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#136 Sentinel lymph node mapping in early-stage ovarian cancer: equivalence of cervix vs utero-ovarian ligament injection for pelvic sentinel lymph node mapping
  1. Alba Orive,
  2. Víctor Lago,
  3. Marta Arnaez,
  4. Pablo Padilla,
  5. Marta Gurrea,
  6. Luis Matute,
  7. Pilar Bello and
  8. Santiago Domingo
  1. Hospital Universitario y Politécnico La Fe, Valencia, Spain


Introduction/Background Lymph nodes metastases occurs in approximately 14% (range 6–30%) of early-stage ovarian cancer and determines severely its evolution and prognostic. Surgical management of ovarian cancer in an apparent early stage includes pelvic and para-aortic lymphadenectomy, which is associated with characteristic complications, such as lymphatic cyst formation and lymphedema, and increases blood loss, surgical time, and length of hospitalization.

Currently, there is not a standardized technique for detection of sentinel node in ovarian cancer. Utero-ovarian ligament tracer injection is the most accepted method, but technical complexity hinders its reproducibility. A recent publication suggests that utero-ovarian ligament and cervix injection could be equivalent lymphatic drainage routes.

Methodology Prospective observational study conducted at “Hospital Universitario y Politécnico La Fe” (Valencia, Spain). All consecutive women with endometrial cancer undergoing sentinel lymph node mapping by cervix injection, as clinical guidelines recommend, were included. Cervical injection was performed at 3, 6, 9 and 12 o´clock by Technetium-99. In addition, indocyanine green was used as second marker and injected into the utero-ovarian ligament or remaining stump after adnexectomy. Equivalence of both techniques for detection of same sentinel lymph node in each hemipelvis was studied. Concordance and discordance rates were determined by McNemar´s exact test.

Results For the time being, twelve cases have undergone the dual-tracer technique. Both tracers identified same sentinel lymph node in nine cases, confirmed by anatomopathological study. In two cases, sentinel node was detected by Technetium-99 injected into the cervix, but no migration occurred after indocyanine green injection into the utero-ovarian ligament. This manifested a detection rate of 91,6% by Technetium-99 cervical injection. Lymphatic migration didn’t occur in only one case.

Conclusion Our research on lymphatic drainage in pelvic area using different tracers suggests that cervix and utero-ovarian ligament injection are equivalent for detection of sentinel lymph node. This could impact on sentinel lymph node setting in patients with apparently early-stage ovarian cancer.

Disclosures All the authors have nothing to disclose.

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