ISSN : 2663-2187

Role of intraoperative Sentinel lymph node sampling in the management of women with early-stage epithelial ovarian cancer

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Dina M. Elsaid , Reda Hemida, Hanan Nabil, Mohamed Ibrahim Eid and Abdelaziz Elrefaeey
» doi: 10.48047/AFJBS.6.15.2024.6650-6663

Abstract

Ovarian cancer represents the 7th most common malignant tumor and, the 8th cause of mortality in women worldwide. Only twenty to thirty percent of patients with ovarian cancer are diagnosed with clinically early-stage (FIGO stage I–II) disease at first presentation. According to FIGO classification, ovarian cancer with LN metastases is classified as FIGO stage IIIA, even in the absence of peritoneal metastases. Those patients are obliged to receive adjuvant chemotherapy, in contrast to patients with FIGO stage I ovarian cancer. Therefore, the recognition of LN metastases is of major importance. Preoperative imaging has low sensitivity in detecting LN metastasis; therefore, complete pelvic and paraaortic lymphadenectomy is recommended as part of surgical staging for early stages. However, this procedure is associated with high morbidity. The concept of the SLN is to determine whether the cancer has spread to the first LN, If the sentinel node is negative for malignancy, then there is a high likelihood that the tumor has not spread to other LNs, so if we can prove its accuracy, we can skip complete lymphadenectomy and its associated co-morbidities. The study aims to assess the feasibility and the accuracy of the SLNP in early epithelial ovarian cancer. Methods: This is a prospective single-arm study that included patients with presumed early stages of epithelial ovarian cancer planned for surgical staging. After abdominal exploration and before removal of the ovary, 0.5 ml of methylene blue dye 1% was injected on the dorsal and ventral side of both the ovarian ligament and the infundiblo-pelvic ligament. The retroperitoneum is then accessed and inspected to identify and remove the sentinel nodes, and then staging is completed including systematic pelvic and paraaortic lymphadenectomy. Results: 37 patients were included. Sentinel nodes were identified in 20 patients (detection rate, 54%). 3 patients had positive nodes out of 4 patients with lymphatic dissemination, (sensitivity, 75%). the false-negative rate of 5%; the negative predictive value of 93.7%, and 3 (8%) intra- and 1 postoperative complication occurred. Conclusion: The detection rate of sentinel nodes in early epithelial ovarian cancer is considered relatively low using blue dye alone. However, the sentinel node procedure is feasible and has good sensitivity and specificity. SLN procedure can provide reliable and useful information on nodal status and may allow the avoidance of systematic lymphadenectomy in the future.

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