Search Results (6)

Background: Borderline ovarian tumours (BOTs) are a unique subset of epithelial ovarian neoplasms characterised by atypical epithelial proliferation without stromal invasion. BOTs are typically diagnosed at an early stage, primarily affect women of reproductive age, and have a favourable prognosis. This study aims to evaluate the clinical characteristics, surgical management, and outcomes of BOTs in a North East London cohort. Methods: A retrospective, multicentric analysis was conducted on 69 patients with histologically confirmed BOTs managed between January 2018 and December 2022 across the Barts Health NHS Trust hospitals. Clinical and demographic data, surgical details, histopathological findings, and recurrence rates were analysed. We used descriptive and exploratory statistical methods. Results: The mean age at diagnosis was 44 years, with 46.37% under 40, including 18 nulliparous women. Most tumours (91.3%) were FIGO stage I, with mucinous histology predominating (56.52%), followed by serous BOTs (27.53%). Ultrasound and MRI demonstrated 65.45% and 81.5% sensitivities for borderline or malignant features, respectively. Surgical approaches included open surgery (75.4%), laparoscopy (17.4%), and robotic-assisted procedures (2.9%). Fertility-sparing surgery (FSS) was performed in all nulliparous women under 40 years of age. Recurrence occurred in 2 cases, both in patients with prior FSS performed over a decade earlier. Conclusions: FSS is a viable option for young women, especially if nulliparous and under the age of 40, with recurrence rates comparable to radical procedures. Most patients were diagnosed early (FIGO I) with excellent prognoses. MRI proved most sensitive for diagnosis, while long-term follow-up with transvaginal ultrasound and CA-125 monitoring is crucial for detecting recurrences. Full article

Background: The aim of this study was to evaluate the serous borderline ovarian tumours (BOTs), the recurrence rates, and the factors affecting recurrence. Methods: A total of 165 patients diagnosed with serous BOT between 2004 and 2019 were included. The patients were evaluated in respect of age, preoperative CA125 levels, FIGO stage, tumour size, stromal micro-invasion, the presence of non-invasive implants, surgical procedures, and lymphadenectomy performed, or all that affects disease-free survival. Results: Early-stage BOT (stage I–II) was determined in 149 (90.3%) patients. Conservative surgery was performed in 57 (34.5%) patients. The non-invasive implantation was detected in 19 (11.5%) patients, and micro-invasion was determined in 31 (18.8%) patients. The median follow-up was 120 months, and recurrence was observed in 8 (4.8%) patients. The 5-year disease-free survival rate was 95.2%, and the 10-year disease-free survival rate was also 95.2%. Univariate analysis showed that elevated preoperative CA125 levels and the presence of micro-invasion were associated with poor disease-free survival outcomes. In the multivariate analysis, the presence of micro-invasion was the only independent poor prognostic factor (HR: 8.944, 95%CI: 2.060–38.833; p:0.003). Conclusions: The micro-invasion was the main factor for recurrence in patients with serous BOT. Full article

Borderline Ovarian Tumours (BOTs) are a heterogenous group of ovarian neoplasms which have increased mitotic activity but lack stromal invasion. We performed a narrative review of the literature, aiming to identify prognostic molecular biomarkers that can potentially be used for treatment personalisation. We identified and discussed BRAF/KRAS, Cancer Antigen 125 (Ca 125), Calprotectin, p16ink4a, and Microsatellite instability (MSI) as the most studied biomarkers related to BOTs. Overall, BRAF and KRAS mutations are associated with earlier-stage and favourable prognosis; KRASmt may indicate extraovarian disease in serous BOT (sBOT). Ca125, the only currently clinically used biomarker, can be assessed pre-operatively and has an established role in post-operative surveillance, especially when it is raised pre-operatively or a high potential for malignant transformation is suspected post-operatively. p16ink4a expression trends could also indicate the malignant transformation of the tumour. Calprotectin has an inferior specificity to Ca125 and is not yet established as a biomarker, whilst there is very limited evidence available for MSI. As new evidence is coming along with artificial intelligence platforms, these biomarkers can be integrated and used towards the development of a precision model for treatment stratification and counselling in women diagnosed with BOTs. Full article

Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage. Full article

To determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences. Full article

Background and objectives: ultrasound is considered to be the primary tool for preoperative assessment of ovarian masses; however, the discrimination of borderline ovarian tumours (BOTs) is challenging, and depends highly on the experience of the sonographer. The Assessment of Different NEoplasias in the adneXa (ADNEX) model is considered to be a valuable diagnostic tool for preoperative assessment of ovarian masses; however, its performance for BOTs has not been widely studied, due to the low prevalence of these tumours. The aim of this study was to evaluate the performance of ADNEX model for preoperative diagnosis of BOTs. Methods: retrospective analysis of preoperative ultrasound datasets of patients diagnosed with BOTs on the final histology after performed surgery was done at a tertiary oncogynaecology centre during the period of 2012–2018. Results: 85 patients were included in the study. The performance of ADNEX model based on absolute risk (AR) improved with the selection of a more inclusive cut-off value, varying from 47 (60.3%) correctly classified cases of BOTs, with the selected cut-off of 20%, up to 67 (85.9%) correctly classified cases of BOTs with the cut-off value of 3%. When relative risk (RR) was used to classify the tumours, 59 (75.6%) cases were identified correctly. Forty (70.2%) cases of serous and 16 (72.7%) cases of mucinous BOTs were identified when AR with a 10% cut-off value was applied, compared to 44 (77.2%) and 15 (68.2%) cases of serous and mucinous BOTs, correctly classified by RR. The addition of Ca125 improved the performance of ADNEX model for all BOTs in general, and for different subtypes of BOTs. However, the differences were insignificant. Conclusions: The International Ovarian Tumour Analysis (IOTA) ADNEX model performs well in discriminating BOTs from other ovarian tumours irrespective of the subtype. The calculation based on RR or AR with the cut-off value of at least 10% should be used when evaluating for BOTs. Full article