Skip to main content
SpringerLink
Log in

Sentinel Lymph Node Biopsy for Extremity and Truncal Soft Tissue Sarcomas: A Systematic Review of the Literature

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Regional lymph node metastasis (RLNM) occurs infrequently in patients with soft tissue sarcoma (STS), although certain STS subtypes have a higher propensity for RLNM. The identification of RLNM has significant implications for staging and prognosis; however, the precise impact of node-positive disease on patient survival remains a topic of controversy. Although the benefits of sentinel lymph node biopsy (SLNB) are well documented in patients with melanoma and breast cancer, whether this procedure offers a benefit in STS is controversial.

Methods

A systematic literature search was performed and articles reviewed to determine if SLNB in patients with extremity/truncal STS impacts disease-free or overall survival.

Results

Six studies were included. Rates of sentinel lymph node positivity were heterogeneous (range 4.3–50%). The impact of SLNB on patient outcomes remains unclear. The overall quality of available evidence was low, as assessed by the Grading of Recommendations, Assessment, Development, and Evaluation system.

Conclusions

The literature addressing the impact of nodal basin evaluation on the staging and management of patients with extremity/truncal STS is confounded by heterogeneous patient cohorts and clinical practices. Multicenter prospective studies are warranted to determine the true incidence of RLNM and whether SLNB could benefit patients with clinically occult RLNM at diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Adapted from Page et al.45

Similar content being viewed by others

References

  1. 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(1):72–7.

    Article  CAS  Google Scholar 

  2. Behranwala K, A’Hern R, Omar A-M, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol. 2004;11(7):714–9.

    Article  Google Scholar 

  3. Nishida Y, Yamada Y, Tsukushi S, Shibata S, Ishiguro N. Sentinel lymph node biopsy reveals a positive popliteal node in clear cell sarcoma. Anticancer Res. 2005;25(6):4413–6.

    Google Scholar 

  4. van Akkooi ACJ, Verhoef C, van Geel AN, Kliffen M, Eggermont AMM, de Wilt JHW. Sentinel node biopsy for clear cell sarcoma. Eur J Surg Oncol. 2006;32(9):996–9.

    Article  Google Scholar 

  5. Gow KW, Rapkin LB, Olson TA, Durham MM, Wyly B, Shehata BM. Sentinel lymph node biopsy in the pediatric population. J Pediatr Surg. 2008;43(12):2193–8.

    Article  Google Scholar 

  6. Kayton ML, Delgado R, Busam K, et al. Experience with 31 sentinel lymph node biopsies for sarcomas and carcinomas in pediatric patients. Cancer. 2008;112(9):2052–9.

    Article  Google Scholar 

  7. Swing DC, Geisinger KR. Sentinel lymph node mapping for alveolar rhabdomyosarcoma. Pathol Case Rev. 2008;13(3):119–21.

    Article  Google Scholar 

  8. Tunn P-U, Andreou D, Illing H, Fleige B, Dresel S, Schlag PM. Sentinel node biopsy in synovial sarcoma. Eur J Surg Oncol. 2008;34(6):704–7.

    Article  Google Scholar 

  9. Dall’Igna P, De Corti F, Alaggio R, Cecchetto G. Sentinel node biopsy in pediatric patients: the experience in a single institution. Eur J Pediatr Surg. 2014;24(6):482–7.

    Article  Google Scholar 

  10. Seal A, Tse R, Wehrli B, Hammond A, Temple CLF. Sentinel node biopsy as an adjunct to limb salvage surgery for epithelioid sarcoma of the hand. World J Surg Oncol. 2005;3:41.

    Article  Google Scholar 

  11. Albores-Zúñiga O, Padilla-Rosciano AE, Martínez-Said H, Cuéllar-Hubbe M, Ramírez-Bollas J. Clear cell sarcoma and sentinel lymph node biopsy: case report and literature review. Cir Cir. 2006;74(2):121–5.

