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

Pim Laven, Roy Kruitwagen, Petra Zusterzeel, Brigitte Slangen, Toon van Gorp, Jochem van der Pol, Sandrina Lambrechts, Pim Laven, Roy Kruitwagen, Petra Zusterzeel, Brigitte Slangen, Toon van Gorp, Jochem van der Pol, Sandrina Lambrechts

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.

Keywords: Ovarian cancer; Sentinel lymph node.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Location of injection of tracers. Tracers were injected on the ventral and dorsal sides of both ligament remains. Black arrow = remnant of infundibulo-pelvic ligament. Grey arrow = remnant of the ovarian ligament (proper ovarian ligament)

References

    1. Kleppe M, Wang T, Van Gorp T, Slangen BF, Kruse AJ, Kruitwagen RF. Lymph node metastasis in stages I and II ovarian cancer: a review. Gynecol Oncol. 2011;123:610–614. doi: 10.1016/j.ygyno.2011.09.013.
    1. Maggioni A, Benedetti Panici P, Dell’Anna T, et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer. 2006;95:699Y704. doi: 10.1038/sj.bjc.6603323.
    1. Harter P, Gnauert K, Hils R, et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer. 2007;17:1238Y1244. doi: 10.1111/j.1525-1438.2007.00931.x.
    1. Ditto A, Martinelli F, Reato C, et al. Systematic Para-aortic and pelvic lymphadenectomy in early stage epithelial ovarian cancer: a prospective study. Ann Surg Oncol. 2012;19:3849Y3855. doi: 10.1245/s10434-012-2439-7.
    1. Carnino F, Fuda G, Ciccone G, et al. Significance of lymph node sampling in epithelial carcinoma of the ovary. Gynecol Oncol. 1997;65:467Y472. doi: 10.1006/gyno.1997.4633.
    1. Benedet JL, Bender H, Jones H, III, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO committee on gynecologic oncology. Int J Gynaecol Obstet. 2000;70:209–262. doi: 10.1016/S0020-7292(00)90001-8.
    1. Angioli R, Plotti F, Palaia I, et al. Update on lymphadenectomy in early and advanced ovarian cancer. Curr Opin Obstet Gynecol. 2008;20:34–39. doi: 10.1097/GCO.0b013e3282f2fd68.
    1. Di Re F, Baiocchi G. Value of lymph node assessment in ovarian cancer: status of the art at the end of the second millennium. Int J Gynecol Cancer. 2000;10:435–442. doi: 10.1046/j.1525-1438.2000.00053.x.
    1. Gipponi M, Bassetti C, Canavese G, Catturich A, Di Somma C, Vecchio C, et al. Sentinel lymph node as a new marker for therapeutic planning in breast cancer patients. J Surg Oncol. 2004;85(3):102–111. doi: 10.1002/jso.20022.
    1. Landi G, Polverelli M, Moscatelli G, Morelli R, Landi C, Fiscelli O, et al. Sentinel lymph node biopsy in patients with primary cutaneous melanoma: study of 455 cases. J Eur Acad Dermatol Venereol. 2000;14(1):35–45. doi: 10.1046/j.1468-3083.2000.00005.x.
    1. Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30(31):3786. doi: 10.1200/JCO.2011.41.2528.
    1. Vanneuville G, Mestas D, Le Bouedec G, et al. The lymphatic drainage of the human ovary in vivo investigated by isotopic lymphography before and after the menopause. Surg Radiol Anat. 1991;13(3):221–226. doi: 10.1007/BF01627990.
    1. Negishi H, Takeda M, Fujimoto T, et al. Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer. Gynecol Oncol. 2004;94(1):161–166. doi: 10.1016/j.ygyno.2004.04.023.
    1. Nyberg RH, Korkola P, Mäenpää J. Ovarian sentinel node: is it feasible? Int J Gynecol Cancer. 2011;21(3):568–572. doi: 10.1097/IGC.0b013e318211ef75.
    1. Kleppe M, Brans B, van Gorp T, et al. The detection of sentinel nodes in ovarian cancer: a feasibility study. J Nucl Med. 2014;55:1799Y1804. doi: 10.2967/jnumed.114.144329.
    1. Angelucci M, Corrado G, Vizza E. Laparoscopic indocyanine green sentinel lymph node mapping in early ovarian cancer. A pilot study and review of the literature. Ital J Gynaecol Obstet. 2016;28:N. 5.
    1. Hassanzadeh M, Farahabadi EH, et al. Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra- operative Tc-99m-Phytate and lymphoscintigraphy imaging. J Ovarian Res. 2016;9(1):55. doi: 10.1186/s13048-016-0265-4.
    1. Nyberg RH, Korkola P, Mäenpää JU. Sentinel node and ovarian tumors: a series of 20 patients. Int J Gynecol Cancer. 2017;27(4):684–689. doi: 10.1097/IGC.0000000000000948.
    1. Buda A, Passoni P, Corrado G, et al. Near-infrared fluorescence-guided sentinel node mapping of the ovary with indocyanine green in a minimally invasive setting: a feasible study. J Minim Invasive Gynecol. 2017;24(1):165–170. doi: 10.1016/j.jmig.2016.09.006.
    1. Speth SC, Kruitwagen RF, Kleppe M, et al. Comparison of intraoperative γ-probe imaging and postoperative SPECT/CT in detection of sentinel nodes related to the ovary. J Nucl Med. 2017;58(2):243–245. doi: 10.2967/jnumed.116.183426.
    1. Lago V, Bello P, Montero B, et al. Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study. Int J Gynecol Cancer. 2019;29(2):377–381. doi: 10.1136/ijgc-2018-000049.
    1. Dell'Orto F, Laven P, Delle Marchette M, Lambrechts S, Kruitwagen R, Buda A. Feasibility of sentinel lymph node mapping of the ovary: a systematic review. Int J Gynecol Cancer. 2019;29:1209–1215. doi: 10.1136/ijgc-2019-000606.
    1. Ucella S, Nero C, Vizza E, Vargiu V, Corrado G. Sentinel-node biopsy in early-stage ovarian cancer: preliminary results of a prospective multicentre study (SELLY) Am J Obstet Gynecol. 2019;221(4):324.e1–324.e10. doi: 10.1016/j.ajog.2019.05.005.
    1. Lago V, Bello P, Montero B, Matute L, Padilla-Iserte P. Sentinel lymph node technique in early-stage ovarian cancer (SENTOV): a phase II clinical trial. Int J Gynecol Cancer. 2020;30(9):1390–1396. doi: 10.1136/ijgc-2020-001289.
    1. Ratnavelu NDG, Brown AP, Malllett S, Scholten RJPM. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016;3(3):CD010360.
    1. Meys EMJ, Kaijser J, Kruitwagen RFPM, Slangen BFM, Van Calster B, Aertgeerts B, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis. Eur J Cancer. 2016;58:17–29. doi: 10.1016/j.ejca.2016.01.007.
    1. Kleppe M, Kraima AC, Kruitwagen RF, Van Gorp T, Smit NN, van Munsteren JC, et al. Understanding lymphatic drainage pathways of the ovaries to predict sites for sentinel nodes in ovarian cancer. Int J Gynecol Cancer. 2015;25:1405–1414. doi: 10.1097/IGC.0000000000000514.
    1. Lago V, Montero B, López S, Padilla-Iserte P, Matute L, Marina T, et al. Ultrastaging protocol in sentinel lymph node for apparent early stage ovarian cancer. Gynecol Oncol. 2021;161:408–413. doi: 10.1016/j.ygyno.2021.03.001.

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