Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging

Malihe Hassanzadeh, Elham Hosseini Farahabadi, Zohreh Yousefi, Sima Kadkhodayan, Leili Zarifmahmoudi, Ramin Sadeghi, Malihe Hassanzadeh, Elham Hosseini Farahabadi, Zohreh Yousefi, Sima Kadkhodayan, Leili Zarifmahmoudi, Ramin Sadeghi

Abstract

Background: Experience on sentinel node mapping in ovarian tumors is very limited. We evaluated the sentinel node concept in ovarian tumors using intra-operativeTc-99m-Phytate injection and lymphoscintigraphy imaging.

Methods: Thirty-five patients with a pelvic mass due to an ovarian pathology were included in the study. The radiotracer was injected just after laparotomy and before removal of the tumor either beneath the normal cortex (10 patients) or in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum two injections of the radiotracer (25 patients). For malignant masses, the sentinel nodes were identified using a hand held gamma probe. Then standard pelvic and para-aortic lymphadenectomy was performed. In case of benign pathologies or borderline ovarian tumors on frozen section, lymphadenectomy was not performed. The morning after surgery, all patients were sent for lymphoscintigraphy imaging of the abdomen and pelvis.

Results: Sentinel node was identified only in 4 patients of the cortical injection group. At least one sentinel node could be identified in 21 patients of the sub-peritoneal group. Sentinel nodes were identified only in the para-aortic area in 21, pelvic/para-aortic areas in 2, and pelvic only area in 2 patients. Three patients had lymph node involvement and all had involved sentinel nodes (no false negative case).

Conclusion: Sentinel node mapping using intra-operative injection of the radiotracer (in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum) is feasible in ovarian tumors. Technical aspects of this method should be explored in larger multicenter studies in the future.

Keywords: Blue dye; Lymphatic mapping; Lymphoscintigraphy; Ovarian tumor; Ovary; Sentinel.

Figures

Fig. 1
Fig. 1
Radiotracer injection in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum
Fig. 2
Fig. 2
A blue para-aortic sentinel node could be identified in this patient intra-operatively (arrow)
Fig. 3
Fig. 3
Planar anterior/posterior lymphoscintigraphy images of a patient. Two para-aortic sentinel nodes are marked by arrows. Activity in the liver is also apparent (black arrows)

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