Sentinel lymph node biopsy in apparently early-stage epithelial ovarian cancer: a systematic review and meta-analysis

Objective: To evaluate the detection rate, sensitivity, and negative predictive value (NPV) of sentinel lymph node (SLN) biopsy in patients with apparently early-stage epithelial ovarian cancer (EOC). Methods: A systematic search of multiple electronic databases was conducted from inception to October 31, 2025. Studies reporting detection rate, sensitivity, and NPV of SLN biopsy in apparently early-stage EOC, with completion pelvic and para-aortic lymphadenectomy as reference standard, were included. Study selection, risk-of-bias assessment, and data extraction were independently performed by four reviewers. Pooled estimates with 95 % confidence intervals (CI) were calculated using random-effects models on a per-patient basis and by anatomical site. Heterogeneity was assessed using the I2statistic. Results: Fourteen studies comprising 365 patients were included. Most studies used indocyanine green injected into the infundibulopelvic ligament for para-aortic mapping and the utero-ovarian ligament for pelvic mapping. The pooled para-aortic detection rate was 79.9 % (95 %CI 66.1–91.4 %; I2 = 74 %), while the pelvic detection rate was 42.7 % (95 %CI 28.5–57.3 %; I2 = 71 %). Pooled NPV was 100 % in both para-aortic and pelvic regions (I2 = 0 %). Sensitivity was 97.8 % (95 %CI 84.0–100 %) in the para-aortic area and 100 % (95 %CI 75.3–100 %) in the pelvis. Conclusions: In apparently early-stage EOC, SLN biopsy shows acceptable para-aortic detection but limited pelvic detection. Nonetheless, sensitivity and NPV indicate high diagnostic accuracy. Further studies are needed to optimize pelvic mapping strategies and confirm these findings. At present, sentinel lymph node mapping in apparently early-stage epithelial ovarian cancer should be regarded as investigational and not as standard of care.