The French National Gynaecological and Obstetrics and Gynaecology Hospital (CNGOF) Guidelines for Ovarian Junction Oncology (2020, upper) || Epidemiology, Biopathology, Imaging and Biomarkers

Abstract: The incidence of junction ovarian tumors (BOTs) increases with age, the middle age of onset is 46 years old, from 15-19 years old, 55-59 years of age peak, the annual incidence rate is about 4.5 In 100,000 cases, the five-year survival rate of FIGO I, II, III and IV patients was 99.7%, 99.6%, 95.3%, and 77.1% (LE3), respectively.
high-risk factors include: family history of malignant tumors (pancreatic cancer, lung cancer, bone cancer, leukemia) (LE3), benign cysts in the ovaries (LE2), inflammation of the fallopian tube ovaries (LE3), LVO progesterone IUDs (LE3), oral contraception Drugs (LE3), progenitor (LE3), hormone replacement therapy (LE3), large amounts of coumanol (LE4), progesterone for infertility (LE3) and nonsteroidal anti-inflammatory drugs (LE3) are not recommended for screening OFS (C-grade).
BOTs recurrence risk is 2% to 24%, the total survival rate over 10 years is more than 94%, the risk of invasive recurrence is 0.5% to 3.8%, and the score and line chart help to assess the risk and provide patients with prognostic information (C-grade).
recommends the classification of BOTs using the WHO tissue classification method, and the presence of micro-immersion lesion lesions (-lt;5mm) and leaching cancers (-lt;5mm with atypical nuclei and interstitific fibrosis reactions) should be reported in the tumor, for Slurry BOTs, it is recommended to label histological subtypes or micro papyrus type/sieve type (C-grade), the invasion occurs to promote connective tissue interstitial reaction, it is recommended to determine invasive or non-invasive (B-grade) according to the underlying fat or peritometrial tissue reaction; For patients with double-sided mucus tumors and/or peritina implantation or peritometrial dummy mucus tumors, it is recommended to exclude primary digestive tract cancer or pancreatic bile duct cancer (C-grade); Tablet spacing is not more than 1cm, tumor spacing greater than 10cm is not more than 0.5cm (C-grade), if no significantly affected large retina is found, it is recommended that at least 4 to 6 system samples should include suspicious areas (C-level), when the suspect BOTs, It is recommended to consult a gynaecological pathologist (C-level) when sampling frozen during surgery.
recommended for BOTs diagnosis (A-level) by vaginal and abdominal ultrasound, pelvic MRI (A-grade) is recommended if the nature of ovarian lesions is not determined, T2, T1, T1 fat saturated sequence, dynamic sequence and diffusion sequence, and injection (B) level), the report should use a malignant tumor scoring system (MR/O-RADS) (C-grade), and put forward histological assumptions (C-grade), pelvic MRI is also recommended for suspected BOTs (C-grade), should describe MRI characteristics to distinguish BOTs subtype (C-grade).
pelvic ultrasound is the preferred method for diagnosis and identification of package blocks in the attachment area during pregnancy (C-grade), for the attachment area unknown swelling, it is recommended to start from 12 weeks of pregnancy pelvic MRI examination, requiring a diagnostic score (C-grade), should minimize the use of radon (C-grade).
recommend serum CA125 and HE4 detection and ROMA scoring system (A-level), if imaging suspect mucus tumor, it is recommended to detect serum CA199 (C-grade), if the preoperative tumor marker is normal, not Regular marker follow-up (C-grade), such as preoperative serum CA125 elevation, is recommended for postoperative follow-up (B-grade), BOTs receive conservative treatment, recommended by vaginal and abdominal ultrasound follow-up (B-grade).
Foreword ovarian junction tumors (BOTs) accounted for 10% to 20% of all ovarian endoskin tumors, the average age of onset was 10 years earlier than ovarian cancer, the prognostication was better, the five-year survival rate was 95%, the 10-year survival rate was 90%, histological types mainly include slurry and mucus.
diagnosis is more difficult, need to be carefully identified, a comprehensive understanding of ultrasound and MRI characteristics, help the choice of surgical methods.
because the patient's illness is young, the prognostication is good, the diagnosis time during pregnancy tends to be late pregnancy, therefore, the surgical treatment of BOTs patients during pregnancy tends to be conservative.
The current management of BOTs varies, and all surgical doctors should be aware of the feasibility of conservative surgery, including advanced patients, systemic hysterectomy or appendectomy without significant benefits, laparoscopic surgery can reduce postoperative rates.
late-stage BOTs surgical treatment is to reduce tumor cells, there is no need for ancillary treatment before surgery, phased or re-phased surgery must be marked FIGO phased and planted stove site.
