Is surgical lymph node assessment necessary for women with mucinous ovarian cancer?

We will discuss “Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis” by Hoogendam and co-workers from 26 October 2016 for 7 days.

*This paper is now free-to-view. The linked mini-commentary by Nagar H on this paper can also be found via this research report.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 26 October 2016 (the discussion will continue for 7 days between 26 October- 2 November 2016)

First hosted discussion session(s) on Twitter starts at GMT+1 (British Summer Time) 8pm on 26 October 2016 (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A 50-year-old woman attended your gynaeoncology clinic regarding the management of a complex ovarian mass. A staging CT confirmed a unilateral mass with features suggestive of malignancy. There was no radiological evidence of metastasis. Multidisciplinary team discussion suggested upfront surgery. She had no comorbidity.

How would you counsel this woman about the proposed operation?

Description of research

Participants Women diagnosed with mucinous ovarian carcinoma undergoing surgical staging
Intervention Studies with ≥10 mucinous ovarian carcinoma cases and surgical lymph nodal assessment
Comparison No surgical lymph nodal assessment
Outcomes Prevalence of lymph node metastases, stage shift based on lymph node assessment and survival data
Study design Systematic review and meta-analysis
Authors’ conclusion Less than 1 in 100 (0.8%) women with stage 1-2 mucinous ovarian cancer undergoing lymph node assessment had metastases in resected lymph nodes.

Discussion Points

  • How do you currently assess the risks of malignancy in women presenting with ovarian masses?
  • How do the different subtypes of ovarian cancers differ in terms of clinical presentation and underlying genetic aberrations? (see suggested reading)
  • What did the Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions (ACROBAT-NRSI) show?
  • What are the strengths and weaknesses of this meta-analysis?
  • Is lymph node dissection a more sensitive method to detect metastases, compared to lymph node sampling?
  • How common is lymph node metastasis in women with other subtypes of ovarian cancer?
  • How often do we know an ovarian mass is likely to be mucinous carcinoma prior to surgery?
  • How may the results influence the current management pathway of women with ovarian masses?

Suggested reading

  • Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)
  • Vaughan S, Coward JI, Bast RC Jr, Berchuck A, Berek JS, Brenton JD, Coukos G, Crum CC, et al. Rethinking ovarian cancer: recommendations for improving outcomes. Nat Rev Cancer. 2011 Sep 23;11(10):719-25.
  • Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 34. Management of suspected ovarian masses in post-menopausal women (July 2016)

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.