Future of sentinel node biopsy in ovarian cancer

Nicolò Bizzarri ¹, Camilla Nero ^1,2, Stefano Di Berardino ¹

⁰UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS.

Current Opinion in Oncology +

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July 17, 2024

View abstract on PubMed

Summary

Sentinel lymph node (SLN) biopsy shows promise for staging early-stage ovarian cancer (OC), with high detection rates and accuracy. Ultrastaging is crucial for identifying micrometastases, improving diagnostic yield in OC management.

Area Of Science

Gynecologic Oncology
Surgical Oncology
Nuclear Medicine Imaging

Background

Sentinel lymph node (SLN) biopsy is explored for staging early-stage ovarian cancer (OC).
While the diagnostic and prognostic roles of lymphadenectomy are known, its therapeutic significance in OC remains debated.
SLN biopsy offers a potential method to reduce surgical morbidity.

Purpose Of The Study

To review the current and future applications of SLN biopsy in ovarian cancer staging.
To evaluate the effectiveness of different tracers and injection sites for SLN detection in OC.
To assess the diagnostic accuracy and complication rates associated with SLN biopsy in OC.

Main Methods

Review of recent evidence on SLN biopsy techniques and outcomes in ovarian cancer.
Analysis of SLN detection rates based on tracer type (indocyanine green, technetium, blue dye) and injection site (ovarian ligaments, cervix).
Evaluation of SLN sensitivity, accuracy, and complication rates, including the role of ultrastaging.

Main Results

Combined tracers (ICG + technetium) yielded the highest SLN detection rate (95%).
SLN detection rates varied significantly based on injection site and tracer, with high sensitivity (73.3-100%) and accuracy (96-100%) reported.
Ultrastaging identified micrometastases in up to 40% of positive SLNs, which might otherwise be missed.

Conclusions

Sentinel lymph node biopsy is a promising tool for assessing lymph node status in apparent early-stage ovarian cancer.
Tracer type, volume, and injection site influence SLN detection rates.
Ultrastaging protocols are essential for detecting low-volume metastases, enhancing the diagnostic value of SLN biopsy in OC.