Brief family history questionnaire to screen for Lynch syndrome in women with newly diagnosed non-serous, non-mucinous ovarian cancers

2022 ◽  
pp. ijgc-2021-003082
Author(s):  
Soyoun Rachel Kim ◽  
Alicia Tone ◽  
Raymond Kim ◽  
Matthew Cesari ◽  
Blaise Clarke ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Family History ◽  
Lynch Syndrome ◽  
Microsatellite Instability ◽  
Extended Family ◽  
Screening Strategy ◽  
Newly Diagnosed ◽  
Predictive Values ◽  
Family History Questionnaire ◽  
Sensitivity Specificity

ObjectivesWhile ovarian cancer is the third most common Lynch syndrome-associated cancer in women, there is no established screening strategy to identify Lynch syndrome in this population. The objective of this study was to assess whether the 4-item brief Family History Questionnaire can be used as a screening tool to identify women with ovarian cancer at risk of Lynch syndrome.MethodsIn this prospective cohort study, participants with newly diagnosed non-serous, non-mucinous ovarian cancer completed the brief Family History Questionnaire, extended Family History Questionnaire, and had tumors assessed with immunohistochemistry for mismatch repair proteins, MLH1 methylation, and microsatellite instability testing. All underwent universal germline testing for Lynch syndrome. Performance characteristics were compared between the brief Family History Questionnaire, extended Family History Questionnaire, immunohistochemistry±MLH1 methylation, and microsatellite instability testing.ResultsOf 215 participants, 169 (79%) were evaluable with both the brief Family History Questionnaire and germline mutation status; 12 of these 169 were confirmed to have Lynch syndrome (7%). 10 of 12 patients (83%) with Lynch syndrome were correctly identified by the brief Family History Questionnaire, compared with 6 of 11 (55%) by the extended Family History Questionnaire, 11 of 13 (85%) by immunohistochemistry±MLH1 methylation, and 9 of 11 (82%) by microsatellite instability testing. The sensitivity, specificity, positive predictive values, and negative predictive values of the brief Family History Questionnaire were 83%, 65%, 15%, and 98%, respectively. A combined approach with immunohistochemistry and the brief Family History Questionnaire correctly identified all 12 patients with Lynch syndrome. The brief Family History Questionnaire was more sensitive than the extended Family History Questionnaire and took <10 min for each patient to complete.ConclusionsThe brief Family History Questionnaire alone or combined with immunohistochemistry may serve as an adequate screening strategy, especially in centers without access to universal tumor testing.

Performance characteristics of brief family history questionnaire to screen for Lynch syndrome in women with newly diagnosed ovarian cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e22525-e22525
Author(s):  
Rachel Soyoun Kim ◽  
Alicia Tone ◽  
Raymond Kim ◽  
Matthew Cesari ◽  
Blaise Clarke ◽  
...  
Keyword(s):  
Family History ◽  
Lynch Syndrome ◽  
Screening Tool ◽  
Extended Family ◽  
Gynecologic Oncology ◽  
Performance Characteristics ◽  
Newly Diagnosed ◽  
Predictive Values ◽  
Family History Questionnaire ◽  
Genetic Assessment

