Detection of lymph node metastases in pediatric and adolescent/young adult sarcoma: Sentinel lymph node biopsy versus fludeoxyglucose positron emission tomography imaging—A prospective trial. Issue 1 (26th August 2016)

• Record Type: Journal Article
• Authors: Wagner, Lars M.; Kremer, Nathalie; Gelfand, Michael J.; Sharp, Susan E.; Turpin, Brian K.; Nagarajan, Rajaram; Tiao, Gregory M.; Pressey, Joseph G.; Yin, Julie; Dasgupta, Roshni
• Is Part Of: Cancer. Volume 123:Issue 1(2017)
• Page Start: 155
• Page End: 160
• Publication Date: 2016-08-26
• Subjects: lymphoscintigraphy -- pediatric sarcoma -- positron emission tomography/computed tomography (PET‐CT) -- sentinel lymph node biopsy -- single‐photon emission computed tomography/computed tomography (SPECT‐CT); Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30282
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Lymph node metastases are an important cause of treatment failure for pediatric and adolescent/young adult (AYA) sarcoma patients. Nodal sampling is recommended for certain sarcoma subtypes that have a predilection for lymphatic spread. Sentinel lymph node biopsy (SLNB) may improve the diagnostic yield of nodal sampling, particularly when single‐photon emission computed tomography/computed tomography (SPECT‐CT) is used to facilitate anatomic localization. Functional imaging with positron emission tomography/computed tomography (PET‐CT) is increasingly used for sarcoma staging and is a less invasive alternative to SLNB. To assess the utility of these 2 staging methods, this study prospectively compared SLNB plus SPECT‐CT with PET‐CT for the identification of nodal metastases in pediatric and AYA patients. METHODS: Twenty‐eight pediatric and AYA sarcoma patients underwent SLNB with SPECT‐CT. The histological findings of the excised lymph nodes were then correlated with preoperative PET‐CT imaging. RESULTS: A median of 2.4 sentinel nodes were sampled per patient. No wound infections or chronic lymphedema occurred. SLNB identified tumors in 7 of the 28 patients (25%), including 3 patients who had normal PET‐CT imaging of the nodal basin. In contrast, PET‐CT demonstrated hypermetabolic regional nodes in 14 patients, and this resulted in a positive predictive value of only 29%. The sensitivity and specificity of PET‐CT for detecting histologically confirmed nodal metastases were only 57% and 52%, respectively. CONCLUSIONS: SLNB can safely guide the rational selection of nodes for biopsy in pediatric and AYA sarcoma patients and can identify therapy‐changing nodal disease not appreciated with PET‐CT. Cancer 2017;155–160. © 2016 American Cancer Society. Abstract : Sentinel lymph node biopsy using lymphoscintigraphy and single‐photon emission computed tomography/computed tomography for anatomic localization is a safe and effective method for identifying regional nodal metastases that may alter therapy. Positron emission tomography/computed tomography does not have sufficient sensitivity or specificity to eliminate the need for tissue sampling.