Occult serous tubal intraepithelial carcinoma and high-grade serous carcinoma at risk-reducing salpingo-oophorectomy in BRCA1/2 carriers: A Czech two-center cohort.

BRCA1, BRCA2

Pathogenic BRCA1 or BRCA2 variants: occult tubo-ovarian lesions (STIC, high-grade serous carcinoma) found at risk-reducing salpingo-oophorectomy

This retrospective cohort from two Czech tertiary centres included 329 asymptomatic carriers of a pathogenic BRCA1 (n=211) or BRCA2 (n=118) variant who underwent prophylactic gynaecological surgery between November 2014 and September 2024, with histopathological assessment using the SEE-FIM protocol (sectioning and extensively examining the fimbria). Ten occult lesions were detected (3.0%; 95% CI 1.7-5.5): five serous tubal intraepithelial carcinomas (STIC, 1.5%) and five invasive high-grade serous carcinomas (HGSC, 1.5%). BRCA1 carriers accounted for eight lesions (3.8%), including all five STIC; BRCA2 carriers had two HGSC (1.7%), both after the age of 55 and with no STIC, the difference between genes not being significant (p=0.504). Occult HGSC occurred at an older age than STIC (median 55.0 vs 43.0 years; p=0.012). The authors stress that the absence of early BRCA2-associated lesions should not be used as an argument for delaying salpingo-oophorectomy beyond current recommendations.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The 3% rate of occult lesions is a reminder that full SEE-FIM examination is non-negotiable at risk-reducing salpingo-oophorectomy. With ten events, the study cannot settle whether surgery could be deferred in BRCA2 carriers, as the authors themselves acknowledge. The associations with a family history of breast cancer and smoking remain exploratory.

Analysis by Dr Thibaut Benquey