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Bizzarri N, Nero C, Di Berardino S, Scambia G, Fagotti A. Future of sentinel node biopsy in ovarian cancer. Curr Opin Oncol 2024; 36:412-417. [PMID: 39016276 PMCID: PMC11309330 DOI: 10.1097/cco.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW The rationale on the use of sentinel lymph node (SLN) biopsy in the surgical staging of apparent early-stage ovarian cancer (OC) is supported by the fact that diagnostic and prognostic role of systematic staging lymphadenectomy has been determined but its therapeutic significance is still matter of controversy. Moreover, SLN biopsy represents an option to decrease intra- and postoperative morbidity. The present review aims to provide an overview on the current and future role of SLN in OC. RECENT FINDINGS Most recent evidence shows that the overall mean per patient SLN detection rate in case of indocyanine green (ICG) alone was 58.6% compared with 95% in case of ICG + technetium, and with 52.9% in case of technetium alone or in combination with blue dye ( P < 0.001). Site of injection has been reported to be in both ovarian ligaments in majority of studies (utero-ovarian ligament and infundibulo-pelvic ligament), before or after ovarian mass removal, at time of primary or re-staging surgery and by minimally invasive or open approach. Cervical injection has been recently proposed to replace utero-ovarian injection. SLN detection rate in patients with confirmed ovarian malignancy varied across different studies ranging between 9.1% and 91.3% for the injection in the utero-ovarian ligament and migration to pelvic lymph nodes and between 27.3% and 100% for the injection in the infundibulo-pelvic ligament and migration to para-aortic lymph nodes. No intra- or postoperative complication could be attributed directly to SLN biopsy. The sensitivity and the accuracy of SLN in detecting lymphatic metastasis ranged between 73.3-100% and 96-100%, respectively. In up to 40% of positive SLNs, largest metastatic deposit was classified as micro-metastasis or isolated tumor cells, which would have been missed without ultrastaging protocol. SUMMARY SLN biopsy represents a promising tool to assess lymph node status in apparent early-stage OC. The type and volume of injected tracer need to be considered as appear to affect SLN detection rate. Ultrastaging protocol is essential to detect low volume metastasis. Sensitivity and accuracy of SLN biopsy are encouraging, providing tracer injection in both uterine and ovarian ligaments.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Camilla Nero
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Di Berardino
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore, Rome, Italy
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Li Q, Zhang L, Fang F, Xu P, Zhang C. Research progress of indocyanine green fluorescence technology in gynecological applications. Int J Gynaecol Obstet 2024; 165:936-942. [PMID: 37953657 DOI: 10.1002/ijgo.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
Indocyanine green is a near-infrared fluorescent dye which is widely used in various fields of surgery and gynecology. It is currently mainly used to detect various malignant tumors, sentinel lymph nodes, endometriosis lesions, ureter or intestinal occlusion, vaginal perfusion, uterine arterial blood perfusion, pelvic nerve, uterine niche, lymphatic edema, metastatic lesion shadow, and so on, providing new methods for decision-making during surgery. This article elaborates the application progress of indocyanine green fluorescence technology in gynecology.
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Affiliation(s)
- Qing Li
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Li Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Fang Fang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Ping Xu
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Chunhua Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
- Macau University of Science and Technology, Macau, China
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Ataei Nakhaei S, Sadeghi R, Mostafavi SM, Treglia G, Hassanzadeh M, Esmaeilpour M, Taheri NS, Farazestanian M. Sentinel Node Mapping in Ovarian Tumors: A Study Using Lymphoscintigraphy and SPECT/CT. CONTRAST MEDIA & MOLECULAR IMAGING 2024; 2024:5453692. [PMID: 38435483 PMCID: PMC10907102 DOI: 10.1155/2024/5453692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/23/2022] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
Purpose Ovarian cancer in the early stage requires a complete surgical staging, including radical lymphadenectomy, implying subsequent risk of morbidity and complications. Sentinel lymph node (SLN) mapping is a procedure that attempts to reduce radical lymphadenectomy-related complications and morbidities. Our study evaluates the feasibility of SLN mapping in patients with ovarian tumors by the use of intraoperative Technetium-99m-Phytate (Tc-99m-Phytate) and postoperative lymphoscintigraphy using tomographic (single-photon emission computed tomography/computed tomography (SPECT/CT)) acquisition. Materials and Methods Thirty-two patients with ovarian mass participated in this study. Intraoperative injection of the radiopharmaceutical was performed just after laparotomy and before the removal of tumor in utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum. Subsequently, pelvic and para-aortic lymphadenectomy was performed for malignant masses, and the presence of tumor in the lymph nodes was assessed through histopathological examination. Conversely, lymphadenectomy was not performed in patients with benign lesions or borderline ovarian tumors. Lymphoscintigraphy was performed within 24 hr using tomographic acquisition (SPECT/CT) of the abdomen and pelvis. Results Final pathological examination showed 19 patients with benign pathology, 5 with borderline tumors, and 6 with malignant ovarian tumors. SPECT/CT identified SLNs in para-aortic-only areas in 6 (20%), pelvic/para-aortic areas in 14 (47%), and pelvic-only areas in 7 (23%) cases. Notably, additional unusual SLN locations were revealed in perirenal, intergluteal, and posterior to psoas muscle regions in three patients. We were not able to calculate the false negative rate due to the absence of patients with involved lymph nodes. Conclusion SLN mapping using intraoperative injection of radiotracers is safe and feasible. Larger studies with more malignant cases are needed to better evaluate the sensitivity of this method for lymphatic staging of ovarian malignancies.
