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Journal of Ovarian Research
Published in: Journal of Ovarian Research 1/2016

Open Access 01-12-2016 | Research

Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging

Authors: Malihe Hassanzadeh, Elham Hosseini Farahabadi, Zohreh Yousefi, Sima Kadkhodayan, Leili Zarifmahmoudi, Ramin Sadeghi

Published in: Journal of Ovarian Research | Issue 1/2016

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Abstract

Background

Experience on sentinel node mapping in ovarian tumors is very limited. We evaluated the sentinel node concept in ovarian tumors using intra-operativeTc-99m-Phytate injection and lymphoscintigraphy imaging.

Methods

Thirty-five patients with a pelvic mass due to an ovarian pathology were included in the study. The radiotracer was injected just after laparotomy and before removal of the tumor either beneath the normal cortex (10 patients) or in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum two injections of the radiotracer (25 patients). For malignant masses, the sentinel nodes were identified using a hand held gamma probe. Then standard pelvic and para-aortic lymphadenectomy was performed. In case of benign pathologies or borderline ovarian tumors on frozen section, lymphadenectomy was not performed. The morning after surgery, all patients were sent for lymphoscintigraphy imaging of the abdomen and pelvis.

Results

Sentinel node was identified only in 4 patients of the cortical injection group. At least one sentinel node could be identified in 21 patients of the sub-peritoneal group. Sentinel nodes were identified only in the para-aortic area in 21, pelvic/para-aortic areas in 2, and pelvic only area in 2 patients. Three patients had lymph node involvement and all had involved sentinel nodes (no false negative case).

