Ovarian Sentinel Node: Is It Feasible?

Nyberg, Reita; Korkola, Pasi; Mäenpää, Johanna

doi:10.1097/igc.0b013e318211ef75

Cited by 32 publications

(40 citation statements)

References 16 publications

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“…Therefore, delaying surgery for a period longer than 15 min was deemed not to be feasible in daily practice. Negishi et al and Nyberg et al waited for 10 min and 10-21 min after injection, respectively (18,19). Intraoperative SN procedures in the case of cervical and endometrial cancer also use comparable time intervals (16).…”

Section: Discussionmentioning

confidence: 99%

“…Negishi et al used injection of an activated charcoal solution into the ovarian capsule to identify SNs and reported the detection of SNs in the paraaortic region in all 11 patients analyzed (overall 18 SNs) and in the pelvic region in 4 patients (overall 4 SNs) (18). Nyberg et al analyzed 16 patients with high-risk uterine cancer by injecting technetium and blue dye into the right or left ovary and detected 1-3 SNs in 15 of the 16 patients (19). The SNs (n 5 30) were all located in the paraaortic region.…”

Section: Discussionmentioning

confidence: 99%

“…The SN technique has been proven effective in vulvar and breast cancer, and SN studies in cervical and uterine cancers are currently under way (14)(15)(16)(17). For the ovary, SN studies are scarce, partly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex (16)(17)(18)(19).…”

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confidence: 99%

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The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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Few sentinel node (SN) studies in ovarian cancer have been reported, mainly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex. To our knowledge, the injection of tracers into the ovarian ligaments has not been explored. The aim of this study was to determine the feasibility of the SN procedure in ovarian cancer with tracer injection into the ovarian ligaments and to establish whether the procedure is safe for the healthcare workers. Methods: The study included patients who were at high risk of ovarian malignancy. Blue dye and radioactive colloid were injected into the proper ovarian ligament and suspensory ligament of the ovary. To measure professional radiation exposure, ring dose meters were worn by the surgeon, theater nurse, and pathologist during 3 procedures. Results: An SN procedure was performed in 21 patients, and at least 1 SN location was identified in all patients using the γ probe before retroperitoneal exploration. SNs were located in the paraaortic and paracaval regions only in 67% of the patients, in the pelvic region only in 9%, and in both the paraaortic/paracaval and the pelvic regions in 24%. All but 2 SNs were found on the ipsilateral side. In 6 patients who underwent retroperitoneal exploration, 1-4 SNs were identified using the γ probe and resected. Blue-stained SNs were detected in 2 patients. Positive SNs were detected in 1 patient with lymph node metastases. The amount of radiation exposure to the surgeon, theater nurse, and pathologist did not exceed the safe limit. Conclusion: The identification of SNs in all cases suggests that the SN procedure performed by injection of tracers in the ovarian ligaments is feasible and promising. The procedure is safe for the involved personnel. Further investigation is necessary to determine the clinical application of this new technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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“…In 8 patients (5 patients with ovarian cancer [patients 1-5] and 3 patients with endometrial cancer [patients [6][7][8]) in whom a surgical staging lymphadenectomy including resection of SNs was performed, a SPECT/CT scan was acquired within 24 h postoperatively. The 5 patients with ovarian cancer were incorporated in a previous report describing the feasibility of the intraoperative SN detection (11).…”

Section: Patientsmentioning

confidence: 99%

“…A sentinel node (SN) procedure may play an important role in the management of epithelial ovarian cancer. Few studies in patients with ovarian cancer have evaluated SNs, partly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex (5)(6)(7)(8)(9). In a previous pilot study, we avoided possible tumor cell spillage by injection of tracers into the ovarian ligaments rather than into the ovarian cortex (10).…”

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confidence: 99%

Comparison of Intraoperative γ-Probe Imaging and Postoperative SPECT/CT in Detection of Sentinel Nodes Related to the Ovary

et al. 2016

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Tracer injection into ovarian ligaments has been shown to detect sentinel nodes (SNs) in patients with ovarian cancer. To determine the possibility that SNs are missed, this feasibility study compared their detection during surgery with their detection on postoperative SPECT/CT. Methods: In 8 patients (with either ovarian or endometrial cancer), after a staging lymphadenectomy including resection of SNs related to the ovary, SPECT/CT was performed within 24 h. Results: SPECT/CT identified hotspots in 4 patients at sites where SNs were resected. In 6 patients, additional sites were found, mainly in the pelvic region. Conclusion: Discrepancies between the g-probe and SPECT/CT may be due to missed SNs during surgery, but with respect to pelvic hotspots, in most cases they are more probably related to remnants of tracer at injection sites. With respect to sites where SNs were resected, remaining hotspots may have been caused by residual lymphatic flow after resection. In clinical early-stage epithelial ovarian cancer, the International Federation of Obstetrics and Gynaecology recommends a staging procedure that includes a complete pelvic and paraaortic lymphadenectomy (1). However, a complete lymphadenectomy is associated with morbidity, including nerve and vessel injury, increased blood loss, increased operating time, and the formation of lymph cysts and lymphedema (2-4). A sentinel node (SN) procedure may play an important role in the management of epithelial ovarian cancer. Few studies in patients with ovarian cancer have evaluated SNs, partly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex (5-9). In a previous pilot study, we avoided possible tumor cell spillage by injection of tracers into the ovarian ligaments rather than into the ovarian cortex (10). We identified at least one SN in all patients with suspected ovarian cancer (n 5 21) (11). However, by the nature of this approach without preoperative imaging of the SN locations, we were conscious that the single use of a g-probe or blue color to detect hotspots during surgery could lead to missed SNs. With this in mind, in the present feasibility study we describe patients in whom, after resection of SNs identified by g-probe and blue dye, postoperative SPECT/CT was performed. MATERIALS AND METHODS PatientsAs described previously, patients diagnosed with a pelvic mass suggestive of a malignant ovarian tumor, and patients with high-grade endometrial cancer planned for staging laparotomy, were eligible to participate in the study (10,11). We included both patients with suspected ovarian malignancy and patients with a high-grade uterine carcinoma. The latter group could be included because these patients undergo the same surgical procedure: total abdominal hysterectomy with bilateral salpingo-oophorectomy and a pelvic and paraaortic lymphadenectomy or lymph node sampling. All patients provided fully informed consent in writing before enrollment in the study, and the protocol was approved by the Local Eth...

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