{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:17:37Z","timestamp":1787735857815,"version":"build-2784847793"},"reference-count":41,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Borderline ovarian tumours (BOTs) are distinct epithelial neoplasms with excellent survival but variable recurrence, including late relapse and occasional malignant transformation. Follow-up strategies remain inconsistent internationally, with no standardised, risk-adapted framework. We aimed to synthesise the evidence on BOT recurrence patterns, risk factors and surveillance strategies, and to propose a structured, risk-adapted surveillance framework. Methods: This is a narrative expert synthesis rather than a systematic review. Three evidence sources were combined: our previously published comprehensive review of BOTs, our recent meta-analysis of recurrence and malignant transformation, and an appraisal of contemporary international guidelines. Clinicopathological and surgical determinants of recurrence were then mapped onto the available follow-up tools through a three-step approach, and the resulting risk strata, surveillance intervals and total follow-up duration were agreed on by consensus within a single tertiary gynaecological oncology centre (the \u201cBarts Framework\u201d). Results: Recurrence occurs in 3\u201310% of patients, with up to one-third arising beyond five years. Key predictors include fertility-sparing surgery (particularly cystectomy), incomplete staging, advanced stage, residual disease, and adverse histological features such as micropapillary\/cribriform architecture and invasive implants. Three targets for surveillance were identified: early detection of recurrence, detection of malignant transformation, and optimisation of fertility. Transvaginal ultrasound emerged as the cornerstone modality, with cross-sectional imaging and tumour markers applied selectively. Four risk strata were derived, each specifying follow-up intensity, modality, total duration and care setting. Low-risk patients can be managed in decentralised settings (gynaecological units), whereas high-risk groups warrant specialist oversight (gynaecological oncology centres). Patient-initiated follow-up is incorporated to minimise unnecessary interventions. Conclusions: This risk-adapted approach provides a scalable framework to standardise BOT surveillance whilst reducing overuse and maintaining oncological safety. The framework is consensus-based and single-institution in origin, and prospective external validation with long-term outcome data is required before wider adoption. Integration of molecular stratification and artificial-intelligence-assisted imaging represents a key future direction.<\/jats:p>","DOI":"10.3390\/cancers18172764","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:11:15Z","timestamp":1787731875000},"page":"2764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk-Adapted Surveillance in Borderline Ovarian Tumours (BOTs): The \u201cBarts\u201d Evidence-Based Framework"],"prefix":"10.3390","volume":"18","author":[{"given":"Sofia","family":"Lekka","sequence":"first","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Haran","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6615-2807","authenticated-orcid":false,"given":"Nadia Amel","family":"Seksaf","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iteeka","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Jeyarajah","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh","family":"Phadnis","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elly","family":"Brockbank","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-5057","authenticated-orcid":false,"given":"Ranjit","family":"Manchanda","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"},{"name":"Centre for Cancer Screening, Prevention & Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London E1 4NS, UK"},{"name":"Department of Health Services Research, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4199-6700","authenticated-orcid":false,"given":"Michail","family":"Sideris","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"},{"name":"Centre for Cancer Screening, Prevention & Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London E1 4NS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Drymiotou, S., Theodorou, E., Rallis, K.S., Nicolaides, M., and Sideris, M. 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