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Recurrence patterns in patients with abnormal cardiophrenic lymph nodes at ovarian cancer diagnosis
  1. Alyssa Larish,
  2. Ismail Mert,
  3. Michaela McGree,
  4. Amy Weaver,
  5. Shannon Sheedy and
  6. William Cilby
  1. Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Alyssa Larish, Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA; alyssalarish{at}


Objectives Metastases in cardiophrenic lymph nodes noted at diagnosis of epithelial ovarian cancer confer a poor prognosis. It is unclear if cardiophrenic nodal metastases portend an atypical pattern of recurrence. We report on patients with radiographically involved cardiophrenic lymph nodes who underwent optimal primary debulking surgery to describe patterns of recurrence and response to chemotherapy.

Methods Patients undergoing primary debulking surgery for stage IIIC/IV epithelial ovarian carcinoma with residual disease ≤1.0 cm at our institution from 2003 to 2011 with a pre-operative computed tomography (CT) scan were identified. Scans were reviewed by blinded radiologists, who identified abnormal cardiophrenic lymph nodes via a qualitative assessment scale based on size, heterogeneity, and architecture.

Results Of the 250 patients identified, a recurrence site was documented in 22/27 (81.5%) with abnormal pre-operative cardiophrenic lymph nodes (defined by an elevated Qualitative Assessment Scale (QAS) score of ≥4), and in 128/223 (57.4%) without abnormal pre-operative cardiophrenic lymph nodes. Median short axis and long axis lymph node diameters for these patients was 9 (range 6–15) mm and 15 (range 11–22) mm, respectively. Cardiophrenic lymph nodes were resected in one patient. Patients with abnormal cardiophrenic nodes are more likely to have synchronous recurrence in thorax/pelvis and abdomen (50.0% (11/22) vs 25.0% (32/128), p=0.02) and less likely to have isolated recurrence in pelvis or abdomen (40.9% (9/22) vs 68.0% (87/128)). All patients who had a CT scan after six cycles of chemotherapy had improvement (defined as reduction of QAS score) in cardiophrenic lymphadenopathy.

Conclusions Despite cardiophrenic adenopathy demonstrating a complete radiographic response to chemotherapy, their presence pre-operatively is associated with an increased risk of recurrence in the thorax. Knowledge of this propensity to recur in the thorax is important to ensure all extra-abdominal recurrence sites are diagnosed and managed appropriately.

  • lymph nodes
  • ovarian cancer
  • neoplasm metastasis
  • pleural cavity
  • lymphatic metastasis

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  • Contributors Each author contributed meaningfully to the final work, including study design (AL, IM, WC), data abstraction (AL), radiology abstraction-review (SS), and data analysis and manuscript preparation or revision (AL, IM, WC, and statisticians AW and MMcG).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. De-identified data may be requested from authors. Approval will be made on a case-by-case basis, compliant with IRB and HIPPA policies.