e22525 Background: Ovarian cancer (OC) is the third most common Lynch syndrome (LS)-associated cancer in women but there is no established screening strategy to identify LS in this population. An adequate family history may identify patients suspected of LS, prompting a referral to genetic assessment. We have previously validated the 4-item brief Family History Questionnaire (bFHQ) in endometrial cancers. The objective of this study was to assess whether bFHQ can be used as a screening tool to identify women with OC at risk of LS. Methods: Prospective cohort study recruited women with newly diagnosed non-serous/non-mucinous OC from three cancer centers in Ontario, Canada. Participants completed bHFQ, extended Family History Questionnaire (eFHQ; encompassing Amsterdam II criteria, Society of Gynecologic Oncology 20-25% criteria and Ontario Ministry of Health criteria), immunohistochemistry (IHC) for mismatch repair (MMR) proteins and universal germline testing for LS. The performance characteristics were compared between bFHQ, eFHQ, and IHC. Results: Of 215 participants, 169 (79%) were evaluable with both bFHQ and germline mutation status; 12 of these 169 were confirmed to have LS (7%). Nine of 12 patients (75%) with LS were correctly identified by bFHQ, compared to 6 of 11 (55%) by eFHQ and 11 of 13 (85%) by IHC. The sensitivity, specificity, positive predictive values and negative predictive values of bFHQ were 75%, 66%, 15% and 98%, compared to 55%, 92%, 35% and 96% for eFHQ and 85%, 90%, 39% and 99% for IHC respectively. IHC was the most sensitive and specific approach. The 4-item bFHQ was more sensitive than eFHQ and took less than 10 minutes for each patient to complete. Conclusions: Patient-administered bFHQ may serve as an adequate screening tool to triage women with OC for further genetic assessment for LS, especially in centers without access to universal tumor testing for IHC for MMR.[Table: see text]

Performance characteristics of a brief Family History Questionnaire to screen for Lynch syndrome in women with newly diagnosed endometrial cancer

2015 ◽  
Vol 136 (2) ◽  
pp. 311-316 ◽  
Author(s):  
Lua Eiriksson ◽  
Melyssa Aronson ◽  
Blaise Clarke ◽  
Golnessa Mojtahedi ◽  
Christine Massey ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
Lynch Syndrome ◽  
Performance Characteristics ◽  
Newly Diagnosed ◽  
Family History Questionnaire

Screening for Lynch syndrome in unselected women with endometrial cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5508-5508
Author(s):  
Sarah E. Ferguson ◽  
Melyssa Aronson ◽  
Lua R Eiriksson ◽  
Golnessa Mojtahedi ◽  
Aaron Pollett ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
High Risk ◽  
Lynch Syndrome ◽  
Germline Mutation ◽  
Mutation Testing ◽  
Low Grade ◽  
Newly Diagnosed ◽  
Mutation Status ◽  
Family History Questionnaire

5508 Background: Endometrial cancer (EC) is often the sentinel cancer in women with Lynch Syndrome (LS) however it is often not recognized in this population. A prospective cohort study comparing family history, immunohistochemistry (IHC) for mismatch repair (MMR) proteins, and tumour morphology to germline mutation status in MMR genes was performed in unselected women with EC to determine which screening strategy was superior in identifying women with LS. Methods: All women with newly diagnosed EC between July 2010 and June 2011 were asked to participate in the prospective screening protocol for LS which included completing an extended family history questionnaire (eFHQ), tumor assessment for LS-associated morphologic features and IHC as well as germline mutation testing. Results: 119 (n = 182, 65%) consented to the study. The median age was 61 (26-91), 96 (81%) stage I, and 42 (35%) had high risk histology. There were 6 (7.4%, n = 81) women that were germline mutation positive (MLH1 N=3; MSH6 n = 2; MSH2 n =1), representing a mutation positive rate of at least 5% in this cohort (6/119). All 3 MLH1 mutation positive women had low grade histology while mutations in MSH2/6 were exclusively found in women with high risk histology. Two of the six mutation positive women were not identified by family history. Mutation positivity was higher in women under age 50 (23%; 5/22) compared to women > age 50 (1%; 1/97)( (p = 0.0008). LS-morphologic features were found in 58 (59%, n = 98) women. The sensitivity, specificity, PPV and NPV of the LS-associated features in predicting LS mutation status was 100%, 42.6%, 7.9% and 100% compared to IHC which was 100%, 76%, 18% and 100% and eFHQ which was 67%, 84%, 27%, 97%. Conclusions: In this unselected population of women with newly diagnosed EC the germline mutation rate for LS was 2-3 times that has previously been reported. Previously described LS-associated morphologic features were not specific to germline mutation status and family history missed one third of women with LS. IHC was the best strategy to identify women with EC who should undergo germline mutation testing.

