title: Understanding Lymphatic Drainage Pathways of the Ovaries to Predict Sites for Sentinel Nodes in Ovarian Cancer.
abstract: OBJECTIVE
  In ovarian cancer, detection of sentinel nodes is an upcoming procedure. Perioperative determination of the patient's sentinel node(s) might prevent a radical lymphadenectomy and associated morbidity. It is essential to understand the lymphatic drainage pathways of the ovaries, which are surprisingly up till now poorly investigated, to predict the anatomical regions where sentinel nodes can be found. We aimed to describe the lymphatic drainage pathways of the human ovaries including their compartmental fascia borders.
  
  
  METHODS
  A series of 3 human female fetuses and tissues samples from 1 human cadaveric specimen were studied. Immunohistochemical analysis was performed on paraffin-embedded transverse sections (8 or 10 μm) using antibodies against Lyve-1, S100, and α-smooth muscle actin to identify the lymphatic endothelium, Schwann, and smooth muscle cells, respectively. Three-dimensional reconstructions were created.
  
  
  RESULTS
  Two major and 1 minor lymphatic drainage pathways from the ovaries were detected. One pathway drained via the proper ligament of the ovaries (ovarian ligament) toward the lymph nodes in the obturator fossa and the internal iliac artery. Another pathway drained the ovaries via the suspensory ligament (infundibulopelvic ligament) toward the para-aortic and paracaval lymph nodes. A third minor pathway drained the ovaries via the round ligament to the inguinal lymph nodes. Lymph vessels draining the fallopian tube all followed the lymphatic drainage pathways of the ovaries.
  
  
  CONCLUSIONS
  The lymphatic drainage pathways of the ovaries invariably run via the suspensory ligament (infundibulopelvic ligament) and the proper ligament of the ovaries (ovarian ligament), as well as through the round ligament of the uterus. Because ovarian cancer might spread lymphogenously via these routes, the sentinel node can be detected in the para-aortic and paracaval regions, obturator fossa and surrounding internal iliac arteries, and inguinal regions. These findings support the strategy of injecting tracers in both ovarian ligaments to identify sentinel nodes.
authors.affiliation: *Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht; †Department of Anatomy and Embryology, Leiden University Medical Center, Leiden; ‡GROW-School for Oncology and Developmental Biology, Maastricht; and §Computer Graphics and Visualization, Department of Intelligent Systems, Delft University of Technology, Delft, the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kleppe
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kraima
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
authors.forename: Noeska N
authors.initials: NN
authors.lastname: Smit
authors.forename: Jacoba C
authors.initials: JC
authors.lastname: van Munsteren
authors.forename: Marco C
authors.initials: MC
authors.lastname: DeRuiter
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D004322:Drainage / Q000379:methods*; D005260:Female; D005333:Fetus / Q000378:metabolism / Q000473:pathology*; D005865:Gestational Age; D006801:Humans; D007124:Immunoenzyme Techniques; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D042601:Lymphatic Vessels / Q000378:metabolism / Q000473:pathology*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010388:Pelvis / Q000473:pathology*; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor