Sentinel Node Biopsy in Pediatric Patients: The Experience in a Single Institution

Abstract

Sentinel lymph node biopsy (SLNB) is an established staging technique in many malignancies, but reports describing this procedure for the evaluation of regional lymph nodes in childhood and adolescents are still scarce. SLNB has progressively gained a role in the staging of pediatric melanoma and some histotypes among soft tissue sarcomas (rhabdomyosarcoma, synovial sarcoma, epithelioid sarcoma, and clear cell sarcoma). We report our experience with 29 patients who were evaluated with SLNB during the past 12 years: 9 alveolar rhabdomyosarcoma, 1 embryonal rhabdomyosarcoma, 7 Ewing Sarcoma/pPNET, 1 clear cells sarcoma, 2 epithelioid sarcoma, 1 epithelioid sclerosing fibrosarcoma, 3 myxoid liposarcoma, 1 adult fibrosarcoma, 1 malignant peripheral nerve sheath tumor, 1 undifferentiated sarcoma, 1 sarcoma not otherwise specified, and 1 melanoma. All, but one, patients underwent a lymphoscintigraphy, and in more than half of the patients, an intraoperative lymphatic mapping with a blue dye injection was performed. In our experience, SLNB was a feasible and reliable technique that allowed a targeted sampling of regional lymph nodes. This technique avoids aggressive operations or random biopsies, leading to an accurate staging without complications. Recently new imaging techniques, such as positron emission tomography–computed tomography scan, have obtained good results in identifying distant and lymphatic metastases, but they have been found to be less reliable than SLNB, especially for small volume metastatic nodal disease in sarcoma.

Keywords

soft tissue sarcoma - melanoma - sentinel node biopsy

• References

• 1 Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977; 39 (2) 456-466
• 2 Morton DL, Wen DR, Wong JH , et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127 (4) 392-399
• 3 Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol 2001; 8 (6) 538-541
• 4 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) 1400-1405
• 5 Wong SL, Balch CM, Hurley P , et al; American Society of Clinical Oncology; Society of Surgical Oncology. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol 2012; 19 (11) 3313-3324
• 6 Cheng G, Kurita S, Torigian DA, Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 2011; 38 (3) 562-575
• 7 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) 2052-2059
• 8 Gibbs P, Moore A, Robinson W, Walsh P, Golitz L, Gonzalez R. Pediatric melanoma: are recent advances in the management of adult melanoma relevant to the pediatric population. J Pediatr Hematol Oncol 2000; 22 (5) 428-432
• 9 Toro J, Ranieri JM, Havlik RJ, Coleman III JJ, Wagner JD. Sentinel lymph node biopsy in children and adolescents with malignant melanoma. J Pediatr Surg 2003; 38 (7) 1063-1065
• 10 Howman-Giles R, Shaw HM, Scolyer RA , et al. Sentinel lymph node biopsy in pediatric and adolescent cutaneous melanoma patients. Ann Surg Oncol 2010; 17 (1) 138-143
• 11 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) 571-578
• 12 De Corti F, Dall'Igna P, Bisogno G , et al. Sentinel node biopsy in pediatric soft tissue sarcomas of extremities. Pediatr Blood Cancer 2009; 52 (1) 51-54
• 13 Neville HL, Andrassy RJ, Lobe TE , et al. Preoperative staging, prognostic factors, and outcome for extremity rhabdomyosarcoma: a preliminary report from the Intergroup Rhabdomyosarcoma Study IV (1991-1997). J Pediatr Surg 2000; 35 (2) 317-321
• 14 Andrassy RJ, Corpron CA, Hays D , et al. Extremity sarcomas: an analysis of prognostic factors from the Intergroup Rhabdomyosarcoma Study III. J Pediatr Surg 1996; 31 (1) 191-196
• 15 Mandell L, Ghavimi F, LaQuaglia M, Exelby P. Prognostic significance of regional lymph node involvement in childhood extremity rhabdomyosarcoma. Med Pediatr Oncol 1990; 18 (6) 466-471
• 16 Wharam MD, Meza J, Anderson J , et al. Failure pattern and factors predictive of local failure in rhabdomyosarcoma: a report of group III patients on the third Intergroup Rhabdomyosarcoma Study. J Clin Oncol 2004; 22 (10) 1902-1908
• 17 Weiss BD, Dasgupta R, Gelfand MJ , et al. Use of sentinel node biopsy for staging parameningeal rhabdomyosarcoma. Pediatr Blood Cancer 2011; 57 (3) 520-523
• 18 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) 187-193
• 19 Maduekwe UN, Hornicek FJ, Springfield DS , et al. Role of sentinel lymph node biopsy in the staging of synovial, epithelioid, and clear cell sarcomas. Ann Surg Oncol 2009; 16 (5) 1356-1363
• 20 Veronesi U, Paganelli G, Galimberti V , et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349 (9069) 1864-1867
• 21 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
• 22 Hicks RJ. Functional imaging techniques for evaluation of sarcomas. Cancer Imaging 2005; 5: 58-65
• 23 Ricard F, Cimarelli S, Deshayes E, Mognetti T, Thiesse P, Giammarile F. Additional Benefit of F-18 FDG PET/CT in the staging and follow-up of pediatric rhabdomyosarcoma. Clin Nucl Med 2011; 36 (8) 672-677
• 24 Raval MV, Bilimoria KY, Bentrem DJ , et al. Use of sentinel lymph node biopsy for melanoma in children and adolescents. J Surg Oncol 2010; 102 (6) 634-639
• 25 Livestro DP, Kaine EM, Michaelson JS , et al. Melanoma in the young: differences and similarities with adult melanoma: a case-matched controlled analysis. Cancer 2007; 110 (3) 614-624
• 26 American Joint Committee on Cancer. AJCC Cancer Staging Manual, 6th ed. Chicago, IL: Springer; 2002
• 27 National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program Public-Use Data (1973–2011). National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2009, based on the November 2008 submission. Available at: www.seer.cancer.gov
• 28 Mu E, Lange JR, Strouse JJ. Comparison of the use and results of sentinel lymph node biopsy in children and young adults with melanoma. Cancer 2012; 118 (10) 2700-2707
• 29 Ferrari A, Bisogno G, De Salvo GL, Indolfi P, Perilongo G, Cecchetto G ; on behalf of the Italian Study on Rare Tumours in Paediatric Age (TREP); Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). The challenge of very rare tumours in childhood: the Italian TREP project. Eur J Cancer 2007; 43 (4) 654-659
• 30 Pastore G, De Salvo GL, Bisogno G , et al; on behalf of the TREP Group; CSD of Epidemiology Biostatistics, AIEOP. Evaluating access to pediatric cancer care centers of children and adolescents with rare tumors in Italy: the TREP project. Pediatr Blood Cancer 2009; 53 (2) 152-155
• 31 Ferrari A, Bisogno G, Cecchetto G , et al. Cutaneous melanoma in children and adolescents: the Italian rare tumors in pediatric age project experience. J Pediatr 2014; 164 (2) 376-82.e1 , 2