acedetection of STIC/HGSC in fallopian tube RRSO specimens from BRCA1/2 carriers to predict peritoneal HGSC
Source article: Additional sectioning and AI-assisted diagnosis reveal underdiagnosis of serous (pre)malignancies in fallopian tube specimen from BRCA1/2 carriers
Abstract: Aim Germline BRCA1/2 pathogenic variant carriers are at increased risk for high-grade serous carcinoma (HGSC) and are therefore advised to have a risk-reducing salpingo-oophorectomy (RRSO) around the age of 40. A risk of 0.9% to develop peritoneal HGSC (pHGSC) remains, which increases up to 27.5% when serous tubal intraepithelial carcinoma (STIC) is detected at RRSO. The relationship between the detection of STIC and the occurrence of pHGSC is still poorly understood. Here, we investigated the role of tissue sam…
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By August 2026, a Histopathology study re-examined fallopian tube tissue from 19 BRCA1/2 carriers who had undergone risk-reducing salpingo-oophorectomy around age 40. Using deeper sections cut at 150 μm intervals and a deep learning model to support STIC detection, the team found occult STIC or HGSC in all patients who later developed peritoneal HGSC despite having no STIC or HGSC at initial diagnosis.
The finding matters because BRCA carriers retain a 0.9% risk of peritoneal HGSC after RRSO, rising to 27.5% when STIC is found, and the origin and progression of these cancers remains debated. The results support a tubal origin and that invasiveness is not required for progression, pointing to potential changes in sampling protocols, while uncertainty remains about optimal sectioning depth, AI validation, and generalizability beyond the small four-group cohort.
- Study included 19 BRCA1/2 carriers in four groups defined by STIC status at RRSO and later development of peritoneal HGSC, with 10-year follow-up.
- Deeper sections were cut at 150 μm intervals and reviewed with a deep learning model to support STIC detection.
- All patients who developed pHGSC without STIC at initial diagnosis had occult STIC or HGSC found on deeper sections.
- Five STICs presented as serous tubal intraepithelial lesions (STILs) in adjacent slides based on low Ki-67 expression.
Additional sectioning at 150 μm intervals with deep learning support detected isolated STIC or HGSC in BRCA1/2 carriers whose initial RRSO pathology was negative but who later developed peritoneal HGSC.
Standard initial pathology of RRSO specimens missed serous (pre)malignancies in BRCA1/2 carriers, leaving occult STIC or HGSC undetected in patients who subsequently developed peritoneal HGSC.
The rundown
Researchers re-examined RRSO specimens from 19 BRCA1/2 carriers divided into STIC without pHGSC (n=5), STIC with pHGSC (n=4), no STIC and no pHGSC (n=5), and no STIC with pHGSC (n=5). They cut deeper sections at 150 μm intervals and applied a deep learning model to support detection, with follow-up of 10 years or until pHGSC development.
In the no-STIC with pHGSC group, deeper sections revealed isolated STIC or HGSC that had been absent at initial diagnosis, while no patients with STIC and pHGSC showed HGSC in deeper sections. The authors also noted STIL presentation in adjacent slides based on low Ki-67, suggesting deeper sections may add value when STIL is diagnosed.
Sources
- Peer-reviewedHistopathology2026-08-12
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