Is Computed Tomography Reliable for Detecting Lymph Node Metastasis in Advanced Epithelial Ovarian Cancer?

Background and Objectives Computed tomography (CT), preferred for diagnosing advanced epithelial ovarian cancer (EOC), may not accurately detect lymph node (LN) metastasis. This study evaluated the ability of CT to detect LN metastasis in advanced EOC. Methods We included 39 patients with advanced EOC who were imaged before and after receiving neoadjuvant chemotherapy using contrast-enhanced CT of the abdomen and pelvis to detect LN metastasis. Surgically resected LNs were subjected to histopathological examination to detect metastasis. The histopathological and CT results were correlated. Results As per CT, 22 and 14 patients, respectively, were pelvic and retroperitoneal LN metastasis negative. However, histopathology detected 7/22 (31.81%) with pelvic LN and 7/14 (50%) with retroperitoneal LN involvement, suggesting the high false negativity of CT. Of 4 and 11 patients with CT-detected pelvic and retroperitoneal LN metastasis, 4/4 (100%) and 6/11 (54.54%), respectively, were metastasis positive via histopathology, indicating some false positivity of CT. Although no significant difference was found between CT and histopathology, CT was not specific or sensitive in detecting LN metastasis. Interpretation and Conclusion CT is neither sensitive nor specific for detecting LN metastasis in advanced EOC compared with histopathology. Lymphadenectomy should be performed to reduce the risk of recurrence.