Lymphography in bone and soft tissue sarcomas. Experiences from three institutions

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Sarcomas, including bone and soft tissue types, represent a significant oncological challenge.
• Understanding metastatic patterns is crucial for patient prognosis and treatment planning.
• Lymphatic involvement is a key factor influencing sarcoma outcomes.

Purpose of the Study:

• To evaluate the diagnostic accuracy of lymphography in detecting metastases in primary bone and soft tissue sarcomas.
• To determine the incidence of lymphatic metastases in different sarcoma subtypes.
• To assess the correlation between lymphatic spread and patient prognosis.

Main Methods:

• Retrospective analysis of 441 patients with primary bone (217) and soft tissue sarcomas (224).
• Lymphography performed during initial diagnostic workup, interpreted for metastatic involvement.
• Correlation of radiological findings with histopathological results from lymph node biopsies in 96 patients.

Main Results:

• Overall metastasis incidence: 21% in bone tumors (osteosarcoma 28%, Ewing's sarcoma 18%, chondrosarcoma 13%) and 28% in soft tissue sarcomas (rhabdomyosarcoma 53%, anaplastic sarcoma 67%).
• Hematogenous spread was more common in bone sarcomas, while lymphatic spread predominated in soft tissue sarcomas.
• Lymphatic metastases significantly correlated with a poorer prognosis.
• Radiologic-histologic correlation of lymph node biopsies achieved 97.7% diagnostic accuracy.

Conclusions:

• Lymphography is a valuable tool for identifying lymphatic metastases in sarcomas.
• The pattern of spread (hematogenous vs. lymphatic) differs between bone and soft tissue sarcomas.
• Presence of lymphatic metastases is a strong indicator of a worse prognosis, underscoring the importance of accurate staging.