Sentinel lymph node biopsy (SLNB) has been widely adopted in the management of early-stage gynaecological cancers such as endometrial, vulvar and cervical cancer. Comprehensive surgical staging is crucial for patients with early-stage ovarian cancer and currently, that includes bilateral pelvic and para-aortic lymph node assessment. SLNB allows the identification, excision and pathological assessment of the first draining lymph nodes, thus negating the need for a full lymphadenectomy. We systematically searched the MEDLINE, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases (from inception to 3 November 2022) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Our search identified 153 articles from which 11 were eligible for inclusion. Patients with clinical stage I–II ovarian cancer undergoing sentinel lymph node biopsy were included. Statistical analysis was performed in RStudio using the meta package, where meta-analysis was performed for the detection. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies C (QUADAS-C) tool. Overall, 11 observational studies met the predetermined criteria and these included 194 women. The meta-analysis showed that the detection rate of sentinel lymph nodes in early-stage ovarian cancer was 94% (95% CI of 86% to 1.00%). Significant heterogeneity was noted among the studies with Q = 47.6, p < 0.0001, I² = 79% and τ² = 0.02. Sentinel lymph nodes in early-stage ovarian cancer have a high detection rate and can potentially have applicability in clinical practice. However, considering the small number of participants in the studies, the heterogeneity among them and the low quality of evidence, the results should be interpreted with caution. Larger trials are needed before a change in clinical practice is recommended.

Salem A, et al. J Cardiovasc Imaging. 2019 Sep;28:e2. https://doi.org/10.4250/jcvi.2019.0077

This study aimed to identify the clinical and sociodemographic risk factors and compare cancer stage, treatment, and survival outcomes associated with ovarian cancer diagnosed following an emergency presentation versus other routes. A systematic search of Embase and MEDLINE was conducted from January 2000 to August 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO: CRD420251111636). Studies were included if they examined risk factors associated with ovarian cancer diagnosis following an emergency presentation. Studies were also included if they compared treatment or survival outcomes between those diagnosed after an emergency presentation and those diagnosed via other routes. The quality of the studies was assessed using the Newcastle-Ottawa scale. Of the 3499 studies identified, 12 met the inclusion criteria and included a total of 127,395 women. All of the studies were conducted in high-income countries. Older age and socioeconomic deprivation were the most common determinants of an ovarian cancer diagnosis following an emergency presentation, although most studies did not adjust for key confounders. This diagnostic route was associated with advanced tumor stage, lower rates of treatment, shorter intervals between diagnosis and treatment initiation, and poorer survival outcomes. While the included studies were at low risk of bias, substantial heterogeneity made cross-study comparison challenging, especially as contradictory findings between larger population-based studies and single-center studies were noted. Women diagnosed with ovarian cancer following an emergency admission have a poor prognosis in many high-income countries. Urgent concerted action is needed to both decrease the number of women diagnosed through this diagnostic pathway and increase their treatment rates to improve survival outcomes.