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Affiliation(s)
- Saeideh Ataei Nakhaei
- Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Malihe Hassanzadeh
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Esmaeilpour
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Sadat Taheri
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Kumar A, Kulkarni S, Pandey A, Mutalik S, Subramanian S. Nano-tracers for sentinel lymph node detection: current trends in technique and application. Nanomedicine (Lond) 2024; 19:59-77. [PMID: 38197375 DOI: 10.2217/nnm-2023-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Sentinel lymph node (SLN) detection and biopsy is a critical staging component for several cancers. Apart from established methods using dyes or radiolabeled colloids, newer techniques are emerging, like near-infrared fluorescent compounds, targeted molecular radiopharmaceuticals and magnetic nano-tracers. In the overview section of this review, we categorize SLN detection tracers based on their principle of use. We discuss the merits of existing tracers and provide a glimpse of in-development formulations. A subsequent clinical section explores the expanded role of SLN detection in management of various cancers, citing current medical guidelines and the leading conclusions of long-term clinical trials. The concluding section tries to provide a perspective of promising developments and the work required to bring them to clinical fruition.
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Affiliation(s)
- Anuj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Sanjay Kulkarni
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Abhijeet Pandey
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Suresh Subramanian
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
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Lago V, Domingo S. Correspondence on "Sentinel lymph node biopsy in ovarian cancer: more questions than certainties" by Fagotti et al. Int J Gynecol Cancer 2023; 33:1989. [PMID: 37940338 DOI: 10.1136/ijgc-2023-005041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Victor Lago
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medicine, CEU Cardenal Herrera University, Moncada, Comunitat Valenciana, Spain
| | - Santiago Domingo
- Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Agustí N, Vidal-Sicart S, Paredes P, Celada-Castro C, Migliorelli F, Glickman A, Marina T, Fusté P, Carreras-Dieguez N, Saco A, Díaz-Feijóo B, Torné A. Mapping sentinel lymph nodes in early-stage ovarian cancer (MELISA) trial - a further step towards lymphadenectomy replacement. Gynecol Oncol 2023; 179:145-151. [PMID: 37980769 DOI: 10.1016/j.ygyno.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Sistematic pelvic and para-aortic lymphadenectomy is part of the staging surgery for early-stage epithelial ovarian cancer, with no therapeutic value. The Mapping Sentinel Lymph Nodes In Early-Stage Ovarian Cancer (MELISA) trial prospectively assessed the SLN detection rate and the diagnostic accuracy of the SLN mapping technique in patients with early-stage epithelial ovarian cancer. METHODS This prospective, single-arm study included patients diagnosed with early-stage epithelial ovarian cancer (FIGO stages I and II), via either primary surgery or re-staging surgery. SLN mapping was performed by injecting 0.2 mL of 37-mBq 99mTc-nanocoloid albumin and 2 mL of 2.5 mg/mL indocyanine green into the infundibulopelvic and utero-ovarian ligaments. After removal of SLNs, a complete systematic pelvic and para-aortic lymphadenectomy was performed. SLN Ultrastaging analysis was applied. The primary outcome was the overall SLN detection rate, either with one or both tracers. Secondary outcomes were the diagnostic accuracy of detecting lymph node metastases and factors that may influence SLN detection. RESULTS Thirty patients were included. SLNs were identified in 27 patients (90%). Detection rates in primary and re-staging surgery were 89% and 92%, respectively. Para-aortic drainage was the predominant lymphatic spread, observed in 26 of 27 patients. Ultrastaging pathologic reports listed 1 SLN with macrometastasis, 1 with micrometastasis, and 5 with isolated tumor cells; the sensitivity of SLN mapping was 100%, with a false-negative rate of 0%. Univariate analysis showed a nonsignificant higher proportion of patients with uterine fibroids, adenomyosis, and endometriosis (100%, 67%, 67%, respectively) in patients in whom SLNs were not detected. CONCLUSION SLN mapping has a high detection rate (90%) and is an accurate technique for detecting lymph node involvement in early-stage epithelial ovarian cancer. SLN mapping is a potential alternative to systematic lymphadenectomy to reduce associated morbidity, but further research is needed to evaluate the impact of SLN mapping on oncologic outcomes and its cost-effectiveness.