Conclusion

Sentinel node mapping using intra-operative injection of the radiotracer (in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum) is feasible in ovarian tumors. Technical aspects of this method should be explored in larger multicenter studies in the future.
Literature
1.
2.
3.
Holschneider CH, Berek JS. Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol. 2000;19(1):3–10.PubMedCrossRef
4.
Angioli R, Plotti F, Palaia I, Calcagno M, Montera R, Cafa EV, Sereni MI, Panici PB. Update on lymphadenectomy in early and advanced ovarian cancer. Curr Opin Obstet Gynecol. 2008;20(1):34–9.PubMedCrossRef
5.
Panici PB, Maggioni A, Hacker N, Landoni F, Ackermann S, Campagnutta E, Tamussino K, Winter R, Pellegrino A, Greggi S, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst. 2005;97(8):560–6.PubMedCrossRef
6.
Takeshima N, Hirai Y, Umayahara K, Fujiwara K, Takizawa K, Hasumi K. Lymph node metastasis in ovarian cancer: difference between serous and non-serous primary tumors. Gynecol Oncol. 2005;99(2):427–31.PubMedCrossRef
7.
Maggioni A, Benedetti Panici P, Dell’Anna T, Landoni F, Lissoni A, Pellegrino A, Rossi RS, Chiari S, Campagnutta E, Greggi S, et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer. 2006;95(6):699–704.PubMedPubMedCentralCrossRef
8.
Ulanday KT, Ward KK, Macera CA, Ji M, Plaxe SC. Regional variation in surgical assessment of lymph nodes for staging among women with early-stage epithelial ovarian cancer. Gynecol Oncol. 2014;132(2):411–5.PubMedCrossRef
9.
Hassanzade M, Attaran M, Treglia G, Yousefi Z, Sadeghi R. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol. 2013;130(1):237–45.PubMedCrossRef
10.
Ansari M, Rad MA, Hassanzadeh M, Gholami H, Yousefi Z, Dabbagh VR, Sadeghi R. Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature. Eur J Gynaecol Oncol. 2013;34(5):387–401.PubMed
11.
Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol. 2012;187(1):25–31.PubMedCrossRef
12.
Sadeghi R, Tabasi KT, Bazaz SM, Kakhki VR, Massoom AF, Gholami H, Zakavi SR. Sentinel node mapping in the prostate cancer. Meta-analysis. Nuklearmedizin Nucl Med. 2011;50(3):107–15.CrossRef
13.
Kadkhodayan S, Hasanzadeh M, Treglia G, Azad A, Yousefi Z, Zarifmahmoudi L, Sadeghi R. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature. Eur J Surg Oncol. 2015;41(1):1–20.PubMedCrossRef
14.
Shafiei S, Bagheri R, Sadri K, Jafarian AH, Attaran D, Mohammadzadeh Lari S, Basiri R, Asnaashari H, Mohammad A, Sadeghi R. Sentinel node mapping for intra-thoracic malignancies: systematic review of the best available evidence. Rev Clin Med. 2015;2(2):52–7.
15.
Nyberg RH, Korkola P, Maenpaa J. Ovarian sentinel node: is it feasible? Int J Gynecol Cancer. 2011;21(3):568–72.PubMedCrossRef
16.
Negishi H, Takeda M, Fujimoto T, Todo Y, Ebina Y, Watari H, Yamamoto R, Minakami H, Sakuragi N. Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer. Gynecol Oncol. 2004;94(1):161–6.PubMedCrossRef
17.
Kleppe M, Brans B, Van Gorp T, Slangen BF, Kruse AJ, Pooters IN, Lotz MG, Van de Vijver KK, Kruitwagen RF. The detection of sentinel nodes in ovarian cancer: a feasibility study. J Nucl Med. 2014;55(11):1799–804.PubMedCrossRef
18.
Vanneuville G, Mestas D, Le Bouedec G, Veyre A, Dauplat J, Escande G, Guillot M. The lymphatic drainage of the human ovary in vivo investigated by isotopic lymphography before and after the menopause. Surg Radiol Anat. 1991;13(3):221–6.PubMedCrossRef
19.
Momennezhad M, Zakavi SR, Dabbagh Kakhki VR, Jangjoo A, Ghavamnasiri MR, Sadeghi R. Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source. Radiol Oncol. 2011;45(3):184–8.PubMedPubMedCentralCrossRef
20.
Vanneuville G, Lebouedec G, Mestas D, Scheye T, Dauplat J, Veyre A. Functional aspects of lymphatic drainage of the human ovary in vivo explored with isotopic lymphography. Bull Assoc Anat. 1991;75(229):177–9.
21.
Kleppe M, Van Gorp T, Slangen BF, Kruse AJ, Brans B, Pooters IN, Van de Vijver KK, Kruitwagen RF. Sentinel node in ovarian cancer: study protocol for a phase 1 study. Trials. 2013;14:47.PubMedPubMedCentralCrossRef
22.
Taghizadeh Kermani A, Bagheri R, Tehranian S, Shojaee P, Sadeghi R, N Krag D. Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature. Lung Cancer. 2013;80(1):5–14.PubMedCrossRef
23.
Abdollahi A, Jangjoo A, Dabbagh Kakhki VR, Rasoul Zakavi S, Memar B, Naser Forghani M, Mehrabibahar M, Sadeghi R. Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. Revista Espanola de Medicina Nuclear. 2010;29(2):73–7.PubMedCrossRef
24.
Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Reza Dabbagh Kakhki V, Aryana K, Forghani MN, Sadeghi R. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg. 2011;202(2):199–202.PubMedCrossRef
25.
Sadeghi R, Forghani MN, Memar B, Rajabi Mashhadi MT, Dabbagh Kakhki VR, Abdollahi A, Zakavi SR. How long the lymphoscintigraphy imaging should be continued for sentinel lymph node mapping? Ann Nucl Med. 2009;23(6):507–10.PubMedCrossRef
