Sentinel lymph node detection in early-stage ovarian cancer: primary results and perspectives
https://doi.org/10.21294/1814-4861-2025-24-4-20-28
Abstract
Aim: to evaluate the results of sentinel-lymph-node (SLN) mapping in detecting lymph node metastasis in apparently early-stage ovarian cancer.
Material and Methods. The prospective unicentric study included 48 patients with stage I–IIA ovarian cancer who underwent surgical staging at the Department of Gynecological Oncology of N.N. Blokhin National Medical Research Center of Oncology from 2022 to 2024. Patients were injected with indocyanine green dye into the infundibulo-pelvic and utero-ovarian ligaments (or ligament’s stumps) to map and remove sentinel lymph nodes (SLNs). After the SLNs were identified and removed, pelvic and para-aortic lymphadenectomy was performed.
Results. Of 48 patients, 40 (83.3 %) had successful mapping of at least one SLN. Three patients (7.5 %) had positive nodes: 1 patient (2.5 %) had metaststic para-aortic SLN; 1 patient (2.5 %) had false-negative para-aortic SLN; and 1 patient (2.5 %) had metastatic pelvic lymph node without SLN detection in this region. Thus, the SLN mapping detection rate was 50 % for metastatic lymph nodes in the para-aortic region. None of the patients with detected SLN in the pelvic region had metastatic lymph nodes. No complications related to SLN technique were observed.
Conclusion. The results of this prospective study do not demons trate that lymph nodes status can be fully predicted by SLN evaluation. Further prospective studies are required to evaluate experience of SLN detection in early-stage ovarian cancer.
About the Authors
M. N. Tikhonovskaya
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Russian Federation
Maria N. Tikhonovskaya, MD, PhD, Researcher, Department of Oncogynecology
24, Kashirskoe shosse, Moscow, 115478
A. S. Shevchuk
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Aleksey S. Shevchuk, MD, PhD, Head of the Department of Oncogynecology; Associate Professor, Department of Oncology and Radiation Therapy, Institute of Surgery
24, Kashirskoe shosse, Moscow, 115478;
1, Ostrovityanova St., Moscow, 117997
References
1. Giammarile F., Vidal-Sicart S., Paez D., Pellet O., Enrique E.L., Mikhail-Lette M., Morozova O., Maria Camila N.M., Diana Ivonne R.S., Delgado Bolton R.C., Valdés Olmos R.A., Mariani G. Sentinel Lymph Node Methods in Breast Cancer. Semin Nucl Med. 2022; 52(5): 551–60. doi: 10.1053/j.semnuclmed.2022.01.006.
2. Crystal J.S., Thompson J.F., Hyngstrom J., Caracò C., Zager J.S., Jahkola T., Bowles T.L., Pennacchioli E., Beitsch P.D., Hoekstra H.J., Moncrieff M., Ingvar C., van Akkooi A., Sabel M.S., Levine E.A., Agnese D., Henderson M., Dummer R., Neves R.I., Rossi C.R., Kane J.M. 3rd, Trocha S., Wright F., Byrd D.R., Matter M., Hsueh E.C., MacKenzie-Ross A., Kelley M., Terheyden P., Huston T.L., Wayne J.D., Neuman H., Smithers B.M., riyan C.E., Desai D., Gershenwald J.E., Schneebaum S., Gesierich A., Jacobs L.K., Lewis J.M., McMasters K.M., O’Donoghue C., van der Westhuizen A., Sardi A., Barth R., Barone R., McKinnon J.G., Slingluff C.L., Farma J.M., Schultz E., Scheri R.P., Vidal-Sicart S., Molina M., Testori A.A.E., Foshag L.J., van Kreuningen L., Wang H.J., Sim M.S., Scolyer R.A., Elashoff D.E., Cochran A.J., Faries M.B.; Multicenter Selective Lymphadenectomy Trials Study Group. Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial. JAMA Surg. 2022; 157(9): 835–42. doi: 10.1001/jamasurg.2022.2055.
3. 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. doi: 10.3389/fmed.2022.922585.
4. Kolomiets L.A., Chernyshova A.L., Chernov V.I., Perelmuter V.M., Pankova O.V. Identification of sentinel lymph nodes in patients with gynecological cancer: Video manual for doctors. Electronic publication. Tomsk, 2022. (in Russian). ISBN: 978-5-6048147-0-3. doi: 10.21294/978-5-6048147-0-3-2022. EDN: VBKYRM.
5. Ovarian cancer/fallopian tube cancer/primary peritoneal cancer: clinical guidelines of the Association of Oncologists of Russia. 2024. (in Russian). [Internet]. [cited 01.06.2025]. URL: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://oncology-association.ru/wp-content/uploads/2024/11/rak-yaichnikov_01.07.pdf.
6. Maggioni A., Benedetti Panici P., Dell'Anna T., Landoni F., Lissoni A., Pellegrino A., Rossi R.S., Chiari S., Campagnutta E., Greggi S., Angioli R., Manci N., Calcagno M., Scambia G., Fossati R., Floriani I., Torri V., Grassi R., Mangioni C. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer. 2006; 95(6): 699–704. doi: 10.1038/sj.bjc.6603323.