Brief family history questionnaire for identification of Lynch syndrome in women with newly diagnosed endometrial cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5026-5026
Author(s):  
Sarah E Ferguson ◽  
Blaise Clarke ◽  
Golnessa Mojtahedi ◽  
Amit M. Oza ◽  
Steve Gallinger ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
Lynch Syndrome ◽  
Medical Record ◽  
Self Report ◽  
Cancer Risk Assessment ◽  
Newly Diagnosed ◽  
Family History Questionnaire ◽  
Significant Difference ◽  
Testing Criteria

5026 Background: Endometrial cancer (EC) is often the sentinel cancer for women with Lynch syndrome (LS); however, it is underappreciated in this population. The Brief Family History Questionnaire (bFHQ) was developed to identify women with EC who have family histories suggestive of LS. The objective of our study was to evaluate the bFHQ compared to an extended family history (eFHQ) and medical record in identifying women with EC who may benefit from genetic cancer risk assessment. Methods: All women with newly diagnosed EC from July 2010 to June 2011 were asked to participate in a prospective screening protocol for LS which included completing two family history questionnaires; the bFHQ which is a 4-item self-report measure and the 37-item eFHQ administered by a research assistant. Family history was also extracted from the medical record. Using the bFHQ women were flagged as requiring additional investigation for LS based on predetermined criteria and the predictive ability of the flag was evaluated treating eFHQ as the gold standard. Comparisons were made between the bFHQ, eFHQ and medical record for families meeting Amsterdam II, Society Gynecologic Oncologist (SGO) 20-25% or the Ontario Ministry of Health (MOH) testing criteria for LS, using generalized estimating equation logistic regression models. Results: 119 (N = 182, 65%) consented to the study and 106 (89%) completed the bFHQ. The median age was 61 (26-91). The number of women who met testing criteria by the eFHQ was 17 (16%) and 33 (31%) were flagged by the bFHQ. The sensitivity, specificity, PPV and NPV of the bFHQ was 88.2%, 79.8%, 45.5% and 97.3%. There was no significant difference in the number of women who met Amsterdam II or SGO 20-25% testing criteria between the bFHQ, eFHQ and medical record (P > 0.05). The numbers of women meeting MOH criteria using the bFHQ (N=16, 15%) and the eFHQ were similar (N=17, 16%) (P = 0.7); however, more women met MOH criteria using the bFHQ and the eFHQ compared to the medical record (N=8, 7.6%) (P = 0.011; P = 0.006). Conclusions: The patient-administered bFHQ is a highly effective tool in identifying women who meet MOH testing criteria for LS and is a good screening tool to identify women with EC for further genetic assessment.

scholarly journals Prevalence of BRCA1 and BRCA2 Mutations Among Patients With Ovarian, Primary Peritoneal, and Fallopian Tube Cancer in India: A Multicenter Cross-Sectional Study

2021 ◽  
pp. 849-861
Author(s):  
Sudeep Gupta ◽  
Senthil Rajappa ◽  
Suresh Advani ◽  
Amit Agarwal ◽  
Shyam Aggarwal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Newly Diagnosed ◽  
Brca1 And Brca2 ◽  
Brca Mutations ◽  
Fallopian Tube Cancer ◽  
Cross Sectional ◽  
Brca2 Mutations ◽  
Brca1 Brca2