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Affiliation(s)
- Núria Agustí
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain.
| | - Sergi Vidal-Sicart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Nuclear Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Nuclear Medicine, Hospital Clinic of Barcelona, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Cristina Celada-Castro
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain
| | - Federico Migliorelli
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain
| | - Ariel Glickman
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain
| | - Tiermes Marina
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain
| | - Pere Fusté
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Núria Carreras-Dieguez
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijóo
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Seon KE, Kim SW, Kim YT. Clinical relevance of sentinel lymph node biopsy in early ovarian cancer. Obstet Gynecol Sci 2023; 66:498-508. [PMID: 37821093 PMCID: PMC10663395 DOI: 10.5468/ogs.23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023] Open
Abstract
The first-line treatment for early ovarian cancer typically involves primary debulking surgery aimed at maximal cytoreduction, alongside adjuvant chemotherapy if clinically indicated. Nodal assessment involving pelvic and para-aortic lymph node dissection is typically performed during the primary debulking surgery. However, the survival benefit of lymphadenectomy in patients with early ovarian cancer has not been well established, and the procedure is associated with longer operation time and higher perioperative complications. With the emergence of minimally invasive surgery as a potential alternative to laparotomy for early ovarian cancer, sentinel lymph node biopsy has been evaluated in this setting. In this review, we summarized the current literature regarding sentinel lymph node biopsy in patients with early ovarian cancer, focusing on the clinical relevance of this method, including its detection rate and diagnostic accuracy. Additionally, we discuss the current status of clinical trials investigating sentinel lymph node biopsy in early ovarian cancer cases.
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Affiliation(s)
- Ki Eun Seon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Zachou G, Yongue G, Chandrasekaran D. Feasibility of Sentinel Lymph Node Biopsy in Early-Stage Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3209. [PMID: 37892029 PMCID: PMC10606383 DOI: 10.3390/diagnostics13203209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) has been widely adopted in the management of early-stage gynaecological cancers such as endometrial, vulvar and cervical cancer. Comprehensive surgical staging is crucial for patients with early-stage ovarian cancer and currently, that includes bilateral pelvic and para-aortic lymph node assessment. SLNB allows the identification, excision and pathological assessment of the first draining lymph nodes, thus negating the need for a full lymphadenectomy. We systematically searched the MEDLINE, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases (from inception to 3 November 2022) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Our search identified 153 articles from which 11 were eligible for inclusion. Patients with clinical stage I-II ovarian cancer undergoing sentinel lymph node biopsy were included. Statistical analysis was performed in RStudio using the meta package, where meta-analysis was performed for the detection. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies C (QUADAS-C) tool. Overall, 11 observational studies met the predetermined criteria and these included 194 women. The meta-analysis showed that the detection rate of sentinel lymph nodes in early-stage ovarian cancer was 94% (95% CI of 86% to 1.00%). Significant heterogeneity was noted among the studies with Q = 47.6, p < 0.0001, I2 = 79% and τ2 = 0.02. Sentinel lymph nodes in early-stage ovarian cancer have a high detection rate and can potentially have applicability in clinical practice. However, considering the small number of participants in the studies, the heterogeneity among them and the low quality of evidence, the results should be interpreted with caution. Larger trials are needed before a change in clinical practice is recommended.