7. Bizzarri N., du Bois A., Fruscio R., De Felice F., De Iaco P., Casarin J., Vizza E., Chiantera V., Corrado G., Cianci S., Magni S., Ferrari D., Giuliani D., Harter P., Ataseven B., Bommert M., Perrone A.M., Scambia G., Fagotti A. Is there any therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer? Gynecol Oncol. 2021; 160(1): 56–63. doi: 10.1016/j.ygyno.2020.10.028.
8. Tikhonovskaya M.N., Shevchuk A.S., Knyazev R.I., Rumyantsev A.A., Afanasyeva K.V. Systematic lymphadenectomy in early-stage ovarian cancer: retrospective study in N.N. Blokhin National Medical Research Center of Oncology. Problems in Oncology. 2025; 71(1): 100–108. (in Russian). doi: 10.37469/0507-3758-2025-71-1-100-108. EDN: NTQMCR.
9. Kleppe M., Brans B., van Gorp T., Slangen B.F., Kruse A.J., Pooters I.N., Lotz M.G., van de Vijver K.K., Kruitwagen R.F. The detection of sentinel nodes in ovarian cancer: a feasibility study. J Nucl Med. 2014; 55(11): 1799–804. doi: 10.2967/jnumed.114.144329.
10. 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(7): 1209–15. doi: 10.1136/ijgc-2019-000606.
11. Tikhonovskaya M.N., Shevchuk A.S. Sentinel lymph node detection in early stage ovarian cancer: the primary experience in N.N. Blokhin national medical Research Center of Oncology. Pelvic Surgery and Oncology. 2022; 12(3): 19–25. (in Russian). doi: 10.17650/2686- 9594-2022-12-3-19-25. EDN: UEBMOQ.
12. El-Ghobashy A.E., Saidi S.A. Sentinel lymph node sampling in gynaecological cancers: techniques and clinical applications. Eur J Surg Oncol. 2009; 35(7): 675–85. doi: 10.1016/j.ejso.2008.09.004.
13. van Manen L., Handgraaf H.J.M., Diana M., Dijkstra J., Ishizawa T., Vahrmeijer A.L., Mieog J.S.D. A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol. 2018; 118(2): 283–300. doi: 10.1002/jso.25105.
14. Lago V., Bello P., Montero B., Matute L., Padilla-Iserte P., Lopez S., Agudelo M., Domingo S. Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study. Int J Gynecol Cancer. 2019; 29(2): 377–81. doi: 10.1136/ijgc-2018-000049.
15. Agusti N., Paredes P., Vidal-Sicart S., Glickman A., Torne A., DíazFeijoo B. Sentinel lymph node mapping in early-stage ovarian cancer: surgical technique in 10 steps. Int J Gynecol Cancer. 2022; 32(8): 1082–83. doi: 10.1136/ijgc-2022-003420.
16. Hassanzadeh M., Hosseini Farahabadi E., Yousefi Z., Kadkhodayan S., Zarifmahmoudi L., Sadeghi R. Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99mPhytate and lymphoscintigraphy imaging. J Ovarian Res. 2016; 9(1): 55. doi: 10.1186/s13048-016-0265-4.
17. Nyberg R.H., Korkola P., Mäenpää J.U. Sentinel Node and Ovarian Tumors: A Series of 20 Patients. Int J Gynecol Cancer. 2017; 27(4): 684–89. doi: 10.1097/IGC.0000000000000948.
18. Lago V., Bello P., Montero B., Matute L., Padilla-Iserte P., Lopez S., Marina T., Agudelo M., Domingo S. Sentinel lymph node technique in early-stage ovarian cancer (SENTOV): a phase II clinical trial. Int J Gynecol Cancer. 2020; 30(9): 1390–96. doi: 10.1136/ijgc-2020-001289.
19. Laven P., Kruitwagen R., Zusterzeel P., Slangen B., van Gorp T., van der Pol J., Lambrechts S. Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection? J Ovarian Res. 2021; 14(1): 132. doi: 10.1186/s13048-021-00887-w.
20. Nero C., Bizzarri N., Di Berardino S., Sillano F., Vizzielli G., Cosentino F., Vargiu V., De Iaco P., Perrone A.M., Vizza E., Chiofalo B., Uccella S., Ghezzi F., Turco L.C., Corrado G., Giannarelli D., Pasciuto T., Zannoni G.F., Fagotti A., Scambia G. Sentinel-node biopsy in apparent early stage ovarian cancer: final results of a prospective multicentre study (SELLY). Eur J Cancer. 2024; 196: 113435. doi: 10.1016/j.ejca.2023.113435.
Supplementary files
|
|
1. Fig. 1. SLN mapping, left pelvic zone (laparotomy). Note: created by the authors | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(708KB)
|
Indexing metadata ▾ | |
|
|
2. Fig. 2. SLN mapping, paraaortic zone (laparoscopy). Note: created by the authors | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(1MB)
|
Indexing metadata ▾ | |
|
|
3. Fig. 3. SLN location by site of ICG injection. Note: created by the authors | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(127KB)
|
Indexing metadata ▾ | |
Review
For citations:
Tikhonovskaya M.N., Shevchuk A.S. Sentinel lymph node detection in early-stage ovarian cancer: primary results and perspectives. Siberian journal of oncology. 2025;24(4):20-28. (In Russ.) https://doi.org/10.21294/1814-4861-2025-24-4-20-28
Views:
22
Email this article 