Patients who wish to remain fertile should consult a fertility specialist to inform them that the risk of recurrence after conservative treatment is higher than that of cure surgery, requires long-term follow-up, and that recurrence may take more than 10 years, while patients undergoing root treatment need to discuss the need for hormone replacement therapy.
the French National Hospital of Gynaecology and Obstetrics (CNGOF) has developed BOTs clinical practice and management guidelines aimed at improving the level of care and setting standards that follow the French National Institutes of Health (HAS).
this paper focuses on the epidemiology, pathology, biomarkers and imaging content of BOTs.
Epidemiology 1 Epidemiological Characteristics In France, there is no BOTs epidemiological data, it is reported that BOTs account for 10% to 20% of ovarian endosthic tumors, with a mesothentic age of 46 years, 10 years ahead of endoskinal ovarian cancer, with a good prognostic prognostic (LE3).
bots patients had an overall five-year survival rate of 95%, a 10-year survival rate of 90%, FIGO I, II, III, Phase IV 5-year survival rate is 99.7% (95% CI: 96.2-1) 00%), 99.6% (95% CI: 92.6-100%), 95.3% (95% CI: 91.8-97.4%), 77.1% (95% CI: 58.0-88.3%) (LE3).
bots incidence increases with age, starting at 15-19 years of age, peaking at 55-59 years of age, with an annual incidence rate of about 4.5 per 100,000 cases (LE3).
if the ovarian tumor is considered benign, the slurry or mucus BOTs standardized risk ratio is 1.69 (95% CI: 1.39-2.03) and 1.75 (95% CI: 1.45-2.10) (LE2), the high-risk factor is under 40 years of age and real tumor (LE2), compared with malignant tumor (45.3%), BOTs are mostly one-sided (79.7%), FIGO I period accounted for 63.7% (LE3).
2 Risk factor BOTs risk associated with family history of cancer (pancreatic, lung, bone and leukemia) (LE3), benign ovary cysts (LE2), pelvic inflammation (LE3), smoking associated with mucus BOTs (LE2), obesity associated with slurry BOTs (LE2), physical activity and BOT There is no association (LE4), fallopian tube ligation is not related to BOTs (LE4), hormone therapy is associated (LE3), where the use of man-moon music reduces the risk of BOTs (0.76 95% CI 0.57-0.99) (LE3), and the conclusion of oral contraceptives is disputed. The relative risk of BOTs in women with more than
births was 0.44 (0.26 to 0.75) (LE3), hormone replacement (LE2), progesterone therapy in infertility patients was also associated with BOTs (LE3), and vitamin D was taken in large quantities Reducing the risk of slurry-based BOTs (LE4), studies of coffee, tea and caffeine have contradictory results, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with BOTs risk (LE3), and acetaminophen is associated with mucus POTS (LE3).
3 BOTs screening BOTs lack sufficient data on clinical, imaging, biomarker, and risk factors, and are not recommended for screening strategies.
4 The overall risk of recurrence of BOTs is 2% to 24% (LE2), the risk of recurrence in patients with leaching implants is 0.5% to 3.8% (LE2), and the recurrence time may exceed 10 years (LE2).
under 40 years of age is a risk factor for recurrence (LE3), while age greater than 50 is a poor prognosmation factor, progression to leaching cancer is higher risk, prognosmation difference (LE3), the risk of recurrence increases with FIGO phased (LE3).
conservative surgery was associated with a high risk of recurrence (LE2), although survival was not affected compared to root-and-treat double-sided excision.
for slurry BOTs, thorough phased surgery can reduce the risk of recurrence, but has no effect on overall survival (LE2), lesions residue can reduce progression-free survival (LE4).
The conclusions on the effects of micro-nipple type and micro-immersion on recurrence vary, for slurry BOTs, micro-nipple type and micro-immersion do not appear to be risk factors for recurrence (LE3), but micro-nipple-like structure increases the risk of recurrence (invasive recurrence or death) (LE2), and the risk of recurrence in patients with leaching lesions (LE2);
As compared to open abdominal surgery (LE2), laparoscopic surgery and lymph node injury were not associated with recurrence (LE3), CA125 abnormalities were independent risk factors for plasma BOTs recurrence (LE4), and Ouldamer scores and Bendifallah line charts were an effective tool for assessing the risk of recurrence (LE3), providing patients with prognostic information (C-grade).
Biopathology 1 Histological diagnostic criteria and classification BOTs for junction ovarian tumors consist of six histological subtypes: slurry, mucus, pulp viscosity, endometrial samples, transparent cells, Brenner, where slurry and mucus are the most common types (LE2), recommended for classification according to WHO standards.
