468 Ultrastaging protocol in sentinel lymph node for apparent early stage ovarian cancer

ObjectiveEarly-stage ovarian cancer might represent an ideal disease scenario for sentinel lymph node application. Nevertheless, the published experience seems to be limited. Our objective was to assess the feasibility and safety concerns of sentinel lymph node biopsy in patients with clinical stage I–II ovarian cancer.MethodsWe conducted a prospective cohort study of 20 patients with histologically confirmed ovarian cancer. 99mTc and indocyanine green were injected into both the utero-ovarian and infundibulopelvic ligament stump, if they were present, during surgical staging. An intraoperative gamma probe and near-infrared fluorescence imaging were used to detect the sentinel lymph nodes. Inclusion criteria included: >18 years of age, suspicious adnexal mass (unilateral or bilateral) at ultrasound and CT imaging or confirmed ovarian tumor after previous surgery (unilateral or bilateral salpingo-oophorectomy with or without hysterectomy). Adverse events were recorded through postoperative day 30. The primary trial end point was to report adverse events related to the technique, including the use of 99mTc and ICG intraperitoneally, as well as the feasibility of the technique.ResultsA total of 20 patients were included in the analysis. Sentinel lymph nodes were detected in 14/15 (93%) pelvic and all 20 (100%) para-aortic regions. Five patients did not have utero-ovarian injection because of prior hysterectomy. The mean time from injection to sentinel lymph node resection was 53±15 min (range; 30–80). The mean number of harvested sentinel lymph nodes was 2.2±1.5 (range; 0–5) lymph nodes in the pelvis and 3.3±1.8 (range; 1–7) lymph nodes in the para-aortic region. There were no adverse intraoperative events, nor any within the 30 days of follow-up related with the technique.ConclusionSentinel lymph node mapping in early-stage ovarian cancer is feasible without major intraoperative or < 30 days safety concerns. (NCT03452982).Trial registration numberClinicalTrials.gov, NCT03452982.

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Sentinel lymph node in early stage ovarian cancer; a literature review

Journal of Mind and Medical Sciences ◽

10.22543/7674.52.p184188 ◽

2018 ◽

Vol 5 (2) ◽

pp. 184-188 ◽

Cited By ~ 2

Author(s):

Irina Balescu ◽

Nicolae Bacalbasa ◽

Mihaela Vilcu ◽

Vladislav Brasoveanu ◽

Iulian Brezean

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Literature Review ◽

Early Stage ◽

Early Stage Ovarian Cancer

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Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000049 ◽

2018 ◽

Vol 29 (2) ◽

pp. 377-381 ◽

Cited By ~ 11

Author(s):

V Lago ◽

P Bello ◽

B Montero ◽

L Matute ◽

P Padilla-Iserte ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Pilot Study ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Near Infrared ◽

Early Stage ◽

Gamma Probe ◽

Sentinel Lymph Nodes ◽

Near Infrared Fluorescence Imaging

IntroductionThere is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm.MethodsPatients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection.ResultsThe sentinel lymph node technique was performed in ten patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively.ConclusionThe detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

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Sentinel-node biopsy in early stage ovarian cancer: a prospective multicentre study (SELLY)

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000886 ◽

2019 ◽

Vol 29 (9) ◽

pp. 1437-1439

Author(s):

Giovanni Scambia ◽

Camilla Nero ◽

Stefano Uccella ◽

Enrico Vizza ◽

Fabio Ghezzi ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Indocyanine Green ◽

Epithelial Ovarian Cancer ◽

Sample Size ◽

Early Stage ◽

Sentinel Lymph Nodes ◽

Exclusion Criteria

BackgroundSystematic para-aortic and bilateral pelvic lymphadenectomy is included in the standard comprehensive surgical staging in presumed early epithelial ovarian cancer. No prospective randomized evidence suggests it has potential therapeutic value, and related morbidity is not negligible.Primary Objective(s)To assess sensitivity, safety, and feasibility of the sentinel lymph node technique in identifying the presence of lymph node metastases in patients with early stage epithelial ovarian cancer.Study HypothesisSentinel lymph node detection with indocyanine green can accurately predict nodal status in a cohort of women with early stage epithelial ovarian cancer.Trial DesignThe SELLY trial is a prospective phase II interventional multicenter study.Major Inclusion/Exclusion CriteriaInclusion criteria: Eastern Cooperative Oncology Group 0–1, apparent International Federation of Gynecology and Obstetrics (FIGO) stage I-II, histologically proven epithelial ovarian cancer.Exclusion criteria: evidence of carcinomatosis, mucinous only at definitive histology.Endpoint(s)Primary endpoint is sensitivity (true positive rate). Secondary endpoints include safety (complications rate of the procedure) and feasibility.Sample SizeAssuming a sensitivity of 98.5% in predicting positive sentinel lymph nodes at histology, a pathological lymph node prevalence of 14.2%, a precision of estimate (ie, the maximum marginal error) d=5%, and a type I error α=0.05, a sample size of 160 patients is needed to test the general hypothesis (ie, to answer whether sentinel lymph nodes identified with indocyanine green can accurately predict nodal status at histology of patients with apparently early epithelial ovarian cancer). Assuming a drop-out rate of 10%, a total of 176 patients will be enrolled in the study.Estimated Dates for Completing Accrual and Presenting ResultsThe accrual should be completed by December 2020 and results should be presented by March 2021.Trial RegistrationThe trial is registered at clinicaltrials.gov (NCT03563781).

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

Journal of Ovarian Research ◽

10.1186/s13048-021-00887-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Pim Laven ◽

Roy Kruitwagen ◽

Petra Zusterzeel ◽

Brigitte Slangen ◽

Toon van Gorp ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Node ◽

Early Stage ◽

Frozen Section ◽

Gamma Probe ◽

Tumor Resection ◽

Blue Dye ◽

Sentinel Nodes

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

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