Sentinel node biopsy in pediatric soft tissue sarcomas of extremities

Abstract

BackgroundSentinel Node Biopsy is an established staging technique in many adult malignancies. However, only few reports describe this procedure for the evaluation of regional lymph nodes in childhood and adolescents. Our experience with sentinel node biopsy in soft tissue sarcomas of extremities in children is reported.MethodsSeventeen children were evaluated with sentinel node biopsy between 2002 and 2007: 11 at initial surgery, 5 at primary re‐excision, 1 at local relapse. The diagnosis was rhabdomyosarcoma in 5 and other soft tissue sarcomas in 12: Ewing/PNET sarcoma 6, epithelioid sarcoma 1, malignant peripheral‐nerve‐sheath tumor 1, undifferentiated sarcoma 1, myxoid liposarcoma 2, adult‐type fibrosarcoma 1. Primary sites included lower limbs (8), upper limbs (9). Mapping of nodes was performed with lymphoscintigraphy plus intra‐operative injections with blue‐dye in 14 cases, with lymphoscintigraphy and intra‐operative injections alone in 2 and 1, respectively.ResultsOf the 17 lymphatic regions (9 axilla, 8 inguinal), 16 were identified with lymphoscintigraphy, 15 by intra‐operative injections. Thirty‐five lymph nodes were removed. Nodes were positive for metastasis in two patients with alveolar rhabdomyosarcoma and undifferentiated sarcoma. There were no complications. No further lymph node metastases were recognized either at diagnosis or during the follow‐up (6–78 months).ConclusionsSentinel node biopsy was technically feasible, reliable, and free of complications. It could be an alternative to aggressive or random biopsies for extremity rhabdomyosarcoma and it can contribute to define those non‐rhabdomyosarcoma soft tissue sarcomas that spread to regional nodes. Pediatr Blood Cancer 2009;52:51–54. © 2008 Wiley‐Liss, Inc.

Application of nuclear medicine to achieve less invasive surgery for malignant solid tumors in children

“…They also found the SN metastasis in one RMS patient out of six cases (16.7%) who underwent lymphoscintigraphy/SLNB whereas no SN metastasis was observed in patients with non‐RMS sarcomas (0/17) . Those findings were consistent with results from previous reports with 11.1–33.3% SN positivity rate for RMS patients …”

Role of lymphoscintigraphy and sentinel lymph node biopsy in the management of pediatric melanoma and sarcoma

“…In a recent review of SLNB in 9 pediatric patients with RMS, a positive SN was found in 1 patient who received regional lymph node irradiation but died 40 months later due to systemic recurrence[6]. De Corti reviewed 5 children with RMS of the extremities who underwent lymphoscintigraphy and SLNB and found SN metastasis in one patient with an alveolar histology[5]. In our study, the SN positivity rate for RMS patients was 16.7% (1/6), similar to the rate seen in IRS-IV[21].…”

Use of sentinel node biopsy for staging parameningeal rhabdomyosarcoma

“…These limitations of physical exam and imaging have sparked the use of SNB as a way to ensure that the most clinically relevant lymph nodes are being sampled. This procedure is routinely used in adults with breast cancer and melanoma 13, and experience is growing in children 6–10. Pediatric studies have most commonly used SNB for evaluation of extremity soft tissue sarcoma, where some type of lymph node sampling is often mandatory even when no clinically suspicious nodes are present 2.…”

“…This technique therefore helps surgeons sample the most clinically relevant nodes, instead of performing either random sampling or more extensive and often debilitating dissections. Use of SNB has most commonly been utilized in RMS of the extremities 6–10. We now describe the first known use of SNB in parameningeal RMS.…”