Lymph node evaluation and prediction of nodal metastasis among Epithelial Ovarian Cancers: A Retrospective study

Objective: 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 June 2022 were included. The distribution of histology, stage and LN metastasis was studied. The predictive value of serum Cancer Antigen (CA) 125, radiologic and surgically enlarged LNs with final LN histopathology was studied.

Results: A total of 96 women with EOCs underwent CRS. Fifty women (52%) underwent primary and 46 women (48%) interval CRS. Seventy-five women (78.13%) of EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. HGSC was the commonest (n=55, 73.33%) histology. The majority of women, 56 (74.67%) were stage III and IV at presentation. Complete cytoreduction was achieved in 59 (78.66%) cases. ROC curve showed a cut-off for CA-125 of 1360 U/ml (AUC 0.702, p 0.002) for LN metastases. 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 were 78.26%, 57.69%, 45%, and 85.71%, respectively.

Conclusion: Serous histology, high-grade tumors, higher CA125 levels, and suspicious LNs in CECT or during surgery are significantly associated with LN metastasis. However, considering a false negative rate of 21.74%, the combination of radiologically and surgically enlarged LNs cannot be used as the sole surrogate marker for lymphadenectomy.