Online first
Review paper
Published online: 2024-08-12
Lymph node metastases, sentinel lymph node biopsy, and lymphadenectomy in soft tissue sarcoma — when and why?
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DOI: 10.5603/ocp.100872
Abstract
The spread of soft tissue sarcomas (STS) through the lymphatic system occurs rarely, mainly in epithelioid sarcoma, angiosarcoma, rhabdomyosarcoma, and clear cell sarcoma (CARE). STS subtypes differ in terms of biological behavior. CARE histology and high-grade nodal disease are defined as risk factors in STS. The nodal involvement status in STS patients correlates with the subsequent development of distant metastases. Regional disease is considered clinically distinct from distant metastatic disease in case of recurrence, and it has a better prognosis and better outcomes in terms of long-term survival. Preoperative sentinel lymph node biopsy (SLNB) may be used to identify high-risk patients, as this technique also allows the determination of patients with occult microscopic lymph node disease. The positive result of SLNB may indicate regional lymphadenectomy (LND). Though data on LND in STS are limited, this tool may play a role in multimodal treatment. In the case of STS, a unified diagnosis protocol is needed but followed by an individual treatment approach depending on the results of nodal involvement.
Keywords: sarcomaSTSlymph nodesSLNBlymphadenectomymetastasisprognosismanagement
References
- Basile G, Mattei JC, Alshaygy I, et al. Curability of patients with lymph node metastases from extremity soft-tissue sarcoma. Cancer. 2020; 126(23): 5098–5108.
- Brady AC, Picado O, Tashiro J, et al. Lymph Node Sampling and Survival in Child and Adolescent Extremity Soft-Tissue Sarcoma. J Surg Res. 2019; 241: 205–214.
- Garcia-Ortega DY, Alvarez-Cano A, Clara-Altamirano MA, et al. Should metastatic lymph nodes be considered at the same clinical stage as distant metastasis in soft tissue sarcomas? Cancer Treat Res Commun. 2021; 26: 100268.
- Miccio JA, Jairam V, Gao S, et al. Predictors of Lymph Node Involvement by Soft Tissue Sarcoma of the Trunk and Extremity: An Analysis of the National Cancer Database. Cureus. 2019; 11(10): e6038.
- Jacobs AJ, Morris CD, Levin AS. Synovial Sarcoma Is Not Associated With a Higher Risk of Lymph Node Metastasis Compared With Other Soft Tissue Sarcomas. Clin Orthop Relat Res. 2018; 476(3): 589–598.
- Teterycz P, Czarnecka A, Szmajdzinska A, et al. 1661P Prognostic role of regional lymph node metastases in soft tissue sarcomas. Ann Oncol. 2020; 31: S988–S989.
- Witt RG, Voss RK, Chiang YJ, et al. Practice Pattern Variability in the Management of Regional Lymph Node Metastasis in Extremity and Trunk Soft Tissue Sarcoma: A Survey of the Society of Surgical Oncology and Musculoskeletal Tumor Society Membership. Ann Surg Oncol. 2023; 30(6): 3668–3676.
- Andreou D, Boldt H, Werner M, et al. 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): 1400–1405.
- Moncayo VM, Alazraki AL, Alazraki NP, et al. Sentinel Lymph Node Biopsy Procedures. Semin Nucl Med. 2017; 47(6): 595–617.
- Nathanson SD, Shah R, Rosso K. Sentinel lymph node metastases in cancer: causes, detection and their role in disease progression. Semin Cell Dev Biol. 2015; 38: 106–116.
- Hayes AJ, Nixon IF, Strauss DC, et al. UK guidelines for the management of soft tissue sarcomas. Br J Cancer. 2024 [Epub ahead of print].
- Vibhakar AM, Cassels JA, Botchu R, et al. Imaging update on soft tissue sarcoma. J Clin Orthop Trauma. 2021; 22: 101568.
- Johannesmeyer D, Smith V, Cole DJ, et al. The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis. Am J Surg. 2013; 206(3): 289–295.
- Gusho CA, Fice MP, O'Donoghue CM, et al. A Population-based Analysis of Lymph Node Metastasis in Extremity Soft Tissue Sarcoma: An Update. J Surg Res. 2021; 262: 121–129.
- 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): 201–206.
- Fong Y, Coit DG, Woodruff JM, et al. 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): 72–77.
- Daigeler A, Kuhnen C, Moritz R, et al. Lymph node metastases in soft tissue sarcomas: a single center analysis of 1,597 patients. Langenbecks Arch Surg. 2009; 394(2): 321–329.
- 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): 682–688.
