Canadian Management of Serous Tubal Intraepithelial Carcinoma.

Abstract

OBJECTIVE To assess the management and outcomes of patients diagnosed with an isolated serous tubal intraepithelial carcinoma lesion across Canada. METHODS This retrospective study included consecutive patients with an isolated serous tubal intraepithelial carcinoma lesion diagnosed between 2006 and 2020 at 15 Canadian centers. Cases underwent multicenter panel pathology review. RESULTS Of 107 patients, 41 serous tubal intraepithelial carcinoma cases (38.3%) were identified at prophylactic surgery for germline pathogenic variants, 36 (33.6%) at surgery for suspicion of malignancy, and 30 (28.0%) at surgery for benign conditions. Treatment groups included observation (n=62, 57.9%), staging surgery (n=35, 32.7%), and adjuvant chemotherapy (n=10, 9.3%). Median follow-up was 55.5 months (interquartile range 30.26-82.07 months). Overall, nine patients developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was not significantly different between treatment groups (P=.181); however, no patient treated with chemotherapy developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was 1.1% (95% CI, 0.1-5.3%) at 2 years and 5.7% (95% CI, 1.8-13.1%) at 5 years. No significant predictive factors were found on univariate analysis. After multicenter pathology review of 59 cases (55.1%), consensus diagnosis was reached: 45 (76.3%) with serous tubal intraepithelial carcinoma, three (5.1%) with serous tubal intraepithelial lesion, seven (11.9%) with high-grade serous carcinoma, and two (3.4%) with normal tissue. Of the cases reviewed, only 1 of 45 patients (2.2%) with confirmed serous tubal intraepithelial carcinoma developed high-grade serous carcinoma at 73 months, indicating a 5-year cumulative incidence of cancer of 2.6% (95% CI, 0.2-11.7). CONCLUSION Management of serous tubal intraepithelial carcinoma varied across centers. The 5-year cumulative incidence of high-grade serous carcinoma after isolated serous tubal intraepithelial carcinoma was 5.7%, consistent with recent literature. However, multicenter pathology review revealed initial underdiagnosed high-grade serous carcinoma, and 5-year cumulative incidence of high-grade serous carcinoma after confirmed serous tubal intraepithelial carcinoma decreased to 2.6%, underscoring the importance of diagnostic confirmation by expert pathologists to guide accurate management.