title: 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.
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.
authors: Division of Pediatric Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Lars M
authors: LM
authors: Wagner
authors: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Nathalie
authors: N
authors: Kremer
authors: Division of Pediatric Radiology and Medical Imaging, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Michael J
authors: MJ
authors: Gelfand
authors: Division of Pediatric Radiology and Medical Imaging, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Susan E
authors: SE
authors: Sharp
authors: Division of Pediatric Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Brian K
authors: BK
authors: Turpin
authors: Division of Pediatric Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Rajaram
authors: R
authors: Nagarajan
authors: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Gregory M
authors: GM
authors: Tiao
authors: Division of Pediatric Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Joseph G
authors: JG
authors: Pressey
authors: Division of Pediatric Pathology and Laboratory Medicine, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Julie
authors: J
authors: Yin
authors: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors: Roshni
authors: R
authors: Dasgupta
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology*; D061305:Lymphoscintigraphy / Q000379:methods; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D012509:Sarcoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: lymphoscintigraphy; pediatric sarcoma; positron emission tomography/computed tomography (PET-CT); sentinel lymph node biopsy; single-photon emission computed tomography/computed tomography (SPECT-CT)