26.
Takei H, Suemasu K, Kurosumi M, Ninomiya J, Horii Y, Inoue K, Tabei T. 99mTc-phytate is better than 99mTc-human serum albumin as a radioactive tracer for sentinel lymph node biopsy in breast cancer. Surg Today. 2006;36(3):219–24.PubMedCrossRef
27.
Higashi H, Natsugoe S, Uenosono Y, Ehi K, Arigami T, Nakabeppu Y, Nakajo M, Aikou T. Particle size of tin and phytate colloid in sentinel node identification. J Surg Res. 2004;121(1):1–4.PubMedCrossRef
28.
Dabbagh Kakhki VR, Jangjoo A, Tavassoli A, Asadi M, Sadri K, Fatahi Masoom A, Mehrabibahar M, Memar B, Ansari M, Sadeghi R. Sentinel node mapping for early breast cancer patients using 99mTc-phytate: single center experience on 165 patients. Iran J Nucl Med. 2012;20(2):25–9.
29.
Eftekhari M, Beiki D, Fallahi B, Arabi M, Memari F, Gholamrezanezhad A, Esmaili J, Akhzari F, Fard-Esfahani A. Assessment the diagnostic accuracy of sentinel lymph nodes lymphoscintigraphy using Technetium-99m phytate in breast cancer. Daru. 2009;17(2):83–7.
30.
Shiravani Z, Hasanzadeh M, Yousefi Z, Kadkhodayan S, Sharifi N, Saeedzadeh M, Attaran M, Dabbagh Kakhki VR, Sadeghi R. The value of lateral lymphoscintigraphy images of the pelvis for gynecological cancers: Are they necessary? Iran J Nucl Med. 2014;22(2):46–50.
31.
Sadeghi R, Alesheikh G, Zakavi SR, Fattahi A, Abdollahi A, Assadi M, Jangjoo A, Keshtgar M. Added value of blue dye injection in sentinel node biopsy of breast cancer patients: do all patients need blue dye? Int J Surg. 2014;12(4):325–8.PubMedCrossRef
32.
Frontado LM, Brouwer OR, van den Berg NS, Matheron HM, Vidal-Sicart S, van Leeuwen FW, Valdes Olmos RA. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Revista Espanola de Medicina Nuclear e Imagen Molecular. 2013;32(4):227–33.PubMed
33.
Takei H, Suemasu K, Kurosumi M, Horii Y, Ninomiya J, Kamimura M, Naganuma R, Uchida K, Igarashi K, Inoue K, et al. Added value of the presence of blue nodes or hot nodes in sentinel lymph node biopsy of breast cancer. Breast Cancer. 2006;13(2):179–85.PubMedCrossRef
34.
Ramin S, Azar FP, Malihe H. Methylene blue as the safest blue dye for sentinel node mapping: emphasis on anaphylaxis reaction. Acta Oncol. 2011;50(5):729–31.PubMedCrossRef
35.
Jangjoo A, Forghani MN, Mehrabibahar M, Sadeghi R. Anaphylaxis reaction of a breast cancer patient to methylene blue during breast surgery with sentinel node mapping. Acta Oncol. 2010;49(6):877–8.PubMedCrossRef
36.
Jangjoo A, Forghani MN, Mehrabibahar M, Rezapanah A, Kakhki VR, Zakavi SR, Ghavamnasiri MR, Kashani I, Hashemian F, Sadeghi R. Comparison of early and delayed lymphoscintigraphy images of early breast cancer patients undergoing sentinel node mapping. Nucl Med Commun. 2010;31(6):521–5.PubMed
37.
Sadeghi R, Forghani MN, Memar B, Abdollahi A, Zakavi SR, Mashhadi MT, Raziee HR, Tavassoli A, Kakhki VR. Comparison of pre-operative lymphoscintigraphy with inter-operative gamma probe and dye technique regarding the number of detected sentinel lymph nodes. Hell J Nucl Med. 2009;12(1):30–2.PubMed
38.
Klapdor R, Langer F, Gratz KF, Hillemanns P, Hertel H. SPECT/CT for SLN dissection in vulvar cancer: Improved SLN detection and dissection by preoperative three-dimensional anatomical localisation. Gynecol Oncol. 2015;138(3):590–6.PubMedCrossRef
39.
Mucke J, Klapdor R, Schneider M, Langer F, Gratz KF, Hillemanns P, Hertel H. Isthmocervical labelling and SPECT/CT for optimized sentinel detection in endometrial cancer: technique, experience and results. Gynecol Oncol. 2014;134(2):287–92.PubMedCrossRef
40.
Sadeghi R. Sentinel node mapping diagnostic studies warrant a unique reporting criteria: Comment on Xiong et al. systematic review. Eur J Surg Oncol. 2014;40(8):1025–6.PubMedCrossRef
41.
Giammarile F, Bozkurt MF, Cibula D, Pahisa J, Oyen WJ, Paredes P, Olmos RV, Sicart SV. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014;41(7):1463–77.PubMedCrossRef
42.
Kadkhodayan S, Farahabadi EH, Yousefi Z, Hasanzadeh M, Sadeghi R. Inappropriate intra-cervical injection of radiotracer for sentinel lymph node mapping in a uterine cervix cancer patient: importance of lymphoscintigraphy and blue dye injection. Asia Oceania J Nucl Med Biol. 2014;2(2):135–7.
43.
Nugent N, Hill AD, Casey M, Kelly L, Dijkstra B, Collins CD, McDermott EW, O’Higgins N. Safety guidelines for radiolocalised sentinel node resection. Ir J Med Sci. 2001;170(4):236–8.PubMedCrossRef
Metadata
Title
Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging
Authors
Malihe Hassanzadeh
Elham Hosseini Farahabadi
Zohreh Yousefi
Sima Kadkhodayan
Leili Zarifmahmoudi
Ramin Sadeghi
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Ovarian Research / Issue 1/2016
Electronic ISSN: 1757-2215
DOI
https://doi.org/10.1186/s13048-016-0265-4

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