Introduction: The Evolving Landscape of Nodal Assessment
In the management of epithelial ovarian cancer (EOC), the status of regional lymph nodes has long served as a cornerstone for staging and prognostic stratification. However, as pathological techniques have advanced—incorporating ultrastaging and immunohistochemistry (IHC)—the detection of increasingly smaller volumes of metastatic disease has become possible. This has led to the identification of isolated tumor cells (ITCs), defined by the American Joint Committee on Cancer (AJCC) as tumor cell clusters measuring no more than 0.2 mm or comprising fewer than 200 cells. While the presence of ITCs carries significant weight in the staging and treatment of breast cancer and melanoma, their clinical relevance in gynecologic malignancies, particularly ovarian cancer, has remained a subject of intense debate among surgical oncologists and pathologists.