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Affiliation(s)
- Georgia Zachou
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
- Department of Obstetrics and Gynaecology, Barnet Hospital, Royal Free London NHS Foundation Trust, London EN5 3DJ, UK
| | - Gabriella Yongue
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
| | - Dhivya Chandrasekaran
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
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Agusti N, Viveros-Carreño D, Grillo-Ardila C, Izquierdo N, Paredes P, Vidal-Sicart S, Torne A, Díaz-Feijoo B. Sentinel lymph node detection in early-stage ovarian cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2023; 33:1493-1501. [PMID: 37487662 DOI: 10.1136/ijgc-2023-004572] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND A systematic pelvic and para-aortic lymphadenectomy remains the surgical standard management of early-stage epithelial ovarian cancer. Sentinel lymph node mapping is being investigated as an alternative procedure; however, data reporting sentinel lymph node performance are heterogeneous and limited. OBJECTIVE This study aimed to evaluate the detection rate and diagnostic accuracy of sentinel lymph node mapping in patients with early-stage ovarian cancer. METHODS A systematic search was conducted in Medline (through PubMed), Embase, Scopus, and the Cochrane Library. We included patients with clinical stage I-II ovarian cancer undergoing a sentinel lymph node biopsy and a pelvic and para-aortic lymphadenectomy as a reference standard. We conducted a meta-analysis for the detection rates and measures of diagnostic accuracy and assessed the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with identifying number CRD42022351497. RESULTS After duplicate removal, we identified 540 studies, 18 were assessed for eligibility, and nine studies including 113 patients were analyzed. The pooled detection rates were 93.3% per patient (95% CI 77.8% to 100%; I2=74.3%, p<0.0001), and the sentinel lymph node technique correctly identified 11 of 12 patients with lymph node metastases, with a negative predictive value per patient of 100% (95% CI 97.6% to 100%; I2=0%). The combination of indocyanine green and 99mTc-albumin nanocolloid had the best detection rate (100% (95% CI 94% to 100%; I2=0%)) when injected into the utero-ovarian and infundibulo-pelvic ligaments. CONCLUSION Sentinel lymph node biopsy in early-stage ovarian cancer showed a high detection rate and negative predictive value. The utero-ovarian and infundibulo-pelvic injection using the indocyanine green and technetium-99 combination could increase sentinel lymph node detection rates. However, given the limited quality of evidence and the small number of reports, results from ongoing trials are awaited before its implementation in routine clinical practice.
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Affiliation(s)
- Nuria Agusti
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia, Bogota, Colombia
- Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Carlos Grillo-Ardila
- Department of Gynecology and Obstetrics, Universidad Nacional de Colombia - Sede Bogotá, Bogota, Colombia
| | - Nora Izquierdo
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Spain
| | - Aureli Torne
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijoo
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Yu H, Wang J, Wu B, li J, Chen R. Prognostic significance and risk factors for pelvic and para-aortic lymph node metastasis in type I and type II ovarian cancer: a large population-based database analysis. J Ovarian Res 2023; 16:28. [PMID: 36717897 PMCID: PMC9885671 DOI: 10.1186/s13048-023-01102-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/14/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To compare the prognosis of lymphatic metastasis in type I and type II epithelial ovarian cancer (OC) and to identify the risk factors for pelvic lymph node metastases (PLNs) and para-aortic lymph node metastases (PALNs). METHODS Patients diagnosed with epithelial OC were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated. The Cox proportional hazards regression model was used to identify independent predictors of survival. RESULTS A total of 11,275 patients with OC were enrolled, including 31.2% with type I and 68.8% with type II. Type II and high tumour stage were risk factors for lymph node involvement (p < 0.05). The overall rate of lymph node metastasis in type I was 11.8%, and that in type II was 36.7%. In the type I group, the lymph node metastasis rates in stages T1, T2, T3 and TXM1 were 3.2%, 14.5%, 40.4% and 50.0%, respectively. In the type II group, these rates were 6.4%, 20.4%, 54.1% and 61.1%, respectively. Age and tumour size had little effect on lymph node metastasis, and grade 3 was not always a risk factor. For the type I group, the 10-year CSS rates of LN(-), PLN( +), PALN( +), and PLN + PALN( +) were 80.6%, 46.6%, 36.3%, and 32.3%, respectively. The prognosis of PLN ( +) was better than that of PALN ( +) in the type I group (p > 0.05). For the type II group, the 10-year CSS rates of LN(-), PLN( +), PALN( +), and PLN + PALN( +) were 55.6%, 18.5%, 25.7%, and 18.2%, respectively. PALN ( +) had a significantly better prognosis than PLN ( +) in the type II group (p < 0.05). CONCLUSIONS The clinical characteristics and prognoses of patients with type I and type II OC differed greatly. Patients with type II and higher tumour stages had poorer prognoses. Type I with PALN metastasis and type II with PLN metastasis indicated a worse prognosis. Patients with stage TI did not require lymph node dissection, especially in the type I group.