PURPOSE There are deficient data on prevalence of germline mutations in breast cancer susceptibility genes 1 and 2 ( BRCA1/ BRCA2) in Indian patients with ovarian cancer who are not selected by clinical features. METHODS This prospective, cross-sectional, noninterventional study in nine Indian centers included patients with newly diagnosed or relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer. The primary objective was to assess the prevalence of BRCA1/ BRCA2 mutations, and the secondary objective was to correlate BRCA1/ BRCA2 status with clinicopathologic characteristics. Mutation testing was performed by a standard next-generation sequencing assay. RESULTS Between March 2018 and December 2018, 239 patients with a median age of 53.0 (range, 23.0-86.0 years) years were included, of whom 203 (84.9%) had newly diagnosed disease, 36 (15.1%) had family history of ovarian or breast cancer, and 159 (66.5%) had serous subtype of epithelial ovarian cancer. Germline pathogenic or likely pathogenic mutations in BRCA1 and BRCA2 were detected in 37 (15.5%; 95% CI, 11.1 to 20.7) and 14 (5.9%; 95% CI, 3.2 to 9.6) patients, respectively, whereas variants of uncertain significance in these genes were seen in four (1.7%; 95% CI, 0.5 to 4.2) and six (2.5%; 95% CI, 0.9 to 5.4) patients, respectively. The prevalence of pathogenic or likely pathogenic BRCA mutations in patients with serous versus nonserous tumors, with versus without relevant family history, and ≤ 50 years versus > 50 years, were 40 of 159 (25.2%; 95% CI, 18.6 to 32.6) versus 11 of 80 (13.8%; 95% CI, 7.1 to 23.3; P = .0636), 20 of 36 (55.6%; 95% CI, 38.1 to 72.1) versus 41 of 203 (20.2%; 95% CI, 14.9 to 26.4; P < .0001), and 20 of 90 (22.2%; 95% CI, 14.1 to 32.2) versus 31 of 149 (20.8%; 95% CI, 14.6 to 28.2; P = .7956), respectively. CONCLUSION There is a high prevalence of pathogenic or likely pathogenic germline BRCA mutations in Indian patients with ovarian cancer.

FSH and LH serum/tumor fluid ratios and malignant tumors of the ovary.

2004 ◽  
Vol 11 (2) ◽  
pp. 315-321 ◽  
Author(s):  
I Rzepka-G√≥rska ◽  
A Chudecka-G≈Çaz ◽  
B Kosmowska
Keyword(s):  
Ovarian Cancer ◽  
Differential Diagnosis ◽  
Malignant Tumors ◽  
Ovarian Tumors ◽  
Predictive Values ◽  
Epithelial Tumors ◽  
Ovarian Carcinogenesis ◽  
Benign Ovarian Tumors ◽  
Sensitivity Specificity

The aim of this work was to compare mean concentrations of gonadotropins in serum and fluid from malignant and benign ovarian tumors. We enrolled 126 patients diagnosed with malignant epithelial tumors (n=40), borderline epithelial tumors (n=14), benign cystadenomas (n=28) and simple cysts (n=44) of the ovary. Premenopausal and postmenopausal subgroups were formed in each group. The concentration of FSH and LH was measured in serum and tumor fluid and the serum/tumor fluid ratio was calculated. The results in each group were compared and the sensitivity, specificity, positive and negative predictive values were determined. Mean concentrations of both gonadotropins in ovarian cancer fluid were significantly higher than in the remaining groups (P ranged from <0.005 to <0.0001). Mean serum/fluid ratios were lowest in ovarian cancer (FSH=2.91, LH=4.19). Our findings support the hypothesis that gonadotropins are involved in ovarian carcinogenesis and suggest that gonadotropin serum/tumor fluid ratios could be of value in the differential diagnosis of functional and organic cysts of the ovary.