    Google Scholar 

  12. Kayton ML, Meyers P, Wexler LH, Gerald WL, LaQuaglia MP. Clinical presentation, treatment, and outcome of alveolar soft part sarcoma in children, adolescents, and young adults. J Pediatr Surg. 2006;41(1):187–93.

    Article  Google Scholar 

  13. Alcorn KM, Deans KJ, Congeni A, et al. Sentinel lymph node biopsy in pediatric soft tissue sarcoma patients: utility and concordance with imaging. J Pediatr Surg. 2013;48(9):1903–6.

    Article  Google Scholar 

  14. 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(9):1271–2.

    CAS  Google Scholar 

  15. Picciotto F, Zaccagna A, Derosa G, et al. Clear cell sarcoma (malignant melanoma of soft parts) and sentinel lymph node biopsy. Eur J Dermatol. 2005;15(1):46–8.

    Google Scholar 

  16. Ferguson PC, Deheshi BM, Chung P, et al. Soft tissue sarcoma presenting with metastatic disease: outcome with primary surgical resection. Cancer. 2011;117(2):372–9.

    Article  Google Scholar 

  17. Riad S, Griffin AM, Liberman B, et al. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res. 2004;426:129–34.

    Article  Google Scholar 

  18. Pradhan A, Grimer RJ, Abudu A, et al. Epithelioid sarcomas: how important is loco-regional control? Eur J Surg Oncol. 2017;43(9):1746–52.

    Article  CAS  Google Scholar 

  19. Basile G, Mattei J-C, Alshaygy I, et al. Curability of patients with lymph node metastases from extremity soft-tissue sarcoma. Cancer. 2020;126(23):5098–108.

    Article  Google Scholar 

  20. Andreou D, Boldt H, Werner M, Hamann C, Pink D, Tunn PU. Sentinel node biopsy in soft tissue sarcoma subtypes with a high propensity for regional lymphatic spread-results of a large prospective trial. Ann Oncol. 2013;24(5):1400–5.

    Article  CAS  Google Scholar 

  21. Parida L, Morrisson GT, Shammas A, et al. Role of lymphoscintigraphy and sentinel lymph node biopsy in the management of pediatric melanoma and sarcoma. Pediatr Surg Int. 2012;28(6):571–8.

    Article  Google Scholar 

  22. Turpin B, Pressey JG, Nagarajan R, et al. Sentinel lymph node biopsy in head and neck rhabdomyosarcoma. Pediatr Blood Cancer. 2019;66(3):1–4.

    Article  Google Scholar 

  23. Wright S, Armeson K, Hill EG, et al. The role of sentinel lymph node biopsy in select sarcoma patients: a meta-analysis. Am J Surg. 2012;204(4):428–33.

    Article  Google Scholar 

  24. Neville HL, Andrassy RJ, Lally KP, Corpron C, Ross MI. Lymphatic mapping with sentinel node biopsy in pediatric patients. J Pediatr Surg. 2000;35(6):961–4.

    Article  CAS  Google Scholar 

  25. McMulkin HM, Yanchar NL, Fernandez CV, Giacomantonio C. Sentinel lymph node mapping and biopsy: a potentially valuable tool in the management of childhood extremity rhabdomyosarcoma. Pediatr Surg Int. 2003;19(6):453–6.

    Article  CAS  Google Scholar 

  26. 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(3):126–9.

    Article  Google Scholar 

  27. Keung EZ, Chiang Y-J, Voss RK, et al. Defining the incidence and clinical significance of lymph node metastasis in soft tissue sarcoma. Eur J Surg Oncol. 2018;44(1):170–7.

    Article  Google Scholar 

  28. Johannesmeyer D, Smith V, Cole DJ, Esnaola NF, Camp ER. The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis. Am J Surg. 2013;206(3):289–95.

    Article  Google Scholar 

  29. Ecker BL, Peters MG, McMillan MT, et al. Implications of lymph node evaluation in the management of resectable soft tissue sarcoma. Ann Surg Oncol. 2017;24(2):425–33.

