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Occasionally, lymph node metastases represent the only component at the time of recurrence of ovarian cancer. In this case, the metastatic nodes predicted by PET/CT completely corresponded to the actual metastatic nodes. Ultrasound (US) could equally have confirmed the presence of such large lymph nodes. PET/CT or US often fails to identify microscopic disease in histopathologically-proven positive nodes. Therefore, it is difficult to reliably exclude lymph node metastases during surveillance following initial surgery for ovarian cancer. In the context of a recurrent ovarian disease, systematic aortic and pelvic node dissection would be considered appropriate in younger women with no other evidence of metastatic disease. This is unlikely to be curative but may produce palliation with symptom control and allow for the trial of novel therapies if available. More commonly, sampling of pelvic and aortic lymph nodes is part of the formal surgical staging of epithelial ovarian cancer at the time of initial surgical treatment. In addition, in women presenting initially with advanced stage ovarian cancer, systematic debulking of enlarged retroperitoneal lymph nodes will be considered if this leads to complete debulking of the tumour.
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