Abstract
Background
Soft tissue sarcomas generally have a ≤5% risk of lymph node metastasis, but synovial, epithelioid, and clear cell subtypes reportedly have a much higher risk. The utility of sentinel lymph node biopsy (SLNB) for patients with these sarcoma subtypes is unknown.
Methods
29 patients with nonmetastatic synovial, epithelioid, and clear cell sarcomas who underwent SLNB were examined.
Results
Median age was 35 years (range 11–73 years), and 69% were male. Tumors were located in the lower extremity in 17 patients and the upper extremity in 12. The histological subtypes were synovial sarcoma in 16 patients, epithelioid sarcoma in 10, and clear cell sarcoma in 3. All patients had a staging chest computed tomography (CT) scan, none of which were suspicious, and 20 patients had staging positron emission tomography (PET) scans (16 negative, 3 indeterminate, and 1 suspicious). All patients had resection of their primary tumor. At least one sentinel node was found in 28 patients (97%), and the median number of sentinel nodes identified was 2 (range 1–4). One patient had a positive sentinel node on routine hematoxylin and eosin (H&E) staining and developed lung metastases. Two patients had positive sentinel nodes following immunohistochemical staining, and both remain disease free despite not undergoing completion lymphadenectomy. One patient developed a lymph node metastasis after a negative SLNB.
Conclusion
For patients with these sarcoma subtypes without radiological evidence of nodal or distant metastases, the incidence of occult lymph node metastasis is relatively low. Determining utility of SLNB may require a multicenter trial.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.
Behranwala KA, A’Hern R, Omar AM, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol. 2004;11:714–9.
Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993;217:72–7.
Riad S, Griffin AM, Liberman B, Blackstein ME, Catton CN, Kandel RA, et al. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res. 2004;426:129–34.
Wagner W, Willich N, Rube C, Prott FJ, Micke O. [Treatment results of soft tissue sarcomas in adults]. Strahlenther Onkol. 1994;170:91–9.
Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987;60:1800–8.
Deenik W, Mooi WJ, Rutgers EJ, Peterse JL, Hart AA, Kroon BB. Clear cell sarcoma (malignant melanoma) of soft parts: A clinicopathologic study of 30 cases. Cancer. 1999;86:969–75.
Daigeler A, Kuhnen C, Moritz R, Stricker I, Goertz O, Tilkorn D, et al. Lymph node metastases in soft tissue sarcomas-a single center analysis of 1,597 patients. Langenbecks Arch Surg. 2008;394:321–9.
Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer–a multicenter validation study. N Engl J Med. 1998;339:941–6.
Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–8; discussion 468–71.
Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.
Reintgen D, Cruse CW, Wells K, Berman C, Fenske N, Glass F, et al. The orderly progression of melanoma nodal metastases. Ann Surg. 1994;220:759–67.
Gadd MA, Cosimi AB, Yu J, Duncan LM, Yu L, Flotte TJ, et al. Outcome of patients with melanoma and histologically negative sentinel lymph nodes. Arch Surg. 1999;134:381–7.
Morton DL, Hoon DS, Cochran AJ, Turner RR, Essner R, Takeuchi H, et al. Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg. 2003;238:538–49; discussion 549–50.
Leong SP, Kashani-Sabet M, Desmond RA, Kim RP, Nguyen DH, Iwanaga K, et al. Clinical significance of occult metastatic melanoma in sentinel lymph nodes and other high-risk factors based on long-term follow-up. World J Surg. 2005;29:683–91.
Baratti D, Pennacchioli E, Casali PG, Bertulli R, Lozza L, Olmi P, et al. Epithelioid sarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol. 2007;14:3542–51.
Blazer DGr, Sabel MS, Sondak VK. Is there a role for sentinel lymph node biopsy in the management of sarcoma? Surg Oncol. 2003;12:201–6.
de Visscher SA, van Ginkel RJ, Wobbes T, Veth RP, Ten Heuvel SE, Suurmeijer AJ, et al. Epithelioid sarcoma: Still an only surgically curable disease. Cancer. 2006;107:606–12.
