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1347 Prediction of lymph node metastasis in early-stage ovarian cancer: value of whole-body diffusion-weighted MRI
  1. Kamiel Verbruggen,
  2. Vincent Vandecaveye,
  3. Ignace Vergote,
  4. Toon Van Gorp,
  5. Els Van Nieuwenhuysen,
  6. Raphaëla Carmen Dresen,
  7. Valérie Broeckhoven and
  8. Thaïs Baert
  1. UZ Leuven, Leuven, Belgium


Introduction/Background The incidence of positive lymph nodes in early-stage ovarian cancer is estimated to be around 15–20%. The standard procedure for determining the stage of high-risk presumed early-stage ovarian cancer involves systematic pelvic and para-aortic lymphadenectomy. However, this surgical staging method is invasive with the risk of developing lymphedema. Our objective was to evaluate the ability of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to accurately predict the presence of lymph node metastases in patients with early-stage ovarian cancer.

Methodology Our study, conducted from January 2012 to December 2021 in a tertiary referral hospital, was a retrospective cohort study. The participants met the following criteria: (a) All patients with a unilateral or bilateral ovarian mass, without signs of intraperitoneal or distant metastases; (b) all histological subtypes were considered; (c) WB-DWI/MRI was performed during the staging process; and (d) systematic pelvic and para-aortic lymphadenectomy was carried out, except for stage I low-grade endometrioid tumours and mucinous tumours with expansive growth.

Nodal signal intensity relative to the surrounding lymph nodes and primary tumour was used on WB-DWI/MRI as a criterion for the prediction of metastatic lymph node involvement irrespective of nodal size.

Results In the study, 49 patients were included (Table 1), out of which 10.2% had lymph node metastases (n=5). WB-DWI/MRI showed a sensitivity of 60.0% (95% confidence interval [CI] 19.9% to 91.9%), a specificity of 88.6% (95% CI 77.1% to 95.8%) and an accuracy of 85.7% (95% CI 72.8% to 94.1%). The positive predictive value was 37.5% (95% CI 11.0% to 71.0%) and the negative predictive value was 95.1 (95% CI 85.7% to 99.2%).

Abstract 1347 Table 1


Conclusion WB-DWI/MRI can predict lymph node metastases in early-stage ovarian carcinoma. The high negative predictive value is particularly interesting in selecting patients with early-stage ovarian cancer for lymphadenectomy by WB-DWI/MRI.

Disclosures None.

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