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Staging Lymphadenectomy in Patients With Clear Cell Carcinoma of the Ovary
  1. Jennifer J. Mueller, MD*,
  2. Marie Holzapfel, MD,
  3. Chan H. Han, MD*,
  4. Kevin Santos, BS*,
  5. Camille Gunderson, MD,
  6. Kathleen Moore, MD,
  7. Britt Erickson, MD§,
  8. Charles A. Leath, MD§,
  9. Elena Diaz, MD,
  10. Christine Walsh, MD,
  11. Stephanie L. Wethington, MD*,
  12. Sheila Z. Dejbakhsh, MD*,
  13. Richard R. Barakat, MD*,,
  14. Ginger J. Gardner, MD*,,
  15. David M. Hyman, MD*,,
  16. Robert A. Soslow, MD#,** and
  17. Mario M. Leitao, MD*,
  1. *Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY;
  2. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA;
  3. University of Oklahoma Health Sciences Center, Oklahoma City, OK;
  4. §Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL;
  5. Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY;
  6. Department of Medicine, Weill Cornell Medical Center, New York, NY;
  7. #Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY; and
  8. **Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, NY.
  1. Address correspondence and reprint requests to Mario M. Leitao Jr, MD, Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail:


Objective The purpose of this study was to assess the rate of lymph node (LN) metastasis in comprehensively staged ovarian clear cell carcinoma (OCCC) clinically confined to the ovary and determine factors associated with LN metastasis.

Methods We identified all cases of OCCC treated at 4 institutions from January 1994 through December 2011. We included cases with disease grossly confined to the ovary that had surgical staging performed, including at least 10 LNs sampled. Clinical and pathologic data were abstracted from electronic medical records, and a deidentified data set was compiled and processed at a single institution. Factors potentially associated with LN metastasis were tested. Appropriate statistical tests were performed.

Results We identified 145 eligible cases that met the criteria for this analysis. Median age was 52.9 years (range, 30–81 years), and median total LN count was 19 (range, 10–74). Seven (4.8%) of 145 comprehensively staged cases had LN metastasis; 6 of these cases (4.1%) were isolated metastasis. Cytologic washings, peritoneal, omental, and fallopian tube involvement were not associated with nodal metastasis. Cases with ovarian surface involvement and positive cytology had a 37.5% incidence of LN positivity, which was statistically meaningful when compared with all other cases (P = 0.003).

Conclusions Women who underwent comprehensive staging for clinical stage I OCCC had an LN metastasis rate of 4.8%. The subgroup of cases with both ovarian surface involvement and positive cytology had the highest incidence of LN metastasis. This may influence clinical decision making on whether to perform lymphadenectomy in patients with incidental OCCC found after salpingo-oophorectomy.

  • Ovarian Cancer
  • Lymph Node
  • Metastasis
  • Staging

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  • This work was funded in part by the Memorial Sloan Kettering Cancer Center core grant P30 CA008748 and in part by (National Institutes of Health) 5K12HD0012580-15 to Dr Leath. The core grant provides funding to institutional cores, such as Pathology, which was used in this study.

  • The authors declare no conflicts of interest.