Rosie McBain

Borderline tumours of the ovary: A 37‐year experience at a tertiary referral centre

IntroductionBorderline ovarian tumours (BOT) are a common epithelial ovarian tumours. Typically diagnosed at an early stage with a good prognosis, many BOT are treated conservatively. Recurrence is common. This update to our last audit in 1997 represents one of the largest audits of BOT to date.Materials and MethodsAll patients with BOT managed at ‘the hospital’ from 1984 to 2021 were included. Expert pathology review was available.ResultsThere were 549 cases included. The recurrence rate was 5% (n = 29/549) with 1.4% (n = 8/549) undergoing malignant transformation. Three of the eight women who recurred as cancer died from their disease. Frozen section was predictive of histologic diagnosis in 92% (n = 55/60) of serous tumours (SBOT), but only 62% (n = 54/87) of mucinous tumours (MBOT). In MBOT where the appendix appeared normal intra‐operatively, it was histologically benign in all cases (n = 63). In SBOT, the recurrence rate was 5/23 (22%), 12/52 (23%), 1/29 (3%) and 3% (P = <0.01) for unilateral cystectomy, unilateral oophorectomy ± cystectomy, bilateral oophorectomy, and bilateral oophorectomy with hysterectomy, respectively, as index procedure. In MBOT this correlated to 2/20 (10%), 3/93 (3%), 0 and 1/58 (2%), respectively.DiscussionThis study describes important information correlating first surgical procedure and fertility‐sparing surgery to recurrence and malignant transformation. For all BOT subtypes, fertility‐preserving surgery increased the risk of recurrence and hysterectomy was not superior to removal of both ovaries. In MBOT, frozen section is of limited utility and the macroscopically normal appendix is very unlikely to be anything but benign, if MBOT is the true histologic diagnosis.

Cystic Spaces in the Endometrium on Ultrasound and Correlations With Pathological Diagnosis: A Contemporary Retrospective Cohort Study in a Tertiary Centre

ObjectivesTo determine the correlation between the ultrasound finding of cystic spaces in the endometrium and endometrial hyperplasia or cancer.Materials and MethodsWe performed a retrospective cohort study at a tertiary teaching hospital in Victoria, Australia, between January 2014 and December 2016. Patients who had a tertiary ultrasound where the endometrium was assessed and underwent endometrial sampling in the subsequent year were included.ResultsThere were 1614 patients who were included, and 154 (9.5%) had endometrial cystic spaces on ultrasound. Sensitivity, specificity, positive predictive value and negative predictive value for a histological finding of polyps were 16.3%, 93.4%, 51.3% and 72.3%, respectively; for endometrial hyperplasia without atypia (EH no A) 40.7%, 91.0%, 7.1% and 98.9%, respectively; for hyperplasia with atypia (EH with A) 25.0%, 90.8%, 5.2%, 98.4%, respectively and for endometrial cancer were 19.5%, 90.7%, 5.2% and 97.7%, respectively. When adjusted for age, endometrial thickness and the presence of polyps on ultrasound, cystic spaces increased the odds of a histologic diagnosis of polyps (adjusted odds ratio (aOR) 2.13 (95% CI 1.41–3.21) P < 0.001) or EH no A (aOR 5.20 (95% CI 2.06–13.12) P < 0.001) and reduced the odds of endometrial cancer (aOR 0.26 (0.08–0.81) P = 0.02).ConclusionCystic spaces on ultrasound are more likely to indicate the presence of EH no A or an endometrial polyp than endometrial cancer. As one in ten patients who had cystic spaces on tertiary ultrasound had a pathologic diagnosis of EH with A or carcinoma, there remains a need for sampling in this group until better data are available.