Abstract：
OBJECTIVE: To describe extension of ovarian tissue beyond visible and National Comprehensive Cancer Network recommended margins among patients with BRCA mutations undergoing minimally invasive risk-reducing salpingo-oophorectomy.
METHODS: A prospective study of patients with BRCA mutations who underwent minimally invasive risk-reducing bilateral salpingo-oophorectomy was conducted. Patient enrollment occurred between October 2021 and 2023. Tissue specimens were analyzed according to the Sectioning and Extensively Examining the Fimbriated End protocol.
RESULTS: Twenty women with BRCA mutations were prospectively enrolled. All patients underwent minimally invasive surgery with 70% undergoing concurrent hysterectomy (n = 14). Approximately half of these procedures were performed with robotic assistance (n = 9, 45%). One patient was admitted overnight (5%); the other nineteen were discharged on the day of surgery (95%). One patient experienced a major complication and required readmission (5%). Extension of ovarian tissue beyond the visible ovary was noted on pathologic examination of six specimens (30%). In one patient this was observed on the left (17%), in three on the right (50%), and in two bilateral extension (33%) was noted. The distance ovarian stroma extended microscopically beyond the visible ovary was between 2 and 14 mm, with a median of 5 mm. Among patients with microscopic extension of ovarian tissue, the majority (n = 5, 83%) had a BRCA2 mutation.
CONCLUSIONS: In women with BRCA mutations undergoing risk-reducing minimally invasive surgery, approximately one third had microscopic extension of ovarian stroma beyond the visible ovary. Current guidelines which recommend resection of at least 20 mm of tissue beyond the visible ovary are likely adequate in this population.
METHODS: A prospective study of patients with BRCA mutations who underwent minimally invasive risk-reducing bilateral salpingo-oophorectomy was conducted. Patient enrollment occurred between October 2021 and 2023. Tissue specimens were analyzed according to the Sectioning and Extensively Examining the Fimbriated End protocol.
RESULTS: Twenty women with BRCA mutations were prospectively enrolled. All patients underwent minimally invasive surgery with 70% undergoing concurrent hysterectomy (n = 14). Approximately half of these procedures were performed with robotic assistance (n = 9, 45%). One patient was admitted overnight (5%); the other nineteen were discharged on the day of surgery (95%). One patient experienced a major complication and required readmission (5%). Extension of ovarian tissue beyond the visible ovary was noted on pathologic examination of six specimens (30%). In one patient this was observed on the left (17%), in three on the right (50%), and in two bilateral extension (33%) was noted. The distance ovarian stroma extended microscopically beyond the visible ovary was between 2 and 14 mm, with a median of 5 mm. Among patients with microscopic extension of ovarian tissue, the majority (n = 5, 83%) had a BRCA2 mutation.
CONCLUSIONS: In women with BRCA mutations undergoing risk-reducing minimally invasive surgery, approximately one third had microscopic extension of ovarian stroma beyond the visible ovary. Current guidelines which recommend resection of at least 20 mm of tissue beyond the visible ovary are likely adequate in this population.
摘要：
目的：描述BRCA突变患者接受微创降低输卵管卵巢切除术的卵巢组织超出可见和国家综合癌症网络推荐的边缘。
方法：对接受微创降低风险双侧输卵管卵巢切除术的BRCA突变患者进行前瞻性研究。患者登记发生在2021年10月至2023年之间。根据切片和广泛检查熏制末端方案分析组织样本。
结果：有BRCA突变的20名女性前瞻性入组。所有患者均接受微创手术，其中70％同时接受子宫切除术（n=14）。这些程序中约有一半是在机器人辅助下进行的（n=9，45％）。一名患者入院过夜（5％）；另外19名患者在手术当天出院（95％）。1例患者出现严重并发症，需要再次入院（5%）。在六个标本（30％）的病理检查中，发现卵巢组织超出可见卵巢。在一名患者中，这在左侧观察到（17％），右边三个（50%），并注意到两次双边扩展（33％）。显微镜下卵巢基质延伸到可见卵巢之外的距离在2到14毫米之间，中位数为5毫米。在卵巢组织显微延伸的患者中，大多数(n=5,83%)有BRCA2突变.
结论：在BRCA突变的女性中，接受降低风险的微创手术，大约三分之一的卵巢间质在可见卵巢之外有微观延伸。目前的指南建议切除可见卵巢以外至少20毫米的组织，在这个人群中可能是足够的。
方法：对接受微创降低风险双侧输卵管卵巢切除术的BRCA突变患者进行前瞻性研究。患者登记发生在2021年10月至2023年之间。根据切片和广泛检查熏制末端方案分析组织样本。
结果：有BRCA突变的20名女性前瞻性入组。所有患者均接受微创手术，其中70％同时接受子宫切除术（n=14）。这些程序中约有一半是在机器人辅助下进行的（n=9，45％）。一名患者入院过夜（5％）；另外19名患者在手术当天出院（95％）。1例患者出现严重并发症，需要再次入院（5%）。在六个标本（30％）的病理检查中，发现卵巢组织超出可见卵巢。在一名患者中，这在左侧观察到（17％），右边三个（50%），并注意到两次双边扩展（33％）。显微镜下卵巢基质延伸到可见卵巢之外的距离在2到14毫米之间，中位数为5毫米。在卵巢组织显微延伸的患者中，大多数(n=5,83%)有BRCA2突变.
结论：在BRCA突变的女性中，接受降低风险的微创手术，大约三分之一的卵巢间质在可见卵巢之外有微观延伸。目前的指南建议切除可见卵巢以外至少20毫米的组织，在这个人群中可能是足够的。
