Clinical Science The role of sentinel lymph node biopsy in select sarcoma patients: a meta-analysis Sharee Wright, M.D., Kent Armeson, M.S., Elizabeth G. Hill, Ph.D., Christian Streck, M.D., Lee Leddy, M.D., David Cole, M.D., Nestor Esnaola, M.D., M.Ph., M.B.A., E. Ramsay Camp, M.D., M.S.C.R.* Department of Surgery, Division of Surgical Oncology, Medical University of South Carolina and Ralph H. Johnson VA Medical Center, Charleston, SC, USA Abstract BACKGROUND: Sentinel lymph node (SLN) biopsy is a staging technique for occult lymph node disease. SLN biopsy has been applied to select patients with sarcoma, although the clinical utility remains uncertain. METHODS: A PubMed/MEDLINE literature search was performed, and SLN biopsy outcomes were analyzed using a Bayesian meta-analytic approach to obtain point and interval estimates of rates of interest. RESULTS: Sixteen studies involving SLN biopsy in patients with sarcoma were identified. Of 114 patients reported, 14 patients had positive SLNs (crude estimate, 12%; meta-analysis estimate, 17%). The meta-analysis false-negative rate was 29% (95% credible interval, 5%–59%). Recurrence and death rates in the SLN-positive group were higher than in the SLN-negative group. CONCLUSIONS: This investigation highlights the current role of SLN biopsy in select patients with sarcoma for tumor staging. Questions regarding the high false-negative rate and management of micrometastatic lymphatic disease in patients with sarcoma still exist. © 2012 Elsevier Inc. All rights reserved. KEYWORDS: Sarcoma; Sentinel; Lymph node The technique of sentinel lymphatic mapping and node biopsy is a minimally invasive technique used to identify patients with occult microscopic lymph node disease. The procedure was first described by Cabanas 1 in 1977 for the management of penile cancer, although the 1992 landmark study in melanoma patients popularized the procedure and led to its widespread use as an effective regional nodal staging procedure. 2–5 This minimally invasive procedure allows the identification of sentinel lymph nodes (SLNs) within a regional lymph node basin receiving lymphatic drainage from the specific anatomic location of the primary tumor. Focused pathologic evaluation of SLNs to identify patients with occult microscopic lymph node disease allows appropriate regional nodal staging and helps direct further therapy, such as selective use of radical lymphadenectomy. The benefit of SLN biopsy in melanoma and breast cancer management has prompted clinicians to apply the surgical technique to other malignancies, such as colon cancer and soft tissue sarcomas. 6–8 Although sarcomas typ- ically metastasize hematogenously, specific sarcoma sub- types have an increased propensity to spread via the lym- phatic system. 9 –11 Sarcoma subtypes such as clear cell, epithelioid, rhabdomyosarcoma, synovial cell, and angio- * Corresponding author. Tel.: 843-876-4420; fax: 843-876-3046. E-mail address: campe@musc.edu Manuscript received November 1, 2011; revised manuscript December 16, 2011 0002-9610/$ - see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2011.12.019 The American Journal of Surgery (2012) 204, 428 – 433