GYN Oncologists More Likely to Follow Risk-Reducing Salpingo-Oophorectomy Guidelines

By Will Boggs MD

September 04, 2019

NEW YORK (Reuters Health) - Most gynecologic oncologists adhere to surgical guidelines for risk-reducing salpingo-oophorectomy, compared with less than half of other obstetrician-gynecologists, researchers report.

"Our data show the importance of communication, particularly between the surgeon and pathologist, to ensure that the pathologist is aware of the indication for surgery so that they can perform a thorough inspection of the tubes and ovaries," said Dr. Annelise M. Wilhite of the University of Minnesota School of Medicine, in Minneapolis.

"Our data also emphasize the importance of staying up to date on current guidelines from organizations such as the National Comprehensive Cancer Network (NCCN) and American College of Obstetricians and Gynecologists (ACOG)," she told Reuters Health by email.

According to these guidelines, the surgical protocol requires complete resection of the fallopian tube, collection of pelvic washings, ligation of the ovarian vessels 2-3 cm proximal to the ovary, and survey of the entire abdomen with biopsies as indicated.

The guidelines also recommend a detailed pathologic review that involves serial sectioning and microscopic examination of the entire specimen using the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) protocol.

Dr. Wilhite and colleagues evaluated adherence to these guidelines in 160 patients treated by 18 gynecologic oncologists and 130 patients treated by 75 ob-gyns at 10 different hospitals. They defined adherence as completing all of the following: collection of washings, complete resection of the fallopian tube, and performing the SEE-FIM pathologic protocol.

Overall, 199 cases (69%) were adherent to NCCN and ACOG recommendations, the team reports in the September issue of Obstetrics and Gynecology.

Adherence rates were more than twice as high among gynecologic oncologists as among ob-gyns (91% vs. 41%, P<0.01).

Gynecologic oncology patients were more likely to be diagnosed with occult neoplasm than were obstetrics and gynecology patients (6.3% vs. 0.8%, P=0.03).

"We would expect similar rates of cancer between the two groups, given that the patients were very similar overall," Dr. Wilhite said. "This means that adhering to the surgical and pathologic protocol likely detects more cases of early cancer, which is beneficial for patients long term."

The SEE-FIM protocol was followed in 99% of cases performed at the University hospital and in 87% of cases performed at nonuniversity hospitals (P<0.01).

"Given the high mortality from ovarian cancer and the lack of a screening test, primary prevention is of the utmost importance," Dr. Wilhite said. "If a woman has a personal or family history of ovarian cancer, referral to a genetic counselor may be warranted. If a patient is found to have a BRCA (or other high-risk) mutation, it is important they are managed by a physician with experience, who is up to date on knowledge of surgical and pathologic guidelines to ensure the best patient care."

"Patients and referring physicians can ask the surgeon if they are familiar with the guidelines and if the pathologists they work with examine the entire surgical specimen, including microscopic sectioning of the fallopian tubes and ovaries," she said.


Obstet Gynecol 2019.