Popliteal lymph nodes in patients with osteosarcoma: are they metastatic?
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SCIENTIFIC ARTICLE
Popliteal lymph nodes in patients with osteosarcoma: are they metastatic? Mark X. Cleary 1 & Laura M. Fayad 1 & Shivani Ahlawat 1 Received: 22 March 2020 / Revised: 27 May 2020 / Accepted: 28 May 2020 # ISS 2020
Abstract Purpose To evaluate the prevalence, imaging appearance, and significance of popliteal lymph nodes (PLN) on magnetic resonance imaging (MRI) in patients with distal femoral or proximal tibial osteosarcoma (OS). Method and materials This study included consecutive patients with OS presenting from May 2016 to March 2018. Inclusion criteria were patients with distal femoral or proximal tibial OS with MRI and pathology at our institution. On MRI, two radiologists recorded primary tumor features (size, location, signal, extra-compartmental extension), and PLN characteristics (mean size, presence/absence of fatty hilum, mineralization, PET/bone scintigraphy avidity, contrast enhancement, and diffusion restriction). Tumor histology, stage, and clinical follow-up were recorded. Descriptive statistics were provided. Results Sixteen patients with OS (age 20 ± 10 (range10–40) years, 10/16 male) were included. Although 81% (13/16) of the patients had PLNs at presentation (size range 0.3–3.6 cm), fewer patients had extra-compartmental spread: intra-articular extension 50% (8/16), skip lesions 19% (3/16), lung metastases 31% (5/16), and osseous metastases 12% (2/16). Four (25% (4/16)) patients had PLN ≥ 1 cm; two were histologically proven reactive. One was presumed metastatic due to rapid development, mineralization, and FDG-avidity on PET/CT. The other ≥ 1 cm PLNs along with all twelve (75% (12/16)) that were < 1 cm in mean diameter were presumed non-metastatic with documented stability for at least 12 months of follow-up. Conclusion PLNs are frequently visible on MRI in patients with OS but are rarely (prevalence = 6%) metastatic. Features on MRI which may suggest metastatic PLNs include large size > 1 cm and loss of a fatty hilum. Keywords Osteosarcoma . Popliteal lymph node . Metastatic . MRI
Introduction Osteosarcoma (OS) is the most common primary malignant bone neoplasm. It constitutes 20% of all malignant bone tumors, with the most common sites involving the distal femur, proximal tibia, and proximal humerus, where bone growth is fastest [1–3]. A very small number of patients may have predisposing factors, such as prior radiation or underlying hereditary disorders associated with alterations of tumor suppressor genes, such as retinoblastoma or Li-Fraumeni syndrome, but
* Shivani Ahlawat [email protected] 1
The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, USA
the overwhelming majority of cases have no underlying risk factors [4]. Osteosarcomas are aggressive tumors, and the majority are characterized as high-grade. Metastases from OS are common, and the typical route of spread is hematogenous, with the most common sites of metastasis being lung, followed by bone. Lymph node me
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