    Article  Google Scholar 

  30. Sherman KL, Kinnier CV, Farina DA, et al. Examination of national lymph node evaluation practices for adult extremity soft tissue sarcoma. J Surg Oncol. 2014;110(6):682–8.

    Article  Google Scholar 

  31. Brady AC, Picado O, Tashiro J, Sola JE, Perez EA. Lymph node sampling and survival in child and adolescent extremity soft tissue sarcoma. J Surg Res. 2019;241:205–14.

    Article  Google Scholar 

  32. Blazer DG, Sabel MS, Sondak VK. Is there a role for sentinel lymph node biopsy in the management of sarcoma? Surg Oncol. 2003;12(3):201–6.

    Article  Google Scholar 

  33. Skinner KA, Eilber FR. Soft tissue sarcoma nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996;5(1):121–7.

    Article  CAS  Google Scholar 

  34. Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987;60(8):1800–8.

    Article  CAS  Google Scholar 

  35. Yoon SS, Maki RG, Asare Elliot A, et al. Soft tissue sarcoma of the trunk and extremities. In: M Amin, SB Edge, FL Green, et al., editors. AJCC cancer staging manual. 8th edn. Springer; 2017. p. 507–15.

    Chapter  Google Scholar 

  36. Pollock R, Baker L, Brennan M, et al. Soft tissue sarcoma. In: S Edge, D Byrd, C Compton, E Al, editors., et al., AJCC cancer staging manual. 7th edn. Cham: Springer; 2010. p. 291–8.

    Google Scholar 

  37. Pollock RE, Baker LH, Blumenstein B, et al. Soft tissue sarcoma. In: F Greene, D Page, I Fleming, et al., editors. AJCC cancer staging manual. 6th edn. Springer; 2002. p. 193–200.

    Google Scholar 

  38. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.

    Article  CAS  Google Scholar 

  39. Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma. Ann Surg. 2005;242(3):302–13.

    Article  Google Scholar 

  40. Gershenwald JE, Andtbacka RHI, Prieto VG, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26(26):4296–303.

    Article  Google Scholar 

  41. Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol. 1998;16(6):2253–60.

    Article  CAS  Google Scholar 

  42. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.

    Article  Google Scholar 

  43. Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. Ann Surg. 2016;264(3):413–20.

    Article  Google Scholar 

  44. Katz M, Hunt K, Veeramachaneni N, et al. (eds). Operative Standards for Cancer Surgery. Volume 3: Sarcoma, Adrenal, Neuroendocrine, Peritoneal Malignancies, Urothelial, Hepatobiliary. American College of Surgeons: Wolters Kluwer; 2023.

  45. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  Google Scholar 

  46. Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3: rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.

    Article  Google Scholar 

  47. Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO melanoma program experience. Ann Surg Oncol. 2000;7(6):469–74.

    Article  CAS  Google Scholar 

  48. Bedrosian I, Faries MB, Guerry D IV, et al. Incidence of sentinel node metastasis in patients with thin primary melanoma (#1 mm) with vertical growth phase. Ann Surg Oncol. 2000;7(4):262–7.

    Article  CAS  Google Scholar 

  49. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2(6):335–40.

    Article  CAS  Google Scholar 

  50. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. 1998;339(14):941–6.

    Article  CAS  Google Scholar 

  51. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996;276(22):1818–22.

    Article  CAS  Google Scholar 

  52. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol. 1997;15(6):2345–50.

    Article  CAS  Google Scholar 

  53. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220(3):391–8.

    Article  CAS  Google Scholar 

  54. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst. 1999;91(4):368–73.

    Article  CAS  Google Scholar 

  55. Van Der Ploeg APT, Van Akkooi ACJ, Haydu LE, et al. The prognostic significance of sentinel node tumour burden in melanoma patients: an international, multicenter study of 1539 sentinel node-positive melanoma patients. Eur J Cancer. 2014;50(1):111–20.

    Article  Google Scholar 

  56. Statius Muller MG, van Leeuwen PA, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with Stage I or II cutaneous melanoma. Cancer. 2001;91(12):2401–8.

