Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?

Abstract

Objective Sentinel lymph node (SLN) detection in ovarian cancer is feasible when tracers are injected before the pathological ovary is resected. This study aims to investigate whether the SLN identification is also feasible in patients whose ovarian tumor has already been resected with injection of the tracer into the ovarian ligaments stumps, i.e. in the event that a frozen section confirms malignancy. Methods Patients who underwent laparotomy with frozen section confirming an ovarian malignancy, and those who underwent a second staging laparotomy after prior resection of a malignant ovarian mass, were included. Blue dye and a radioactive isotope were injected in the stumps of the ligamentum ovarium proprium and the ligamentum infundibulo-pelvicum. After an interval of at least 15-min, the sentinel node(s) were identified using either the gamma-probe and / or blue dye. Results A total of 11 patients were included in the study, the sentinel node (SLN) procedure was completed in all 11 patients. At least one SLN was identified in 3 patients, resulting in a rather low detection rate of 27,3%. Conclusion In this study we showed that SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection. Trial registration NCT02540551

Feasibility of sentinel lymph node mapping in ovarian tumors: A systematic review and meta-analysis of the literature

“…A number of three studies by Lago et al ( 10 , 11 ) and Laven et al ( 12 ) considered an overall total of 41 patients with tracer injection after ovarian mass resection during the same or a subsequent surgical procedure. In other words, the patients underwent laparotomy with frozen section for a pelvic mass suspicious for malignancy or a second staging laparotomy after prior resection of a malignant ovarian mass.…”

“…In such cases, the reliability could be lower due to alteration of the lymphatic drainage after ovarian mass resection. Laven et al ( 12 ) reported that “SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection.” However, SLN detection rates were 100% in the Lago et al’s studies ( 10 , 11 ). As such, overall, detection rate for these cases (with the injection site in the ligament stumps) was 59% [95% CI: 32–81].…”

“…An injection was performed only at the infundibulopelvic stump if a hysterectomy had been previously performed. SLN detection rates were 100% in the Lago et al's studies (10,11), but the reported detection rate was much lower (27%) by Laven et al (12). However, overall, pooled detection rate for the cases (with the injection site in the ligament stumps) was 59% [95% CI: 32-81].…”

“…The majority of the studies considered 15 min as the median time between tracer injection and sentinel lymph node mapping (visually for Blue dye and by NIR/ICG system and handed gamma probe for ICG and Tc-99m radiocolloid tracer, respectively) (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, Angelucci et al ( 20) considered only 2 min before the start of sentinel lymph node mapping.…”

Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors

“…A clinical study of early-stage epithelial ovarian cancer found a higher positive rate (88.9 vs. 41.7%) for immediate surgical staging than for delayed surgical staging ( 25 ). Results of another clinical trial of early-stage ovarian cancer showed that if SLN mapping was postponed until 5–8 weeks after tumor resection, SLN mapping would not be successfully localized ( 26 ).…”