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 17 Regs Limited-Use, Nov 2006 Sub (1973–2004 varying), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007, based on the November 2006 submission [accessed March 2008].
Greene FL PDL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual, 6th edition. New York: Springer-Verlag, 2002.
Tunn PU, Andreou D, Illing H, Fleige B, Dresel S, Schlag PM. Sentinel node biopsy in synovial sarcoma. Eur J Surg Oncol. 2008;34:704–7.
Al-Refaie WB, Ali MW, Chu DZ, Paz IB, Blair SL. Clear cell sarcoma in the era of sentinel lymph node mapping. J Surg Oncol. 2004;87:126–9.
Fantini F, Monari P, Bassissi S, Maiorana A, Cesinaro AM. Sentinel lymph node biopsy in clear cell sarcoma. J Eur Acad Dermatol Venereol. 2007;21:1271–2.
Picciotto F, Zaccagna A, Derosa G, Pisacane A, Puiatti P, Colombo E, et al. Clear cell sarcoma (malignant melanoma of soft parts) and sentinel lymph node biopsy. Eur J Dermatol. 2005;15:46–8.
van Akkooi AC, Verhoef C, van Geel AN, Kliffen M, Eggermont AM, de Wilt JH. Sentinel node biopsy for clear cell sarcoma. Eur J Surg Oncol. 2006;32:996–9.
Seal A, Tse R, Wehrli B, Hammond A, Temple CL. Sentinel node biopsy as an adjunct to limb salvage surgery for epithelioid sarcoma of the hand. World J Surg Oncol. 2005;3:41.
Cochran AJ, Ohsie SJ, Binder SW. Pathobiology of the sentinel node. Curr Opin Oncol. 2008;20:190–5.
Clark J, Rocques PJ, Crew AJ, Gill S, Shipley J, Chan AM, et al. Identification of novel genes, SYT and SSX, involved in the t(X;18)(p11.2;q11.2) translocation found in human synovial sarcoma. Nat Genet. 1994;7:502–8.
Zucman J, Delattre O, Desmaze C, Epstein AL, Stenman G, Speleman F, et al. EWS and ATF-1 gene fusion induced by t(12;22) translocation in malignant melanoma of soft parts. Nat Genet. 1993;4:341–5.
Crippa F, Gerali A, Alessi A, Agresti R, Bombardieri E. FDG-PET for axillary lymph node staging in primary breast cancer. Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:S97–102.
Acland KM, Healy C, Calonje E, O’Doherty M, Nunan T, Page C, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma. J Clin Oncol. 2001;19:2674–8.
Volker T, Denecke T, Steffen I, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol. 2007;25:5435–41.
Chagpar AB, Carlson DJ, Laidley AL, et al. Factors influencing the number of sentinel lymph nodes identified in patients with breast cancer. Am J Surg. 2007;194:860–4; discussion 864–5.
Lin KM, Patel TH, Ray A, et al. Intradermal radioisotope is superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes. J Am Coll Surg. 2004;199:561–6.
Mudun A, Sanli Y, Ozmen V, et al. Comparison of different injection sites of radionuclide for sentinel lymph node detection in breast cancer: single institution experience. Clin Nucl Med. 2008;33:262–7.
Karam A, Stempel M, Cody HSr, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg. 2008;207:543–8.
Port ER, Fey J, Gemignani ML, et al. Reoperative sentinel lymph node biopsy: a new option for patients with primary or locally recurrent breast carcinoma. J Am Coll Surg. 2002;195:167–72.
Roumen RM, Kuijt GP, Liem IH. Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol. 2006;32:1076–81.
Acknowledgements
Dr. Maduekwe was supported by an NIH K30 Clinical Research Curriculum Award through the Scholars in Clinical Science Program at Harvard Medical School.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maduekwe, U.N., Hornicek, F.J., Springfield, D.S. et al. Role of Sentinel Lymph Node Biopsy in the Staging of Synovial, Epithelioid, and Clear Cell Sarcomas. Ann Surg Oncol 16, 1356–1363 (2009). https://doi.org/10.1245/s10434-009-0393-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0393-9