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Management of STIC in Patients Undergoing RRSO

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Management of STIC

Oncologic outcomes of incidental serous tubal intraepithelial carcinoma and associated high-grade serous carcinoma in high-risk patients undergoing risk-reducing surgery - PubMed
The study supports the critical need for timely risk-reducing surgery in high-risk populations, as well as a comprehensive pathologic examination along with vigilant post-operative surveillance. Consensus guidelines for management of serous tubal intraepithelial carcinoma are necessary to identify a …
PubMedEliane Aoun
Risk of Peritoneal Carcinomatosis After Risk-Reducing Salpingo-Oophorectomy: A Systematic Review and Individual Patient Data Meta-Analysis - PubMed
<span><i>BRCA</i>-PV carriers with STIC at RRSO have a strongly increased risk to develop PC which increases over time, although current data are limited by small numbers of events.</span>
PubMedMiranda P Steenbeek
Summary Outcomes from Steenback et al (2022)

STIC Management

Management of Serous Tubal Intra-epithelial Carcinoma varies significantly. This current publication from Canada is one of the largest series evaluating the outcomes of patients with STIC based on the treatment strategy.

Canadian Management of Serous Tubal Intraepithelial Carcinoma - PubMed
Management of serous tubal intraepithelial carcinoma varied across centers. The 5-year cumulative incidence of high-grade serous carcinoma after isolated serous tubal intraepithelial carcinoma was 5.7%, consistent with recent literature. However, multicenter pathology review revealed initial underdi …
PubMedElisabeth Spénard
KEY MESSAGEMain Findings
STIC is uncommon but clinically meaningfulIn risk‑reducing salpingo‑oophorectomies for BRCA carriers, 0.4 – 11 % contain an isolated STIC; incidence in unselected populations is lower but not negligible.
Progression risk differs sharply by genetic backgroundFive‑ and ten‑year risk of primary peritoneal carcinoma after STIC is ~10 % and ~25 % for pathogenic‑variant (PV) carriers, versus ~3 – 6 % in PV‑negative cohorts.
High‑risk carriers progress fasterMedian time to invasive cancer in BRCA/other PV cohorts is roughly 2 – 3 years, though late events still occur.
Surgical staging & adjuvant chemotherapy show no clear survival benefitMulticentre series report no significant reduction in subsequent HGSC incidence with systematic staging procedures or empiric chemotherapy compared with surveillance.
Diagnostic reproducibility is challengingExpert pathology review re‑classifies about 1 in 8 community STIC diagnoses, underscoring the need for SEE‑FIM processing and subspecialty review.

Update 03-22-26

Is it worth staging patients after an incidental diagnosis of STIC?

Peritoneal cancer risk after risk reducing salpingo-oophorectomy, impact of mutational status and STIC lesions - PubMed
These findings highlight the importance of early RRSO, meticulous tubal evaluation, and extended post-surgical surveillance in genetically at-risk women. Detection of STIC warrants tailored follow-up strategies. Further studies are needed to assess the effectiveness and morbidity of staging surgery …
PubMedClaire Saule

This is another paper in a series of retrospective reviews examining the rates of peritoneal carcinomatosis in patients with STIC at the time of risk-reduction salpingo-oophorectomy. There are two relevant questions that need to be answered in this group of patients

  • What is the risk of peritoneal carcinoma development in this group?
  • When we find STIC, should we offer restaging surgery for these patients?

From all the available literature, these three (including the one above) are the most important studies

Its worth noting, that cummulatively, 52 patients who underwent restaging, ZERO had any added value!

So, based on these data, the answers are - Roughly 1/10 patients with STIC at diagnosis will develop peritoneal carcinomatosis at 5 years, and 1/3 will develop peritoneal carcinomatosis at 10 years. Restaging is not a worthwhile endeavor.