- Sawamura C, Matsumoto S, Shimoji T, et al. Lymphadenectomy and histologic subtype affect overall survival of soft tissue sarcoma patients with nodal metastases. Clin Orthop Relat Res. 2013; 471(3): 926–931.
- Martínez-Trufero J, Cruz Jurado J, Hernández-León CN, et al. Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations. Spanish Group for Sarcoma research (GEIS -GROUP). Part II. Cancer Treat Rev. 2021; 99: 102260.
- van Akkooi ACJ, Verhoef C, van Geel AN, et al. Sentinel node biopsy for clear cell sarcoma. Eur J Surg Oncol. 2006; 32(9): 996–999.
- Behranwala KA, A'Hern R, Omar AM, et al. Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol. 2004; 11(7): 714–719.
- Connolly EA, Bhadri VA, Wake J, et al. Systemic treatments and outcomes in CIC-rearranged Sarcoma: A national multi-centre clinicopathological series and literature review. Cancer Med. 2022; 11(8): 1805–1816.
- Makise N, Yoshida A. CIC-Rearranged Sarcoma. Surg Pathol Clin. 2024; 17(1): 141–151.
- Antonescu CR, Owosho AA, Zhang L, et al. Sarcomas With CIC-rearrangements Are a Distinct Pathologic Entity With Aggressive Outcome: A Clinicopathologic and Molecular Study of 115 Cases. Am J Surg Pathol. 2017; 41(7): 941–949.
- Brčić I, Brodowicz T, Cerroni L, et al. Undifferentiated round cell sarcomas with CIC-DUX4 gene fusion: expanding the clinical spectrum. Pathology. 2020; 52(2): 236–242.
- Jitheesh A, Pai A. When Sarcomas Mimic Lymphomas: A BCOR-Rearranged Sarcoma Case Report. Cureus. 2024; 16(2): e54944.
- Aranza S, Roydhouse C, Mitchell C, et al. A rare diagnostically challenging case of CIC-DUX4 sarcoma arising in the neck. Pathology. 2023; 55(4): 568–571.
- Lehane F, Tsikleas G, Bettington A, et al. "Cyst" on the forearm of a 28-year-old female: Case report of a CIC-rearranged sarcoma. J Cutan Pathol. 2019; 46(8): 599–602.
- Machado I, Cruz J, Lavernia J, et al. Superficial EWSR1-negative undifferentiated small round cell sarcoma with CIC/DUX4 gene fusion: a new variant of Ewing-like tumors with locoregional lymph node metastasis. Virchows Arch. 2013; 463(6): 837–842.
- Aranza S, Roydhouse C, Mitchell C, et al. A rare diagnostically challenging case of CIC-DUX4 sarcoma arising in the neck. Pathology. 2023; 55(4): 568–571.
- Brady EJ, Hameed M, Tap WD, et al. Imaging features and clinical course of undifferentiated round cell sarcomas with CIC-DUX4 and BCOR-CCNB3 translocations. Skeletal Radiol. 2021; 50(3): 521–529.
- Chmiel P, Krotewicz M, Szumera-Ciećkiewicz A, et al. Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma. Curr Oncol. 2024; 31(1): 307–323.
- Czarnecka AM, Sobczuk P, Kostrzanowski M, et al. Epithelioid Sarcoma-From Genetics to Clinical Practice. Cancers (Basel). 2020; 12(8).
- Al-Refaie WB, Andtbacka RHI, Ensor J, et al. Lymphadenectomy for isolated lymph node metastasis from extremity soft-tissue sarcomas. Cancer. 2008; 112(8): 1821–1826.
- Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003; 97(10): 2530–2543.
- Liu H, Zhang H, Zhang C, et al. Pan-Soft Tissue Sarcoma Analysis of the Incidence, Survival, and Metastasis: A Population-Based Study Focusing on Distant Metastasis and Lymph Node Metastasis. Front Oncol. 2022; 12: 890040.
- Wang X, Feng J, Li Z, et al. Characteristics and prognosis of embryonal rhabdomyosarcoma in children and adolescents: An analysis of 464 cases from the SEER database. Pediatr Investig. 2020; 4(4): 242–249.
- Machado I, Cruz J, Lavernia J, et al. Superficial EWSR1-negative undifferentiated small round cell sarcoma with CIC/DUX4 gene fusion: a new variant of Ewing-like tumors with locoregional lymph node metastasis. Virchows Arch. 2013; 463(6): 837–842.
- Mori T, Kobayashi E, Kawai A. [Ⅰ.New TNM Classification of Bone and Soft Tissue Sarcoma-Changes between the 7th and 8th Editions]. Gan To Kagaku Ryoho. 2019; 46(3): 433–436.