Small nipples/sieve-like slurry BOTs are mostly two-sided, exogenous, FIGO phased over phase I, combined immersion planting (LE2), the histological type is defined as low-level invasive slurry cancer (LE3), so, For slurry-based BOTs, it is recommended to indicate histological subtypes (C-grade), assess the invasive potential of peritina implants (B-grade), increase the risk of recurrence and death of immersive growers (LE2), and recommend to assess whether the plantation stoves are immersive (B-grade).
implantation is defined as potential fat or peritiotic tissue damage associated with a substitiotic response to connective tissue growth at the contact site of the tumor.
if there is no immersive planting or uncertainty, it is recommended to define it as an undetermined type of immersion planting.
There is peritina implantation and/or two-sided mucus BOTs, which tend to have the possibility of mucus adenocarcinoma ovarian metastasis (LE3), and further examination is recommended in patients with this type of patient or peritometrial dummy tumor to exclude gastroenterology tumors or pancreatic bile cancer (C-grade).
cell BOTs is a special type, closely related to transparent cell carcinoma (LE3), it is recommended to widely extract tumor tissue to exclude transparent cell carcinoma (C-grade).
immunoglostification helps to identify BOTs histological subtypes (LE3), but it does not distinguish between junction tumors and leaching cancer, invasiveness is based entirely on morphological changes, and immunoglomeration is not recommended to identify leaching cancer (C-grade).
recommends clarifying the presence of micro-immersion lesions (-lt;5mm) or micro-immersion cancers (-lt;5mm, nucleopathic, connective tissue procreation interstitium reactions), considering the repeatability of diagnosis of tumors and implantation lesions Risk of sexuality and overdiagnosis is recommended for review by gynaecologists (C-grade): tumor edge property judgment, histological subtype, metastasis invasive, atypical slurry BOTs combined peritina transfer, mucus and transparent cell BOTs.
2 histological method suggests extensive sampling of suspected BOTs to exclude leaching cancer, especially in real areas and metastatic lesions, tumor envelopes, and changes in ligation.
For tumors with a diameter of more than 10cm, the sampling interval shall not exceed 1cm, and for tumors with a diameter greater than 10cm, the sampling interval shall not exceed 0.5cm and shall include all nipples and solid areas (C-grade).
a slurry-based BOTs with microc nipples requires a wider sampling (1cm for 2 pieces) (C-grade) to rule out micro-immersion or apparent immersion lesions (LE3).
mucus BOTs are stronger than other histological subtypes and should not ignore the risk of micro-immersion or immersive cancer, requiring wider sampling (LE3), even if the tumor diameter is 10cm, it is recommended to sample 2 pieces per centimeter (C grade).
in the event of micro-immersion or epithelial cancer, further sampling is recommended to rule out lesions (C-grade), peritina implants must be fully sourced.
without lesions to the naked eye retinal tissue, should be taken from 4 to 6 pieces (depending on the size of retinal excision) (LE3) to avoid leakage (C-grade), all lymph nodes and planting stoves should be taken from the material (C-grade).
3 The value of fast-frozen pathology in BOTs is inefficient, the compliance rate is only 69-73% (LE2), 20% to 21% of patients are underdiagnosed, 6% to 10% of patients are overdiagnosed (LE2).
attention should be paid to improving the performance of rapid freezing diagnostics and reducing overdiagnosis (LE4).
Other factors affecting diagnostic accuracy are mucus subtypes, one-sidedness (LE2), tumor volume (LE4), whether the professional level of pathology and gynaecological pathologists affect accuracy is controversial, histological type does not have a significant impact on diagnosis (LE4), and gynaecological pathologists (C-level) should be consulted when the BOTs are suspected.
4 Laparoscopic surgery specimen analysis BOTs cytological diagnostic performance (LE3), for the attachment area suspected block unsalted puncture risk of tumor spread, it is not recommended to blind puncture (C-grade).
cyst or ovaries need to be sent for a pathological examination (LE3) and the cyst cannot be treated as cytology (LE3).
taken from the lesions area peritina smear helps to determine invasiveness (LE4), the range of requirements for implantation and material removal is large enough to include tumors and adjacent tissue (C-grade).
5 Tissue fixation and transshipment preservation Cooling time, fixed type and fixed time affect morphology, protein and nucleic acid preservation (LE4), it is recommended that tissue specimens be fixed in a timely manner in neutral Formarin liquid (4% formaldehyde), no later than 1 hour after removal (C-grade), for large surgical specimens can be sealed storage at 4 degrees C, storage time can be extended to 48 hours (C-grade), fixed time of at least 6 hours