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Affiliation(s)
- Hailin Yu
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jieyu Wang
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Beibei Wu
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jun li
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Ruifang Chen
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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El-Swaify ST, Laban M, Ali SH, Sabbour M, Refaat MA, Farrag N, Ibrahim EA, Coleman RL. Can fluorescence-guided surgery improve optimal surgical treatment for ovarian cancer? A systematic scoping review of clinical studies. Int J Gynecol Cancer 2023; 33:549-561. [PMID: 36707085 DOI: 10.1136/ijgc-2022-003846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The predicament of achieving optimal surgical intervention faced by surgeons in treating ovarian cancer has driven research into improving intra-operative detection of cancer using fluorescent materials. OBJECTIVE To provide a literature overview on the clinical use of intra-operative fluorescence-guided surgery for ovarian cancer, either for cytoreductive surgery or sentinel lymph node (SLN) biopsy. METHODS The systematic review included studies from June 2002 until October 2021 from PubMed, Web of Science, and Scopus as well as those from a search of related literature. Studies were included if they investigated the use of fluorescence-guided surgery in patients with a diagnosis of ovarian cancer. Authors charted variables related to study characteristics, patient demographics, baseline clinical characteristics, fluorescence-guided surgery material, and treatment details, and surgical, oncological, and survival outcome variables. After screening 2817 potential studies, 24 studies were included. RESULTS Studies investigating the role of fluorescence-guided surgery to visualize tumor deposits or SLN biopsy included the data of 410 and 118 patients, respectively. Six studies used indocyanine green tracer with a mean SLN detection rate of 92.3% with a pelvic and para-aortic detection rate of 94.8% and 96.7%, respectively. The sensitivity, specificity, and positive predictive value for micrometastases detection of OTL38 and 5-aminolevulinc acid at time of cytoreduction were 92.2% vs 79.8%, 67.3% vs 94.8%, and 55.8% vs 95.8%, respectively. CONCLUSION Fluorescence -guided surgery is a technique that may improve the detection rate of micrometastases and SLN identification in ovarian cancer. Further research is needed to establish whether this will lead to improved patient outcomes.
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Affiliation(s)
| | - Mohamed Laban
- Gynecologic Oncology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Sara H Ali
- Ain Shams University Hospitals, Cairo, Egypt
| | | | | | | | - Eman A Ibrahim
- Department of Pathology, Ain Shams University Hospitals, Cairo, Egypt
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Kampan NC, Teik CK, Shafiee MN. Where are we going with sentinel nodes mapping in ovarian cancer? Front Oncol 2022; 12:999749. [PMID: 36408149 PMCID: PMC9669053 DOI: 10.3389/fonc.2022.999749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Lymph node involvement is a major predictive indicator in early-stage epithelial ovarian cancer (EOC). There is presently no effective way to determine lymph node involvement other than surgical staging. As a result, traditional ovarian cancer surgery still includes pelvic and paraaortic lymphadenectomy. However, it might be linked to higher blood loss, lengthier operations, and longer hospital stays. The creation of a technique for accurately predicting nodal status without significant lymphadenectomy is thus the subject of ongoing research. Sentinel lymph nodes (SLN) mapping is a routine procedure in oncological surgery and has been proven to be effective and safe in cervical, vulvar, and uterine cancer. On the other hand, SLN mapping is not yet widely accepted and recognized in EOC. A thorough search of the literature was conducted between January 1995 to March 2022, using PubMed and Embase. This review included studies on lymphatic outflow of the ovaries and the sentinel lymph node method. A total of 13 studies involving 212 patients who underwent sentinel lymph node mapping for ovaries were included. Both open and laparoscopic approach are used. The most popular injection site is the ovarian ligaments, and a variety of agents are utilized, although the main markers were, technetium-99m radiocolloid (Tc-99m) or indocyanine green, either alone or in combination. Overall detection rate for SLN in ovaries is 84.5% (interquartile range: 27-100%). We suggest a standardized method for sentinel lymph node mapping in ovarian cancer. The detection rates, characterization and true positive rates of the approach in investigations support further study. The use of ultra-staging is essential for lower-volume metastasis and reproducibility. To ascertain the clinical utility of sentinel node in early ovarian cancer, larger collaborative prospective clinical trials are necessary.
