Adherence to guideline-based preoperative and intraoperative care during Risk-Reducing Bilateral SalpingoOophorectomy among Gynecologist-Oncologists compared to General Gynecologists Pegah Bahar1, BA; Sarah Werner, MD2, Jeannine Villella2, DO; 1Zucker
School of Medicine at Hofstra/Northwell, Hempstead, NY 1Klar Leadership Development and Innovation Management Program 2Department of Gynecology/Oncology, Lenox Hill Hospital, New York, NY
BACKGROUND • Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited cancer syndrome characterized by significantly increased risk for development of breast and ovarian cancer. • Risk-Reducing Bilateral Salpingoopherectomy (rrBSO) is the only proven intervention to reduce risk of ovarian cancer in this high-risk population • Optimal surgical technique for rrBSO includes 5 distinct steps as outlined by both the Society of Gynecologic Oncology (SGO) and the American College of Obstetrics and Gynecology (ACOG) since 2005. • ACOG and SGO recommends adnexal specimens be sectioned in 2-3 mm sections, for optimal pathologic examination to enhance detection of occult malignancy • rrBSO can be performed by both general gynecologists and gynecologist oncologists.
OBJECTIVE
RESULTS
RESULTS Demographic Data
General Gynecologist Gynecologic (n = 114) Oncologist (n = 122)
Age (median, min, max)
52 (29. 77)
49 (32, 83)
BMI (median, min, max)
25.4 (18.4, 46.4)
26.8 (15.6, 54.8)
Ethnicity (frequency) Hispanic Not Hispanic Unknown
3 109 2
6 114 2
Race (frequency) Asian Native Hawaiian Black White More than one race Unknown
2 1 9 90 9 3
12 0 10 86 11 3
Table 1: Demographics by surgeon group Screened in univariable analysis and none were shown to be associated with procedure compliance
• We aim to evaluate adherence at 3 large multicenter institutions across Northwell Health to published surgical guidelines for rrBSO when performed by gynecologists oncologists compared to general gynecologists
Figure 2: Percentage of rrBSO techniques performed, by level of training All 5 Steps GO vs GYN: OR = 7.816 (95% CI: 2.640-23.138, p=0.0002)
• Retrospectively evaluate the utility of preoperative CA-125 and pelvic ultrasound as predictors of occult malignancy identified at the time of rrBSO
CONCLUSION • Our results show that gynecologic oncologists were more likely to adhere to published guidelines for rrBSO
METHODS • Retrospective review of patients who underwent rrBSO across 3 high volume, academic sites from Oct 1st, 2015 to Dec 31st 2020 was performed. • Inclusion criteria: rrBSO performed and patient had a documentation BRCA1/2 mutation or a strong family history of breast and/or ovarian cancer as documented by the operating surgeon • Exclusion criteria: patients with known gynecological cancer, suspected gynecologic pathologic as indication for their surgery, or those with rrBSO plus total hysterectomy
Figure 1: Percentage of adherence to pre-op and serial sectioning guidelines by level of training
Occult Malignancy STIC (n = 2) B-cell lymphoma (n = 1)
CA-125 Not Performed Not Performed
Serous Carcinoma (n = 2) Not Performed
• Univariable and multivariable logistic regression was used to screen variables with a p-value criterion of p < 0.05 for entry into the model selection procedure. POSTER TEMPLATES BY:
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• This demonstrates a need for institution wide education and implementation of procedural standards, as well as standardized nomenclature for dictations, to ensure provider adherence to rrBSO guidelines
Pre-Op Imaging
REFERENCES
Not Performed Not Performed Not Performed
1. 2. 3. 4.
Table 2: Characteristics of patients diagnosed with occult malignancy, 2.12% of total rrBSO population
5.
Hereditary breast and ovarian cancer syndrome. Practice Bulletin No. 182. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:130:e110-26. Sherman ME et al Pathologic Findings at rRsk-rRducing Salpingoophorectomy: Preliminary Results from GOG-0199. Journal of Clin Oncol 2014: 32(29) 3275-83. Newcomb LK, Toal CT, Rindos NB, Wang L, Mansuria SM. Risk-reducing Bilateral Salpingo-oophorectomy: Assessing the Incidence of Occult Ovarian Cancer and Surgeon Adherence to Recommended Practices. J Minim Invasive Gynecol. 2020 Nov-Dec;27(7):1511-1515. doi: 10.1016/j.jmig.2020.01.004. Epub 2020 Jan 9. PMID: 31927044. ACOG Practice Bulletin No. 103: Hereditary breast and ovarian cancer syndrome. Obstetrics Gynecol. 2009 Apr; 113(4): 957-966. doi: 10.1097/AOG.0b013e3181a106d4.PMID:19305347 Malacarne DR, Boyd LR, Long Y, Blank SV. "Best practices in risk reducing bilateral salpingo-oophorectomy: the influence of surgical specialty". World J Surg Oncol. 2017;15(1):218. Published 2017 Dec 11. doi:10.1186/s12957-017-1282-5