title: Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas.
abstract: OBJECTIVE
  There is controversy regarding the pattern of lymphatic spread in unilateral stage I invasive ovarian carcinomas. The purpose of this study is 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 were identified. Pathology reports were reviewed to identify metastatic LN involvement, number of involved nodes, and their locations. Patients with gross disease in the pelvis or abdomen or those who had grossly positive LNs removed 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. Grade 3 tumors were more commonly seen in LN-positive versus LN-negative patients (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 patients had LN sampling only on the side ipsilateral to the neoplastic ovary, 4 of whom (10%) had LN metastases. Fifty-four patients had bilateral sampling performed, 10 of whom (19%) had LN metastases. Of these 10 patients, isolated ipsilateral LN metastases were seen in 5 (50%) cases. Isolated contralateral LN metastases were seen in 3 (30%) cases, and bilateral metastases were seen in 2 (20%).
  
  
  CONCLUSIONS
  In this cohort of patients with clinical stage I ovarian carcinoma 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 recommended to accurately stage ovarian carcinoma.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: I
authors.initials: I
authors.lastname: Cass
authors.forename: A J
authors.initials: AJ
authors.lastname: Li
authors.forename: C D
authors.initials: CD
authors.lastname: Runowicz
authors.forename: A L
authors.initials: AL
authors.lastname: Fields
authors.forename: G L
authors.initials: GL
authors.lastname: Goldberg
authors.forename: R S
authors.initials: RS
authors.lastname: Leuchter
authors.forename: L D
authors.initials: LD
authors.lastname: Lagasse
authors.forename: B Y
authors.initials: BY
authors.lastname: Karlan
mesh_terms: D001012:Aorta, Abdominal; D002277:Carcinoma / Q000473:pathology*; D004848:Epithelium / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology*; D010388:Pelvis; D012189:Retrospective Studies; D016019:Survival Analysis