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Ataei Nakhaei S, Mostafavi SM, Farazestanian M, Hassanzadeh M, Sadeghi R. Feasibility of sentinel lymph node mapping in ovarian tumors: A systematic review and meta-analysis of the literature. Front Med (Lausanne) 2022; 9:950717. [PMID: 35979203 PMCID: PMC9376319 DOI: 10.3389/fmed.2022.950717] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose of the report Since the presence of lymph node metastases upstages the disease and to reduce the morbidity of total lymphadenectomy, sentinel lymph node (SLN) mapping in ovarian mass has been the focus of extensive research. This study aims to review all the literature associated with ovarian SLN mapping and assess the feasibility of ovarian SLN mapping. Materials and methods PubMed and Scopus were searched using the following keywords: (Sentinel lymph node) AND (Ovary OR Ovarian) AND (Tumor OR Neoplasm OR Cancer). All studies with information regarding sentinel node biopsy in ovaries were included. Different information including mapping material, injection sites, etc., was extracted from each study. In total, two indices were calculated for included studies: detection rate and false-negative rate. Meta-analysis was conducted using Meta-MUMS software. Pooled detection rate, sensitivity, heterogeneity, and publication bias were evaluated. Quality of the studies was evaluated using the Oxford center for evidence-based medicine checklist. Results Overall, the systematic review included 14 studies. Ovarian SLN detection rate can vary depending on the type of tracer, site of injection, etc., which signifies an overall pooled detection rate of 86% [95% CI: 75–93]. The forest plot of detection rate pooling is provided (Cochrane Q-value = 31.57, p = 0.003; I2 = 58.8%). Trim and fill method resulted in trimming of 7 studies, which decreased the pooled detection rate to 79.1% [95% CI: 67.1–87.5]. Overall, pooled sensitivity was 91% [59–100] (Cochrane Q-value = 3.93; p = 0.41; I2 = 0%). The proportion of lymph node positive patients was 0–25% in these studies with overall 14.28%. Conclusion Sentinel lymph node mapping in ovarian tumors is feasible and seems to have high sensitivity for detection of lymph node involvement in ovarian malignant tumors. Mapping material, injection site, and previous ovarian surgery were associated with successful mapping. Larger studies are needed to better evaluate the sensitivity of this procedure in ovarian malignancies.
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Affiliation(s)
- Saeideh Ataei Nakhaei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Mostafa Mostafavi
- Department of Artificial Intelligence, School of Computer Engineering, University of Isfahan, Isfahan, Iran
| | | | - Malihe Hassanzadeh
- Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- *Correspondence: Ramin Sadeghi, ;
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Wang T, Xu Y, Shao W, Wang C. Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors. Front Med (Lausanne) 2022; 9:922585. [PMID: 35847801 PMCID: PMC9276931 DOI: 10.3389/fmed.2022.922585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022] Open
Abstract
The sentinel lymph nodes (SLNs) is a group of lymph nodes initially involved in the metastatic spread of cancer cells. SLN mapping refers to intraoperative localization and biopsy of SLNs with specific tracers to assess lymph node metastases. It is widely used in a variety of tumor surgeries for its high sensitivity and high negative predictive value. In the evaluation of the status of lymph node metastases in gynecological malignancies, it has received increasingly more attention due to its minor invasiveness, few complications, and high diagnosis rate. The National Comprehensive Cancer Network (NCCN) guidelines provide an excellent introduction to the indications and methods of SLN techniques in vulvar, cervical, and endometrial cancers, but they provide little explanation about some specific issues. In this review, we summarize different dyes and injection methods and discuss the indications of application and the clinical trials of SLN mapping in gynecological malignant tumors, aiming to provide a reference for the rational application of sentinel techniques in gynecology malignant tumors before relevant guidelines are updated.
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