Pier Carlo Zorzato

Sentinel lymph node biopsy in apparently early-stage epithelial ovarian cancer: a systematic review and meta-analysis

To evaluate the detection rate, sensitivity, and negative predictive value (NPV) of sentinel lymph node (SLN) biopsy in patients with apparently early-stage epithelial ovarian cancer (EOC). A systematic search of multiple electronic databases was conducted from inception to October 31, 2025. Studies reporting detection rate, sensitivity, and NPV of SLN biopsy in apparently early-stage EOC, with completion pelvic and para-aortic lymphadenectomy as reference standard, were included. Study selection, risk-of-bias assessment, and data extraction were independently performed by four reviewers. Pooled estimates with 95 % confidence intervals (CI) were calculated using random-effects models on a per-patient basis and by anatomical site. Heterogeneity was assessed using the I Fourteen studies comprising 365 patients were included. Most studies used indocyanine green injected into the infundibulopelvic ligament for para-aortic mapping and the utero-ovarian ligament for pelvic mapping. The pooled para-aortic detection rate was 79.9 % (95 %CI 66.1-91.4 %; I In apparently early-stage EOC, SLN biopsy shows acceptable para-aortic detection but limited pelvic detection. Nonetheless, sensitivity and NPV indicate high diagnostic accuracy. Further studies are needed to optimize pelvic mapping strategies and confirm these findings. At present, sentinel lymph node mapping in apparently early-stage epithelial ovarian cancer should be regarded as investigational and not as standard of care.

Sentinel lymph node biopsy in apparently early-stage ovarian cancer: beyond removal of green nodes and surgical experience

Systematic pelvic and para-aortic lymphadenectomy is the standard procedure for surgical staging in apparently early-stage ovarian cancer. The role of sentinel lymph node biopsy remains unclear. To evaluate the diagnostic accuracy, feasibility, and safety of sentinel lymph node biopsy when performed by a single operator with a standardized technique. Case series of 36 patients with apparently early-stage ovarian cancer who underwent surgery performed by a single operator following the SELLY trial protocol. Sentinel lymph node mapping was performed by injecting the tracer into the infundibulopelvic and utero-ovarian ligaments. Sentinel node biopsy was followed by systematic pelvic and para-aortic lymphadenectomy. Thirty-six consecutive patients with apparently early-stage ovarian cancer were enrolled; 22 patients underwent immediate surgery and 14 delayed procedures after incidental diagnosis. 86.1 % of patients had successful mapping of at least one SLN, and 54.8 % had successful mapping in both pelvic and para-aortic regions. Three patients had isolated tumor cells (ITCs) and one patient had macro-metastasis in SLN. No cases of false negative SLN were observed. The sensitivity and negative predictive value were 100 %. We had five (13.9 %) postoperative complications not related to the SLN procedure itself. SLN is a reliable and safe surgical procedure in apparent early-stage ovarian cancer regardless of immediate and delayed surgery, but strict protocol adherence and expert surgeons are mandatory. SLN mapping in apparent early-stage ovarian cancer is feasible and accurate in detecting lymph node metastasis.

Fertility-sparing vs hysterectomy for uterine STUMP: A pragmatic clinical study.

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare neoplasms with unpredictable clinical behavior. Optimal management, particularly in reproductive-aged women, remains controversial, with limited data comparing the safety of fertility-sparing versus hysterectomy. This multicentre retrospective cohort study included women aged 18-85 with histologically confirmed STUMP treated at 17 Italian gynecologic oncology centers from 2010 to 2023. Patients underwent either fertility-sparing surgery (myomectomy or hysteroscopic resection) or definitive surgery (hysterectomy ± salpingo-oophorectomy). Kaplan-Meier and Cox models were used to compare recurrence-free survival (RFS) and overall survival (OS). Median (range) follow-up was 51 (1-291) months. Among 401 women, 106 (26.4 %) received fertility-sparing treatment (mean [± SD] age: 35.3 ± 6.8 years) and 295 (73.6 %) underwent definitive surgery (mean [± SD] age: 47.7 ± 9.2). At total follow-up, recurrence occurred in 12.5 % of patients, predominantly within the pelvis. Median RFS was longer after definitive surgery than after fertility-sparing procedures (50.0 vs 42.5 months; HR 2.39 [95 % CI 1.36-4.19]), although this difference disappeared when benign (leiomyoma) recurrences were excluded (HR 1.74 [95 % CI 0.90-3.34]). At last available follow-up, 97.5 % of patients were alive, with no significant OS difference between treatment groups (HR 0.22 [95 % CI 0.27-1.79]). Outcomes were comparable across menopausal status and concurrent adnexal removal. Definitive surgery reduces recurrence risk, but long-term survival is similarly excellent after fertility-sparing surgery in appropriately selected women with STUMP. Conservative management represents a reasonable option for patients desiring fertility, provided they receive counseling regarding recurrence risk, diagnostic uncertainty, and the need for long-term surveillance.