Molecular detection of occult tumor cells can be a prognostic indicator important for clinical staging and selection of therapeutic strategies. Detection of low-level expression of EWS-FLI fusion transcripts in bone marrow and blood has been reported in sarcomas.3738 Micrometastases were detected in 31% of patients with localized disease and 50% of patients with clinically metastatic tumors. RT-PCR detection of specific fusion transcripts has been used to study the marrow and body fluids of patients with ES, ARMS, and desmoplastic small round cell tumors (DSRCT). Molecular evidence of metastasis was detected in all patients with clinically evident metastatic tumors but not in the patients with localized disease.39 Such applications are just beginning to be explored. Although correlative studies are needed to validate the prognostic significance of occult tumor cells, it is clear that molecular staging is an emerging field that may change the approach to the clinical management of patients with soft tissue sarcomas.
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