Pattern of lymph node metastases in clinically unilateral stage invasive epithelial ovarian carcinomas

Purpose. There is controversy regarding the pattern of lymphatic spread in unilateral stage I invasive ovarian carcinomas. The purpose of this study i s to describe the incidence and distribution of lymph node (LN) metastases in ovarian carcinomas clinically confined to one ovary. Methods. Ninety-six patients with disease visibly confined to one ovary wer e identified. Pathology reports were reviewed to identify metastatic LN inv olvement, number of involved nodes, and their locations. Patients with gros s disease in the pelvis or abdomen or those who had grossly positive LNs re moved for debulking were excluded from this review. Results. Fourteen of ninety-six patients (15%) had microscopically positive LNs on pathologic review. All of these 14 patients had grade 3 tumors. Gra de 3 tumors were more commonly seen in LN-positive versus LN-negative patie nts (P < 0.001). Pelvic nodes were positive in 7 patients (50%), paraaortic nodes in 5 patients (36%), and both in 2 patients (14%). Forty-two patient s had LN sampling only on the side ipsilateral to the neoplastic ovary, 4 o f whom (10%) had LN metastases. Fifty-four patients had bilateral sampling performed, 10 of whom (19%) had LN metastases. Of these 10 patients, isolat ed ipsilateral LN metastases were seen in 5 (50%) cases. Isolated contralat eral LN metastases were seen in 3 (30%) cases, and bilateral metastases wer e seen in 2 (20%). Conclusions. In this cohort of patients with clinical stage I ovarian carci noma with disease limited to one ovary, bilateral LN sampling increased the identification of nodal metastases. Ipsilateral sampling may result in the understaging of patients. Bilateral pelvic and paraaortic LN sampling is r ecommended to accurately stage ovarian carcinoma. (C) 2001 Academic Press.