Understanding Lymphatic Drainage Pathways of the Ovaries to Predict Sites for Sentinel Nodes in Ovarian Cancer

Abstract

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Sentinel Node and Ovarian Tumors: A Series of 20 Patients

“…It, however, described that a considerable number of lymphatic vessels are present in mesovarium along the entire length of the ovary. 7 To our experience, the tracers leak out from the tiniest holes and smudge the operation field, hampering the visibility of blue-stained lymphatics and the use of gamma detector in pelvis. Our 1-spot injection to the mesovarium gave similar SN distribution results compared with the study by Kleppe et al, 6 although they injected the tracers to both ovarian ligaments.…”

“…6,7 According to a recent article, 3 lymphatic drainage pathways from the ovaries can be distinguished. The 2 main routes drain the ovaries via the suspensory ligament toward the PA/PC areas and via the proper ligament of the ovaries toward the obturator fossa and the internal iliac artery.…”

Lymphatic Vessel Network Structure and Physiology

“…Recent work suggests two major drainage pathways, and one additional minor route in humans (541). One of the major drainage routes, from the cranial side of the ovary, follows along with the ovarian artery in the infundibulopelvic ligament toward the para-aortic and paracaval nodes (541). This route probably accounts for the metastases to these nodes commonly observed in ovarian epithelial cancers (145).…”

“…The minor pathway, with a smaller number of lymphatic vessels, follows the round ligament to the inguinal nodes. Inguinal metastasis is less common with ovarian cancers (541). Lymphatics may also participate in a feedback transport mechanism for regulation of ovarian hormone production (1024, 1025).…”

Exploratory Study of Sentinel Biomarkers in Gynecologic Cancers

“…Because metastases of ovarian cancer are lymphatic spread, the sentinel lymphnode can be find out in the para-aortic and paracaval regions, obturator fossa and surrounding internal iliac arteries, and inguinal regions. Thus, the strategy of injecting tracers in both ovarian ligaments to identify sentinel nodes is supported [1]. For ultra-early diagnosis of ovarian cancers, analyses of metaboromes including proteomes and cancer exosomes in serum are of most importance.…”