The significance of paracardiac lymph node enlargement in ovarian cancer

Prognostic significance of supradiaphragmatic lymph nodes at initial presentation in patients with stage III high-grade serous ovarian cancer

“…While it is known that the supradiaphragmatic nodes receive transdiaphragmatic drainage from the peritoneal cavity and are commonly seen on the baseline CT of patients with ovarian cancer, the prognostic significance of these lymph nodes has always been unclear [9]. Previous studies have found an association with peritoneal metastases and poorer prognoses [19], and lymph nodes meeting traditional 10-mm short-axis size criteria with decreased progression-free survival and overall survival [20]. As a result, these nodes may be overlooked and not rigorously documented in the radiology reports.…”

“…While small supradiaphragmatic lymph nodes, sometimes also referred to as epiphrenic, cardiophrenic, or paracardiac lymph nodes, are seen on baseline CT in 30-75% patients with ovarian cancer [8][9][10], these are often well below the size threshold of 10 mm defined by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines [6]. The optimal size threshold for identification of supradiaphragmatic lymphadenopathy in the context of ovarian cancer has not yet been studied, and the clinical and prognostic significance of these supradiaphragmatic lymph nodes is also under continued investigation and has not yet been established [9,19]. At present, there are also no specific recommendations regarding the management of supradiaphragmatic lymphadenopathy.…”

ESUR guidelines: ovarian cancer staging and follow-up

“…Inclusion of the lung bases in the field of view enables assessment of cardiophrenic lymph nodes and pleural effusion [16]. In the latter, cytology should be obtained as only positive findings indicate stage IV disease.…”

“…However, liver surface metastases (Fig. 5) are frequent, and surface metastases with (subcapsular) and without infiltrative growth into the liver (and spleen) should be differentiated as they influence the surgical management [23] & If pleural effusion is present, cytology must be positive to diagnose stage IV ovarian cancer & Cardiophrenic lymph nodes larger than 5 mm should be regarded as suspicious for stage IV [16] & In patients with peritoneal carcinomatosis and elevation of CA-125 without an ovarian mass, extra-ovarian peritoneal carcinomatosis should be considered and other sites within the examination volume, such as stomach, pancreas, colon and appendix, should be scrutinised [24] and IGCB may be informative & Primary peritoneal cancer may also present peritoneal carcinomatosis without an enlarged ovary and again IGCB should be considered & In patients with a history of a previous primary cancer from the GI tract or breast, the differential diagnosis should include metastases to the ovaries [25] & The role of CT staging is to confirm the clinical and ultrasound suspicion of ovarian cancer and to define disease extent in order to plan primary treatment and IGCB where appropriate Staging the treated patient The combination of clinical assessment and CA-125 measurement is routinely used to monitor patients treated for ovarian cancer in many institutions [26]. In this setting, CT is used to evaluate treatment response and to assess suspected relapse with rising CA-125 levels or clinically suspicious symptoms.…”

Ovarian Cancer

“…Superior diaphragmatic adenopathy is detected in approximately 15% of patients with advanced ovarian cancer and is usually associated with grave prognosis (Fig. 7) [65].…”