Introduction Consensus regarding lymph node evaluation in epithelial ovarian cancer is emerging. The objective of the present study was to evaluate surgico-pathological findings, lymph node (LN) involvement, and prediction of LN metastasis by preoperative imaging and intraoperative assessment in women with epithelial ovarian cancer (EOC).

Methods Women with EOCs who underwent cytoreductive surgery (CRS) between Jan 2019 to April 2022 were included. Distribution of histology, stage and LN metastasis was studied. Predictive value of radiologic and surgically enlarged LNs with final histopathology was studied.

Results A total of 101 women with EOCs underwent CRS, of which 5 (4.95%) with co-existent endometrial cancer were excluded. Fifty women (52%) underwent primary and 46 women (48%) interval CRS. HGSC was commonest (n=66, 68.75%), followed by mucinous (n=15, 15.63%), endometrioid (n=6, 6.25%), LGSC (n=4, 4.17%) and carcinosarcoma (n=2, 2.08%). Majority of women, 69 (71.88%) were stage III and IV at presentation. Complete cytoreduction was achieved in 75 (78.12%) cases. Seventy-five women (78.13%) of EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. Both radiologically and surgically enlarged LNs significantly predicted LN metastasis on histopathology (p=0.02 and 0.006 respectively). The combined sensitivity, specificity, PPV, and NPV of both CECT and surgically enlarged LNs was 78.26%, 57.69%, 45%, and 85.71%, respectively

Conclusion/Implications Serous histology, high-grade tumors and suspicious LNs in CECT and during surgery are significantly associated with LN metastasis.