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Minerva Medica 2019 August;110(4):358-66

DOI: 10.23736/S0026-4806.19.06145-7


language: English

The role of sentinel node in early ovarian cancer: a systematic review

Stefano UCCELLA 1, 2 , Pier Carlo ZORZATO 1, Gabriele LANZO 1, Anna FAGOTTI 2, Stefano CIANCI 2, Davide GALLINA 1, Salvatore GUELI ALLETTI 2, Giorgia MONTEROSSI 2, Massimo FRANCHI 3, Fabio GHEZZI 4, Gian Franco ZANNONI 5, Giovanni SCAMBIA 2

1 Division of Obstetrics and Gynecology, Department of Maternal, Neonatal, and Infant Medicine, Ospedale degli Infermi, ASL Biella, Ponderano, Biella, Italy; 2 Division of Gynecologic Oncology, Department of Women and Children’s Health, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy; 3 Department of Obstetrics and Gynecology, Verona University Hospital, University of Verona, Verona, Italy; 4 Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy; 5 Department of Gynecologic Pathology, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy

INTRODUCTION: Early ovarian cancer (EOC) is defined as ovarian cancer macroscopically limited to the ovaries at the time of initial diagnosis. Approximately only 25% of patients with ovarian cancer are affected by EOC. This condition requires complete surgical staging, including systematic lymphadenectomy up to the level of the renal vessels, with the consequent risk of complications and morbidity. With the aim to reduce the procedure-related morbidity, sentinel lymph node mapping (SLNm) has been introduced as an experimental procedure in EOC staging. The aim of the present study is to systematically review the available series on this interesting issue.
EVIDENCE ACQUISITION: Studies were identified by searching electronic databases. The search was systematically applied to PubMed, ClinicalTrials.gov, Scopus and Web of Science looking for records describing the use of sentinel lymph node technique in EOC from January 1st, 1989 to January 1st, 2019. A total of 10 studies were identified for inclusion. Of the 121 patients involved in these studies, only 43 had a histologically-confirmed diagnosis of EOC and were included in the present analysis.
EVIDENCE SYNTHESIS: SLN (paraaortic and/or pelvic) overall detection rate (DR) was of 97.6%. The overall sensitivity (SS) and negative predictive value (NPV) of the included cases were 66.7% and 96.6%, respectively. We calculated also NPV, SS and DR based on the anatomical lymph node district, with a value of 100% both in the lumbo-aortic and in the pelvic district and a DR of 83.3% and 43% respectively.
CONCLUSIONS: This review shows that evidence on SLNm in EOC is still scant. Based on the limited data available, SLNm may provide potentially useful information on nodal status in patients affected by this disease.

KEY WORDS: Sentinel lymph node; Ovarian neoplasms; Minimally-invasive surgical procedures; Indocyanine green; Lymph node excision

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