- Connolly EA, Bhadri VA, Wake J, et al. Systemic treatments and outcomes in CIC-rearranged Sarcoma: A national multi-centre clinicopathological series and literature review. Cancer Med. 2022; 11(8): 1805–1816.
- Keung EZ, Chiang YJ, 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): 170–177.
- Tunn PU, Andreou D, Illing H, et al. Sentinel node biopsy in synovial sarcoma. Eur J Surg Oncol. 2008; 34(6): 704–707.
- de Visscher SA, van Ginkel RJ, Wobbes T, et al. Epithelioid sarcoma: Still an only surgically curable disease. Cancer. 2006; 107(3): 606–612.
- Emori M, Tsuchie H, Nagasawa H, et al. Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma. Int J Surg Oncol. 2019; 2019: 6708474.
- de Juan Ferré A, Álvarez Álvarez R, Casado Herráez A, et al. SEOM Clinical Guideline of management of soft-tissue sarcoma (2020). Clin Transl Oncol. 2021; 23(5): 922–930.
- von Mehren M, Kane JM, Agulnik M, et al. Soft Tissue Sarcoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022; 20(7): 815–833.
- Park HoY, Chung HW, Yoon MA, et al. Enhancing local recurrence detection in patients with high-grade soft tissue sarcoma: value of short-term Ultrasonography added to post-operative MRI surveillance. Cancer Imaging. 2024; 24(1): 12.
- Burkhard-Meier A, Jurinovic V, Berclaz LM, et al. Differentiation of benign and metastatic lymph nodes in soft tissue sarcoma. Clin Exp Metastasis. 2024; 41(2): 131–141.
- Wagner LM, Kremer N, Gelfand MJ, et al. 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. Cancer. 2017; 123(1): 155–160.
- Pavlidis ET, Pavlidis TE. New trends in the surgical management of soft tissue sarcoma: The role of preoperative biopsy. World J Clin Oncol. 2023; 14(2): 89–98.
- 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): 428–433.
- Witt RG, Cope B, Erstad DJ, et al. Sentinel Lymph Node Biopsy and Formal Lymphadenectomy for Soft Tissue Sarcoma: A Single Center Experience of 86 Consecutive Cases. Ann Surg Oncol. 2022; 29(11): 7092–7100.
- Ostafiichuk VK, Korovin SI, Kukushkina NM. 1663P Local recurrence and 5-year survival control of primary localized sarcoma of the soft tissues of the extremities and body. Ann Oncol. 2020; 31(Suppl 4): S989.
- van Praag VM, Rueten-Budde AJ, Jeys LM, et al. A prediction model for treatment decisions in high-grade extremity soft-tissue sarcomas: Personalised sarcoma care (PERSARC). Eur J Cancer. 2017; 83: 313–323.
- Ikuta K, Nishida Y, Imagama S, et al. The current management of clear cell sarcoma. Jpn J Clin Oncol. 2023; 53(10): 899–904.
- Sobanko JF, Meijer L, Nigra TP. Epithelioid sarcoma: a review and update. J Clin Aesthet Dermatol. 2009; 2(5): 49–54.
- Ognjanovic S, Linabery AM, Charbonneau B, et al. Trends in childhood rhabdomyosarcoma incidence and survival in the United States, 1975-2005. Cancer. 2009; 115(18): 4218–4226.
- Miwa S, Yamamoto N, Hayashi K, et al. Recent Advances and Challenges in the Treatment of Rhabdomyosarcoma. Cancers. 2020; 12(7): 1758.
- 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): 1903–1906.
- Gazendam AM, Popovic S, Munir S, et al. Synovial Sarcoma: A Clinical Review. Curr Oncol. 2021; 28(3): 1909–1920.
- Wang L, Lao IW, Yu L, et al. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett. 2017; 14(5): 5370–5378.
- Cao J, Wang J, He C, et al. Angiosarcoma: a review of diagnosis and current treatment. Am J Cancer Res. 2019; 9(11): 2303–2313.
- Oliveira Monteiro A, Branco Ferreira I, César A, et al. Cutaneous Angiosarcoma in an Unusual Location and Without Predisposing Factors. Eur J Case Rep Intern Med. 2020; 7(12): 001939.
- Fujisawa Y, Yoshino K, Fujimura T, et al. Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor. Front Oncol. 2018; 8: 46.
- Ramakrishnan N, Mokhtari R, Charville GW, et al. Cutaneous Angiosarcoma of the Head and Neck-A Retrospective Analysis of 47 Patients. Cancers (Basel). 2022; 14(15).