Postpartum Opportunistic Salpingectomy Compared With Bilateral Tubal Ligation After Vaginal Delivery for Ovarian Cancer Risk Reduction

Wagar, Matthew K.; Forlines, Grayson L.; Moellman, Nicholas; Carlson, Anisa; Matthews, Michael R.; Williams, Makeba

doi:10.1097/aog.0000000000005118

Cited by 5 publications

(2 citation statements)

References 39 publications

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“…Additionally, the cost-effectiveness of opportunistic salpingectomy compared to tubal ligation immediately after vaginal delivery was modelled by Wagar et al, showing that opportunistic salpingectomy was more cost-effective than tubal ligation with an incremental cost-effectiveness ratio (ICER) of USD 26,150/QALY, showing potential cost savings of the procedure in cases where permanent contraception is desired [101]. Similarly, compared to tubal ligation at the time of caesarean delivery, opportunistic salpingectomy was shown to have an ICER of USD 23,189/QALY [102].…”

Section: Safety Of Salpingectomymentioning

confidence: 99%

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs

Sowamber,

Lukey,

Huntsman

et al. 2023

Current Oncology

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Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.

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Section: Safety Of Salpingectomymentioning

confidence: 99%

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs

Sowamber,

Lukey,

Huntsman

et al. 2023

Current Oncology

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“…1,13,[18][19][20] However, the heterogeneity of tubal precursor lesions has not been well characterized. With the increasing adoption of opportunistic salpingectomy as a preventive measure for HGSC in average-risk women, 21,22 in addition to prophylactic salpingo-oophorectomy in the high-risk population, pathologists are likely to encounter an increasing number of tubal precursor lesions in routine surgical pathology practice. STICs are clinically significant due to their potential association with HGSC after salpingectomy.…”

mentioning

confidence: 99%

Morphologic and Molecular Heterogeneity of High-grade Serous Carcinoma Precursor Lesions

Chien,

Wang,

Huang

et al. 2024

American Journal of Surgical Pathology

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Serous tubal intraepithelial carcinoma (STIC) is the fallopian tube precursor lesion for most cases of pelvic high-grade serous carcinoma (HGSC). To date, the morphologic, molecular, and clinical heterogeneity of STIC and a less atypical putative precursor lesion, termed serous tubal intraepithelial lesion, has not been well characterized. Better understanding of precursor heterogeneity could impact the clinical management of women with incidental STICs (without concurrent carcinoma) identified in cases of prophylactic or opportunistic salpingectomy. This study analyzed morphologic and molecular features of 171 STICs and 21 serous tubal intraepithelial lesions. We assessed their histologic features, Ki-67 and p53 staining patterns, and genome-wide DNA copy number alterations. We classified all precursor lesions into 2 morphologic subtypes, one with a flat surface (Flat) and the other characterized by budding, loosely adherent, or detached (BLAD) morphology. On the basis of pathology review by a panel of 8 gynecologic pathologists, we found 87 BLAD, 96 Flat, and 9 indeterminate lesions. As compared with Flat lesions, BLAD lesions were more frequently diagnostic of STIC (P<0.0001) and were found concurrently with HGSC (P<0.0001). BLAD morphology was also characterized by higher Ki-67 proliferation index (P<0.0001), presence of epithelial stratification (P<0.0001), and increased lymphocyte density (P<0.0001). BLAD lesions also exhibited more frequent DNA copy number gain/amplification at the CCNE1 or CMYC loci canonical to HGSCs (P<0.0001). Both BLAD morphology and STIC diagnoses are independent risk factors for an elevated Ki-67 proliferation index. No correlation was observed between BLAD and Flat lesions with respect to patient age, presence of germline BRCA1/2 mutation, or p53 staining pattern. These findings suggest that tubal precursor lesions are morphologically and molecularly heterogeneous, laying the foundation for further studies on the pathogenesis of HGSC initiation and identifying histologic features predictive of poor patient outcomes.

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Salpingectomy for ectopic pregnancy reduces ovarian cancer risk—a nationwide study

Yen,

Wu,

Stone

et al. 2024

JNCI Cancer Spectrum

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Recent studies propose fallopian tubes as the tissue origin for many ovarian epithelial cancers. To further support this paradigm, we assessed whether salpingectomy for treating ectopic pregnancy had a protective effect using the Taiwan Longitudinal National-Health-Research Database. We identified 316,882 women with surgical treatment for ectopic pregnancy and 3,168,820 age- and index-date-matched controls from 2000-2016. In a nested cohort, 91.5% of cases underwent unilateral salpingectomy, suggesting that most surgically managed patients have salpingectomy. Over a follow-up period of 17 years, the ovarian carcinoma incidence was 0.0069 (95%CI : 0.0060-0.0079) and 0.0089 (95%CI : 0.0086-0.0092) in the ectopic pregnancy and the control groups, respectively (p < .001). After adjusting the events to per 100-person years, the hazard ratio in the ectopic pregnancy group was 0.70 (95%CI : 0.61-0.80). The risk reduction occurred only in epithelial ovarian cancer (HR : 0.73, CI : 0.63-0.86) and not in non-epithelial subtypes. These findings show a decrease in ovarian carcinoma incidence following salpingectomy for treating ectopic pregnancy.

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Postpartum Opportunistic Salpingectomy Compared With Bilateral Tubal Ligation After Vaginal Delivery for Ovarian Cancer Risk Reduction

Abstract: After vaginal delivery, opportunistic salpingectomy is more cost effective than bilateral tubal ligation for reducing the risk of ovarian cancer.

Cited by 5 publications

References 39 publications

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs

Morphologic and Molecular Heterogeneity of High-grade Serous Carcinoma Precursor Lesions

Salpingectomy for ectopic pregnancy reduces ovarian cancer risk—a nationwide study

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