    Article  CAS  Google Scholar 

  57. van Akkooi ACJ, de Wilt JHW, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol. 2006;17(10):1578–85.

    Article  Google Scholar 

  58. Keung EZ, Tsai J-W, Ali AM, et al. Analysis of the immune infiltrate in undifferentiated pleomorphic sarcoma of the extremity and trunk in response to radiotherapy: rationale for combination neoadjuvant immune checkpoint inhibition and radiotherapy. Oncoimmunology. 2018;7(2):e1385689.

    Article  Google Scholar 

  59. Raut CP, Bonvalot S, Gronchi A. A call to action: why sarcoma surgery needs to be centralized. Cancer. 2018;124(23):4452–4.

    Article  Google Scholar 

  60. Song Y, Ecker BL, Tang R, et al. Trends in practice patterns and outcomes: a decade of sarcoma care in the United States. Surg Oncol. 2019;29:168–77.

    Article  Google Scholar 

  61. Venigalla S, Nead KT, Sebro R, et al. Association between treatment at high-volume facilities and improved overall survival in soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2018;100(4):1004–15.

    Article  Google Scholar 

  62. Lazarides AL, Kerr DL, Nussbaum DP, et al. Soft tissue sarcoma of the extremities: what is the value of treating at high-volume centers? Clin Orthop Relat Res. 2019;477(4):718–27.

    Article  Google Scholar 

Download references

Acknowledgment

Editorial support was provided by Bryan Tutt, Scientific Editor, MD Anderson Cancer Center Research Medical Library.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Emily Z. Keung MD, AM, Jessica Maxwell MD, MBA & Christina L. Roland MD, MS

  2. Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kate J. Krause MS

  3. Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Carol D. Morris MD, MS

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Aimee M. Crago MD

  5. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Matthew T. Houdek MD

  6. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    John Kane MD

  7. Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Valerae Lewis MD

  8. Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

    Dario Callegaro MD

  9. Department of Orthopedic Surgery, University of Iowa, Iowa City, IA, USA

    Benjamin Miller MD

  10. Department of Pathology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alexander J. Lazar MD, PhD

  11. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Rebecca Gladdy MD, PhD

  12. Department of Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Chandrajit P. Raut MD & Mark Fairweather MD

  13. Department of Orthopedic Surgery, NYU Langone Grossman School of Medicine, New York, NY, USA

    Nicola Fabbri MD

  14. Department of Surgery, Georgetown University Medical Center, Washington, DC, USA

    Waddah Al-Refaie MD

  15. Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Sandra L. Wong MD, MS

Authors
  1. Emily Z. Keung MD, AM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate J. Krause MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica Maxwell MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carol D. Morris MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aimee M. Crago MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew T. Houdek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John Kane MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Valerae Lewis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dario Callegaro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Benjamin Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alexander J. Lazar MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rebecca Gladdy MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Chandrajit P. Raut MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Nicola Fabbri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Waddah Al-Refaie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mark Fairweather MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Sandra L. Wong MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Christina L. Roland MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily Z. Keung MD, AM.

Ethics declarations

Disclosures

Aimee Crago has participated in a Scientific Advisory Board for Springworks Therapeutics, and Jessica Maxwell has participated in a Scientific Advisory Board for Ipsen Pharmaceuticals. Emily Z. Keung, Kate J. Krause, Carol D. Morris, Matthew T. Houdek, John Kane, Valerae Lewis, Dario Callegaro, Benjamin Miller, Alexander J. Lazar, Rebecca Gladdy, Chandrajit P. Raut, Nicola Fabbri, Waddah Al-Refaie, Mark Fairweather, Sandra L. Wong, and Christina L. Roland have no disclosures to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keung, E.Z., Krause, K.J., Maxwell, J. et al. Sentinel Lymph Node Biopsy for Extremity and Truncal Soft Tissue Sarcomas: A Systematic Review of the Literature. Ann Surg Oncol 30, 958–967 (2023). https://doi.org/10.1245/s10434-022-12688-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-12688-6

Search

Navigation