Local recurrence and assessment of sentinel lymph node biopsy in deep soft tissue leiomyosarcoma of the extremities

A retrospective review of patients treated for extremity deep soft tissue leiomyosarcoma at our institution over a 10-year period was conducted. Patients developing local recurrence or lymph node metastasis were identified. The presence or absence of lymphatics in the primary tumours was assessed by immunohistochemical expression of LYVE-1 and podoplanin.27 patients (mean age 62 years) were included in the study. 15 were female and 12 male. Lymph node metastasis was seen in only two cases (7%); intratumoural lymphatics were identified in the primary tumours of both these cases. Local recurrence occurred in 25.9% of cases despite complete excision and post-operative radiotherapy; the mean time to recurrence was 10.1 months.On the basis of this study, we do not advocate sentinel lymph node biopsy in this group of patients except in those cases in which intratumoural lymphatics can be demonstrated. Close follow up is important especially for high grade leiomyosarcomas, particularly in the first year, as these tumours have a high incidence of local recurrence.Leiomyosarcoma of soft tissues is a malignant tumour composed of tumour cells that exhibit smooth muscle differentiation. Leiomyosarcomas are generally thought to account for 5-10% of soft tissue sarcomas [1-3]. These tumours arise most commonly in the retroperitoneum but can develop in any location; in one study of 75 soft tissue leiomyosarcomas, 33% were noted to arise in extremity soft tissues\The behaviour of leiomyosarcoma of extremity deep soft tissues has not been studied independently of those arising in other locations.Regional lymph node metastasis in patients with soft tissue sarcomas is an infrequent event occurring in 2.6 - 5% of all patients [4-6]. Sentinel lymph node biopsy (SLNB) has been employed for staging of soft tissue sarcomas, particularly epithelial sarcoma [7-9]. The incidence of lymph node metastasis in extremity leiomyosarcomas is clearly important with regard to whether SLNB should be ca