Bone and Soft Tissue Sarcomas

Annals of Surgical Oncology

, 16:1356

First online:

Role of Sentinel Lymph Node Biopsy in the Staging of Synovial, Epithelioid, and Clear Cell Sarcomas

  • Ugwuji N. MaduekweAffiliated withDivision of Surgical Oncology, Department of Surgery, Massachusetts General Hospital
  • , Francis J. HornicekAffiliated withDivision of Orthopedic Oncology, Department of Orthopedics, Massachusetts General Hospital
  • , Dempsey S. SpringfieldAffiliated withDivision of Orthopedic Oncology, Department of Orthopedics, Massachusetts General Hospital
  • , Kevin A. RaskinAffiliated withDivision of Orthopedic Oncology, Department of Orthopedics, Massachusetts General Hospital
  • , David C. HarmonAffiliated withDivision of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital
  • , Edwin ChoyAffiliated withDivision of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital
  • , Andrew E. RosenbergAffiliated withDepartment of Pathology, Massachusetts General Hospital
  • , G. Petur NielsenAffiliated withDepartment of Pathology, Massachusetts General Hospital
  • , Thomas F. DeLaneyAffiliated withDepartment of Radiation Oncology, Massachusetts General Hospital
    • , Yen-Lin ChenAffiliated withDepartment of Radiation Oncology, Massachusetts General Hospital
    • , Mark J. OttAffiliated withDepartment of Surgery, LDS Hospital
    • , Sam S. YoonAffiliated withDivision of Surgical Oncology, Department of Surgery, Massachusetts General Hospital Email author 

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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.