surgery and its consequences. Proper staging is defined as an exploration of the entire abdominal cavity with peritoneal washings, infracolic omentectomy, and multiple peritoneal biopsies as the cornerstone of a successful treatment, and this is only possible through a midline incision. For stage I disease, conservative surgery consisting of unilateral salpingo-oophorectomy or cystectomy in case of bilateral ovarian involvement or when the disease develops in the only remaining ovary is a valuable alternative in a number of young patients who want to preserve their fertility. Patients with advanced-stage disease or who are finished childbearing are treated with radical surgery consisting of peritoneal washings, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, complete peritoneal resection of macroscopic lesions, or multiple peritoneal biopsies; in case of mucinous BOTs, patients also are treated with an appendectomy.
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Affiliation(s)
- Isabelle Cadron
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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50
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Silva-Filho AL, Carmo GAL, Athayde GRS, Assis ME, Almeida RC, Leal RHS, Lamaita RM, Santos-Júnior JL, Castro e Silva JG. Safe fertility-preserving management in gynecological malignancies. Arch Gynecol Obstet 2007; 275:321-30. [PMID: 17219164 DOI: 10.1007/s00404-006-0271-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To provide a review in the available literature about the safe fertility-preserving management in gynecological malignancies, focusing on the selection criteria of the patients, treatment options and follow-up. DESIGN Literature survey. RESULTS The incidence of cancer in women who still want to get pregnant is increasing significantly. An early detection in gynecological malignancies allows less aggressive approaches to cure such disorders. A more conservative management, which preserves fertility, is considered safe and an option for those who have not completed their child-bearing. CONCLUSIONS Selected patients with cervical, endometrial and ovarian cancer may be candidates to a safe fertility-preserving management. A careful stage and follow-up of the patients is essential to achieve success with this practice.
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Affiliation(s)
- Agnaldo L Silva-Filho
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, School of Medicine, Avenida Professor Alfredo Balena 190, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil.
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