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Adopting a Uniform Approach to Site Assignment in Tubo-Ovarian High-Grade Serous Carcinoma: The Time has Come

Singh, Naveena F.R.C.Path.; Gilks, C. Blake M.D.; Hirshowitz, Lynn F.R.C.Path.; Wilkinson, Nafisa F.R.C.Path.; McCluggage, W. Glenn F.R.C.Path.

International Journal of Gynecological Pathology: May 2016 - Volume 35 - Issue 3 - p 230–237
doi: 10.1097/PGP.0000000000000270

There is currently sufficient evidence that nonuterine high-grade serous carcinoma (HGSC) originates in the fallopian tube in the majority of cases, but this is not uniformly reflected in our diagnostic terminology. This is because there remains wide variation in awareness and acceptance of this evidence, which conflicts with traditional views on origin. Accurate disease classification is fundamental to routine clinical practice and research, particularly at a time when exciting new approaches to therapy, early detection, and prevention are appearing on the horizon. We feel the time has come to minimize individual and institutional variations in practice, and agree on an evidence-based approach to uniform terminology and primary site assignment. In this paper we put forward a proposal for a unified approach based on published research evidence and discuss the reasons why it is vital to agree on a uniform protocol. We propose the term “Tubo-ovarian HGSC” in preference to “pelvic” or “Müllerian,” as it accurately reflects the origin of this disease in the vast majority of cases, and is unambiguous, distinguishing it clearly from uterine serous carcinoma and ovarian low-grade serous carcinomas. A detailed protocol for primary site assignment is presented for different scenarios, which is easy to follow and has been developed with a view to promoting a uniform approach worldwide.

Department of Cellular Pathology (N.S.), Barts Health NHS Trust, London

Department of Cellular Pathology (L.H.), Birmingham Women’s NHS Trust, Birmingham

Department of Pathology (N.W.), St James’s Hospital, Leeds

Department of Pathology (W.G.M), Belfast Health and Social Care Trust, Belfast, UK

Department of Anatomic Pathology (C.B.G.), Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Canada

The authors declare no conflict of interest.

Address correspondence and reprint requests to Naveena Singh, FRCPath, Department of Cellular Pathology, Barts Health NHS Trust, 2nd Floor, 80 Newark Street, London E1 2ES, UK. E-mail:

©2016International Society of Gynecological Pathologists