Restaging surgery for women with borderline ovarian tumors

Fauvet, R.; Boccara, Joëlle; Dufournet, Charlotte; David-Montefiore, Emmanuel; Poncelet, C.; Daraı̈, Émile

doi:10.1002/cncr.20098

Cited by 139 publications

(101 citation statements)

References 70 publications

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“…According to our results, in 9 -20% of the evaluated hospitals, a pelvic, and in 3 -7%, a para-aortal lymph node dissection were performed. These data are in accordance with other international trials (Fauvet et al, 2004;Cusido et al, 2007;Kumpulainen et al, 2007).…”

Section: Surgical Therapysupporting

confidence: 93%

“…Moreover, it is not yet clear whether these lymph node implantations represent real metastases, in situ transformed secondary muellerian epithelia or hyperplastic mesothelial cells (Shiraki et al, 1992;Chang et al, 2008). Concerning the performing of lymph node resection, at least 20% of the patients with FIGO stage I have to be upgraded as belonging to FIGO stage IIIc, but the prognostic relevance is in our opinion unimportant (Fauvet et al, 2004;Sehouli et al, 2005a, b;Silva et al, 2006). According to our results, in 9 -20% of the evaluated hospitals, a pelvic, and in 3 -7%, a para-aortal lymph node dissection were performed.…”

Section: Surgical Therapymentioning

confidence: 86%

“…A general recommendation for completion of the hysterectomy cannot be suggested because of lack of a validated benefit for the patients (Fauvet et al, 2004;Cadron et al, 2007;Cusido et al, 2007). On the one hand, this is due to the fact that following conservative surgical management for BOT, the patient outcome is still excellent, but otherwise the rare recurrences usually exhibit a peritoneal location (Seidman et al, 1998;Trope et al, 2000;Yokoyama et al, 2006).…”

Section: Surgical Therapymentioning

confidence: 99%

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Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

Coumbos¹,

Sehouli

Chekerov

et al. 2009

Br J Cancer

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The aim of this survey was to analyse the standard of care in diagnostic, surgery, chemotherapy and aftercare management for patients with borderline tumours of the ovary (BOTs) in Germany. A structured questionnaire comprising different dimensions was sent to all 1114 gynaecological departments. The questionnaire could be returned anonymously. The overall response rate was 29.0% (323 departments). Most departments were on secondary care (71.8%), tertiary care (23.2%) or university hospital (5.0%) level. Most clinicians performed not more than five BOT operations (89.2%) per year. Most departments (93.2%) used in addition to classical bimanual examination and vaginal ultrasound, tumour marker CA-125 detection, CT scan, MRI or PET-CT techniques. Departments in university and tertiary care hospitals performed more often a fresh frozen section (87 vs 64%). In young women, clinicians performed much seldom unilateral salpingo-oophorectomy (92%) and only in 53% biopsies of the contralateral ovary. Generally, biopsies of the contralateral ovary were performed in 4 -53% of the patients. Chemotherapy was mostly favoured in 'high-risk' patients with tumour residual, microinvasion or invasive implants. Thus, a high grade of insecurity in diagnostic and therapy of BOT exists in some gynaecological departments and underlines the need for more educational and study activities.

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Section: Surgical Therapysupporting

confidence: 93%

Section: Surgical Therapymentioning

confidence: 86%

Section: Surgical Therapymentioning

confidence: 99%

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Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

Coumbos¹,

Sehouli

Chekerov

et al. 2009

Br J Cancer

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“…Concerning the restaging procedure, retrospective studies have shown that, even when such staging procedures are performed, they have no impact on survival in patients with BTO. [21][22][23] However, if there are no descriptions regarding the abdominal cavity and peritoneal surfaces, restaging is recommended because in 39% of BTO, the omentum is involved and 9% have invasive implants. 24 On the other hand, in cases of over-diagnosis, surgeons have concerns about fertility-preserving surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary

Kim

Park

et al. 2009

J Gynecol Oncol

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Objective:We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. Methods: All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. Results: Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0±11.4 vs. 13.7±7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients ＜ 35 years of age had fertility-preserving surgery. Conclusion: Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.

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“…Retrospective studies show that, even when such staging procedures are performed, they have no impact on the survival (9,32). In patients in whom surgery has been performed for presumed benign disease and there is no description of the abdominal cavity and peritoneal surface, we do recommend restaging because in 39% of BOTs, the omentum is involved, with 9% invasive implants (33).…”

Section: Restaging Proceduresmentioning

confidence: 99%

Management Dilemmas in Borderline Ovarian Tumor

Haritwal¹,

Makhija²,

Arora³

et al. 2014

IJWHR

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IntroductionBorderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. As the term borderline implies they clinically behave intermediate between benign and malignant tumors. Synonyms of BOT include tumors of borderline malignancy, tumors of low malignant potential, and atypical proliferative tumors (1). Histologically, the borderline tumors are defined by the presence of nuclear atypia, epithelial stratification, mitotic activity, and absence of stromal invasion (2,3). Lack of invasion of the ovarian stroma by neoplastic cells is the cardinal feature that separates BOT from invasive ovarian carcinomas (IOC). According to the World Health Organization classification schemata, 2003 (4), BOT are classified on the basis of histopathology and histogenesis into serous, mucinous, endometrioid, clear cell, and transitional (Brenner) subtypes. Serous and mucinous neoplasms constitute the majority of BOT and occur mostly in women of reproductive age. The mean age of presentation of BOT is approximately 20 years earlier than that of IOC (5). It is most frequently seen between the ages 30 and 50 years. Because BOT behaves in a much less aggressive way, in most women the condition has not spread beyond the ovary when it is diagnosed (stage 1 disease). Despite some of the histologic features suggestive of malignancy, the clinical prognosis of these tumors is excellent compared with that of invasive ovarian carcinoma. Although patients have an excellent prognosis, risk of recurrence remains in some cases (6). We present an interesting case series of BOTs and discuss the management dilemmas associated. Materials and MethodsFor literature review we performed a literature search of relevant articles that were based on management dilemmas. We searched Medline/Pubmed electronic database and "Google Scholar" search engine in the internet for articles on this topic since 1995. Additionally, the data of 4 patients with BOT, who were treated in our Institute, are reported and reviewed by medical data information and patient interview, to establishing a database for a better understanding of the management dilemmas of BOT. Case 1A 19-years-old unmarried girl presented at our hospital with the complaint of lower abdominal pain for 6 years. Menstrual cycles were irregular with excessive bleeding and pain during cycles since 4-5 years. Ultrasound (USG) examination showed right ovarian cyst measuring 10×10 cm with multiple septations and no solid area, suggestive AbstractObjective: Borderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. The aim of this study is to analyze and discuss the management dilemmas associated with BOT.

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Restaging surgery for women with borderline ovarian tumors

Cited by 139 publications

References 70 publications

Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary

Management Dilemmas in Borderline Ovarian Tumor

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