Can we rely on the size of the lymph node in determining nodal metastasis in ovarian carcinoma?

Abstract

This study endeavored to determine whether lymph node size is a reliable indicator in determining lymph node metastasis in common epithelial ovarian cancer. We reviewed pathologic sections of pelvic and para-aortic lymph nodes removed from 104 ovarian carcinoma patients who underwent either primary surgical staging or secondary surgery from January 1994 to July 2001. All sections of each individual node were measured in two dimensions. The different sizes of nodes were studied statistically to determine the optimal sensitivity and specificity in predicting cancer metastasis. A nodal size of 10 mm was a specific point of interest. Of 2069 total nodes obtained, 110 nodes (5.3%) had metastatic cancer. More than half (55.4%) of these positive nodes had a nodal long axis of 10 mm and less. The sensitivity and specificity of nodal size at 10 mm were 44.5% and 81.1%, respectively. We conclude that lymph node size is not a good indicator in determining epithelial ovarian cancer metastasis. Mere sampling of only the enlarged nodes does not reflect the true positive incidence of nodal metastasis. To avoid inaccurate staging and improper management, complete lymph node dissection is proposed as part of surgical staging for ovarian cancer.

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

“…These authors suggested that systematic lymphadenectomy should be performed, rather than lymph node sampling, to determine the therapeutic impact of lymph node resection in epithelial ovarian cancers. Determining nodal metastases by palpation at the time of surgery has been found to have significant limitations (Petru et al, 1994;Arango et al, 2000;Eisenkop and Spirtos, 2001;Tangjitgamol et al, 2003).…”

Supra-clavicular lymph node metastatic spread in patients with ovarian cancer disclosed at 18F-FDG-PET/CT: an unusual finding

“…In this respect, it is worth noting that a recent review on this topic did not take into account the prevalence of extra-abdominal positive nodes [11]. The same occurred in a recent paper reviewing nodal metastasis in ovarian cancer [12]. Conversely, Cormio and colleagues [5] reviewed 162 patients with epithelial ovarian carcinoma and reported five cases of extra-abdominal lymphatic spread.…”

Gynecologic tumors: how to communicate imaging results to the surgeon

“…At present, a noninvasive method to recognize lymph node metastases with certainty does not exist. However, if CT shows the presence of lymph nodes with a short axis >10 mm, suspicion of metastasis should be raised [ 37 ] . Of note, retroperitoneal lymphadenopathies above the renal vessels and around the celiac axis (Fig.…”