Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers - 16/01/21

Doi : 10.1016/j.jogoh.2020.101965

Cyrille Huchon ^a,^⁎ , Nicolas Bourdel ^b, Cendos Abdel Wahab ^c, Henri Azaïs ^d, Sofiane Bendifallah ^e, Pierre-Adrien Bolze ^f,^g, Jean-Luc Brun ^h,ⁱ, Geoffroy Canlorbe ^d, Pauline Chauvet ^b, Elisabeth Chereau ^j, Blandine Courbiere ^k, Thibault De La Motte Rouge ^l, Mojgan Devouassoux-Shisheboran ^m,ⁿ, Caroline Eymerit-Morin ^o,^p,^q, Raffaele Fauvet ^r, Elodie Gauroy ^s, Tristan Gauthier ^t, Michael Grynberg ^u, Martin Koskas ^s, Elise Larouzee ^s, Lise Lecointre ^v, Jean Levêque ^w,^x, Francois Margueritte ^t, Emmanuelle Mathieu D’argent ^e, Krystel Nyangoh-Timoh ^w,^x, Lobna Ouldamer ^y, Jade Raad ^u, Emilie Raimond ^z, Rajeev Ramanah ^A, Lucie Rolland ^k, Pascal Rousset ^B,^C, Christine Rousset-Jablonski ^D,^E,^F, Isabelle Thomassin-Naggara ^c, Catherine Uzan ^d, Marie Zilliox ^v, Emile Daraï ^e
^a APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France
^b Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
^c APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
^d AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
^e Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
^f Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France
^g Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
^h Service de Chirurgie Gynécologique, Centre Aliénor d’Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, France
ⁱ Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
^j Service de gynécologie obstétrique, Hopital Saint Joseph, 13005 Marseille, France
^k Centre Clinico-Biologique d’AMP, Pôle Femmes – Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
^l Département d’oncologie médicale, Centre Eugène Marquis, 35000 Rennes, France
^m Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, France
ⁿ Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
^o Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020 Paris, France
^p UPMC Paris VI, Sorbonne Universities, France
^q Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
^r Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
^s Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
^t Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
^u Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
^v Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
^w Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France
^x CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
^y Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
^z Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51000 Reims, France
^A Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000 Besançon, France
^B Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France
^C Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
^D Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France
^E Centre Hospitalier Lyon Sud, Pierre-Bénite, France
^F Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France

^⁎Corresponding author.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

pages	8
Iconographies	1
Vidéos	0
Autres	0

Abstract

The incidence (rate per 100 000) of borderline ovarian tumors (BOTs) increases progressively with age, starting at 15–19 years and peaking at around 4.5 cases per 100 000 at an age of 55–59 years (LE3) with a median age of 46 years. The five year survival for FIGO stages I, II, III and IV is 99.7 % (95 % CI: 96.2–100 %), 99.6 % (95 % CI: 92.6–100 %), 95.3 % (95 % CI: 91.8–97.4 %) and 77.1 % (95 % CI: 58.0–88.3 %), respectively (LE3).

An epidemiological association exists between the individual risk of BOT and family history of BOT and certain other cancers (pancreatic, lung, bone, leukemia) (LE3), a personal history of benign ovarian cyst (LE2), a personal history of tubo-ovarian infection (LE3), the use of a levonorgestrel intrauterine device (LE3), oral contraceptive use (LE3), multiparity (LE3), Hormonal replacement therapy (LE3), high consumption of Coumestrol (LE4), medical treatment for infertility with progesterone (LE3) and non-steroidal anti-inflammatory drug use (LE3).

Screening for BOTs is not recommended for patients (Grade C).

The overall risk of recurrence of BOTs varies between 2% and 24 %, with an overall survival greater than 94 % at 10 years, and the risk of an invasive recurrence of a BOT ranges from 0.5 % to 3.8 %. The use of scores and nomograms can be useful in assessing the risk of recurrence, and providing patients with information (Grade C).

The WHO classification is recommended for classifying BOTs. It is recommended that the presence of a microinvasive focus (<5 mm) and microinvasive carcinoma (<5 mm with an atypical nuclei and a desmoplastic stroma reaction) within a BOT be reported. In cases of serous BOT, it is recommended to specify the classic histological subtype or micropapillary / cribriform type (Grade C).

When confronted with a BOT, it is recommended that the invasive or non-invasive nature of peritoneal implants can be investigated based solely on the invasion and destruction of underlying adipose or peritoneal tissue which has a desmoplastic stromal reaction where in contact with the invasive clusters (Grade B).

For bilateral mucinous BOTs and / or in cases with peritoneal implants or peritoneal pseudomyxoma, it is recommended to also look for a primitive digestive or pancreato-biliary cancer (Grade C).

It is recommended to sample ovarian tumors suspected of being BOTs by focusing samples on vegetations and solid components, with at least 1 sample per cm in tumors with a size less than 10 cm and 2 samples per cm in tumors with a size greater than 10 cm (Grade C). In cases of BOTs and in the absence of macroscopic omental involvement after careful macroscopic examination, it is recommended to perform at least 4–6 systematic sampling blocks and to include all peritoneal implants (Grade C).

It is recommended to consult an expert pathologist in gynecology when a BOT suspicion requires intraoperative extemporaneous histology (grade C).

Endo-vaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended that a pelvic MRI be performed (Grade A). To analyze an adnexal mass with MRI, it is recommended to use an MRI protocol with T2, T1, T1 Fat Sat, dynamic and diffusion sequences as well as gadolinium injection (Grade B). To characterize an adnexal mass with MRI, it is recommended to include a score system for malignancy (ADNEX MR/O-RADS) (Grade C) in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being a BOT (Grade C). Macroscopic MRI features should be analyzed to differentiate BOT subtypes (Grade C).

Pelvic ultrasound is the first-line examination for the detection and characterization of adnexal masses during pregnancy (Grade C). Pelvic MRI is recommended from 12 weeks of gestation in case of an indeterminate adnexal mass and should provide a diagnostic score (Grade C). Gadolinium injection must be minimized as fetal impairment has been proven (Grade C).

It is recommended that serum levels of HE4 and CA125 be evaluated and that the ROMA score for the diagnosis of an indeterminate ovarian mass on imaging be used (grade A). In case of suspicion of a mucinous BOT on imaging, dosage of serum levels of CA 19−9 can be considered (Grade C).

If the determination of tumor markers is normal preoperatively, routine dosage of tumor markers in BOT follow-up is not recommended (Grade C).

In case of preoperative elevation in tumor markers, the determination of serum CA 125 levels is recommended in the follow-up of BOT (Grade B). When conservative treatment of a BOT has been adopted, the use of endovaginal and transabdominal ultrasonography is recommended during follow-up (Grade B).

Le texte complet de cet article est disponible en PDF.

Keywords : Borderline ovarian tumor, Guidelines