KEY TAKEAWAYS
- The MELISA trial aimed to compare SLN mapping to full lymphadenectomy for accurate staging in early OC.
- The study found simultaneous injection of radiotracer and ICG yields a high overall SLN detection rate with a 100% negative predictive value in early-stage epithelial OC.
Pelvic and para-aortic lymphadenectomy is routinely performed during staging surgery for early-stage ovarian cancer (EOC) to assess prognosis and guide adjuvant therapy despite its linked risk of significant morbidity. Researchers aimed to compare sentinel lymph node (SLN) mapping to full lymphadenectomy for accurate staging in early OC.
Patients with suspected malignant ovarian masses or undergoing restaging surgery after confirmed malignancy were enrolled. A radiotracer was injected into the infundibulo-pelvic and utero-ovarian ligament before adnexal tumor removal, followed by intraoperative imaging using a portable gammacamera.
After 15 minutes, the tumor was removed and sent for frozen section assessment. Upon malignancy, confirmation, indocyanine green (ICG) was injected into the ligament stumps, and a gamma detector probe, a gamma camera, and a near-infrared camera guided sentinel lymph node SLN detection. Ultrastaging of SLN was conducted.
About 62 patients were initially eligible, with 30 patients with EOC included in the final analysis. No statistically significant differences were observed in baseline and surgical characteristics based on SLN detection outcomes. SLNs were detected in 90% of patients (27/30), with a detection rate of 88.89% in primary surgery and 91.67% in re-staging surgeries (P> 0.999).
Among the detected SLNs, 96.30% were in the aortic region, 48.15% in the pelvic region, and 44.44% in both regions. SLN metastases were found in 18.52% of cases (5/27), with a false-negative rate of 0% (95% CI: 0 – 43.4) and a negative predictive value (NPV) of 100% (95% CI: 85.1 – 100). Notably, only low-volume SLN metastases were identified. [Percentage values: SLN detection 90%, SLN detection in primary surgery 88.89%, SLN detection in re-staging surgeries 91.67%, SLN metastases 18.52%, False-negative rate 0%, NPV 100%]
The study found simultaneous injection of radiotracer and ICG yields a high overall SLN detection rate with a 100% negative predictive value in early-stage epithelial OC.
Source: https://ijgc.bmj.com/content/33/Suppl_3/A284.2.abstract
Clinical Trial: https://clinicaltrials.gov/study/NCT05184140
Agustí Garcia N, Celada C, Paredes P, Sicart-Vidal S, Glickman A, Marina T, Fusté P, Carreras N, Migliorelli F, Torne A, Díaz-Feijóo B. Mapping sentinel lymph node in early-stage ovarian cancer: MELISA trial results. J Clin Oncol. 2021;39(suppl 15):491. DOI:10.1200/JCO.2021.39.15_suppl.491