Universal endometrial cancer tumor typing: How much has immunohistochemistry, microsatellite instability, and MLH1 methylation improved the diagnosis of Lynch syndrome across the population?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17119-e17119
Author(s):  
Ryan Kahn ◽  
Sushmita Gordhandas ◽  
Brandon Paul Maddy ◽  
Becky Baltich Nelson ◽  
Gulce Askin ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lynch Syndrome ◽  
Microsatellite Instability ◽  
Large Scale ◽  
Screening Method ◽  
Cochrane Library ◽  
Predictive Values ◽  
Msi Analysis ◽  
Weighted Prevalence ◽  
Mlh1 Methylation

e17119 Background: Universal tumor testing for defective DNA mismatch repair (MMR) is recommended for all women diagnosed with endometrial cancer (EC) to identify those with underlying Lynch syndrome (LS). However, since its implementation in 2013, the effectiveness of this screening method on identifying individuals with LS across the population has not been well studied. The aim of this study was to evaluate outcomes of MMR immunohistochemistry (IHC), MLH1 methylation, and microsatellite instability (MSI) analysis among EC patients. Methods: We conducted a complete systematic search of online databases PubMed, Embase, Medline, and Cochrane Library between 1990-2018. A DerSimonian–Laird random-effects model meta-analysis was utilized to estimate the weighted prevalence of LS diagnoses. Results: The comprehensive search produced 3,427 publications. 29 peer-review studies met the inclusion criteria. 6,649 EC patients were identified, 206 (3%) were confirmed to have LS following positive universal tumor molecular screening.5,917 patients underwent tumor IHC, 28% had abnormal staining. 3,140 patients underwent MSI analysis, 31% had MSI instability. Among EC patients with deficient IHC staining or positive MSI analysis, the weighted prevalence of LS was 15% and 19% respectively. 1159 patients exhibited loss of MLH1 staining, 143 (13.7%) were found to be MLH1 methylation negative, 32 demonstrated a germline MLH1 mutation (2.8% of all MLH1 absent staining; 22.4% of all MLH1 methylation negative). 43% of EC patients diagnosed with LS via tumor typing would have been missed by family history-based screening alone. Conclusions: Despite widespread implementation of universal tumor testing in EC, data regarding results have previously been limited. For the first time, this study provides large-scale predictive values that will help practitioners evaluate abnormal results in the context of LS and aid in patient counseling. [Table: see text]

Assessment of the diagnostic value of microsatellite instability in the urine of bladder cancer patients.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 384-384
Author(s):  
Hussein Mustafa Khaled ◽  
Abdel-Rahman Zekri ◽  
Mai B Mohamed ◽  
Fatma M Diab ◽  
Mona Abdellateif ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Microsatellite Instability ◽  
Tumor Tissue ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Urine Samples ◽  
Tissue Samples ◽  
Predictive Values ◽  
Promising Tool ◽  
Sensitivity Specificity

384 Background: Microsatellite alterations in urine sediments have proved to be a promising tool for detection of bladder cancer (BC) due to its high sensitivity and specificity. Methods: We assessed the possible prognostic and predictive values of microsatellite alterations in tissue samples and urine sediments obtained from Egyptian patients with BC, and their utility as diagnostic, prognostic and predictive value. Microsatellite instability (MSI) and loss of heterozygosity (LOH) were assessed using 13 microsatellite markers in tumor tissue and urine sediments of 30 patients with BC. The concordance between MSI in tissue and urine samples was determined. Results: We found that MSI was more frequent than LOH (100% and 46.7%; respectively). D16S310, MBP and IFN-α showed the highest MSI frequency in urine samples (70%, 70% and 66.67%; respectively), while MBP, ACTBP2 and D9S171 (66.67%, 63.33%, and 60%; respectively) were the most frequently detected in tumor tissue. All markers correlated significantly with the pathological subtypes (more frequent in TCC) and hematuria. The concordance between tissue and urine was statistically significant for , D9S171, D16S476, FGA and ACTBP2 (P = 0.04, 0.015, 0.02 and 0.007; respectively). When we combined D16S476 and D9S171, the sensitivity, specificity, PPV and NPV reached (80.0%, 75.0%, 82.8% and 71.4%; respectively) for diagnosis of BC . Conclusions: Thus MSI in urine sediments could be a sensitive and reliable method for diagnosis of BC.

Sign in / Sign up

Export Citation Format

Share Document