Sentinel lymph node biopsy in apparently early-stage ovarian cancer: beyond removal of green nodes and surgical experience

Background: Systematic pelvic and para-aortic lymphadenectomy is the standard procedure for surgical staging in apparently early-stage ovarian cancer. The role of sentinel lymph node biopsy remains unclear. Objective: To evaluate the diagnostic accuracy, feasibility, and safety of sentinel lymph node biopsy when performed by a single operator with a standardized technique. Methods: Case series of 36 patients with apparently early-stage ovarian cancer who underwent surgery performed by a single operator following the SELLY trial protocol. Sentinel lymph node mapping was performed by injecting the tracer into the infundibulopelvic and utero-ovarian ligaments. Sentinel node biopsy was followed by systematic pelvic and para-aortic lymphadenectomy. Results: Thirty-six consecutive patients with apparently early-stage ovarian cancer were enrolled; 22 patients underwent immediate surgery and 14 delayed procedures after incidental diagnosis. 86.1 % of patients had successful mapping of at least one SLN, and 54.8 % had successful mapping in both pelvic and para-aortic regions. Three patients had isolated tumor cells (ITCs) and one patient had macro-metastasis in SLN. No cases of false negative SLN were observed. The sensitivity and negative predictive value were 100 %. We had five (13.9 %) postoperative complications not related to the SLN procedure itself. Conclusion: SLN is a reliable and safe surgical procedure in apparent early-stage ovarian cancer regardless of immediate and delayed surgery, but strict protocol adherence and expert surgeons are mandatory. SLN mapping in apparent early-stage ovarian cancer is feasible and accurate in detecting lymph node metastasis.