Premium
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
Author(s) -
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
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30282
Subject(s) - medicine , sentinel lymph node , positron emission tomography , biopsy , radiology , sarcoma , lymph node , prospective cohort study , nuclear medicine , cancer , pathology , breast cancer
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.