Investigation of Ultrasound Parameters for the Differential Diagnosis of Malignant and Benign Peripheral Nerve Sheath Tumors

Abstract

Objectives The objectives were to identify the key features of malignant and benign peripheral nerve sheath tumors (PNSTs) and determine a strategy for differentiating them using sonography. Methods Forty‐six malignant peripheral nerve sheath tumors (MPNSTs) and 83 benign peripheral nerve sheath tumors (BPNSTs) confirmed by pathology from April 2010 to July 2021 were included. The general data and grayscale and color Doppler ultrasonic manifestations were compared between the two groups. We used single factor, multifactor, and area under the receiver operating characteristic (ROC) curve analyses to extract significant malignant risk factors and then established a scoring system with these factors. Results The significant variables identified in univariate analysis (P < .05) were maximum diameter, location, shape, boundary, encapsulation, echogenicity, texture pattern, calcification, entering or exiting nerve, and vascularity. Shape, boundary and vascularity were significant risk factors, and a scoring system was established. The area under the ROC curve (0.925) confirmed the usefulness of the scoring system for differentiating MPNSTs and BPNSTs. Conclusions Ultrasonography is an effective method for differentiating MPNSTs from BPNSTs.

Magnetic Resonance Imaging Features for Differentiating Low-Grade and High-Grade Malignant Peripheral Nerve Sheath Tumors

“…A previous study assessing dynamic contrast-enhanced MRI reported that early arterial enhancement was significantly more frequent in MPNSTs than in benign peripheral nerve sheath tumors (BPNSTs; 50% [4 of 8] vs 11% [2 of 18], P = 0.03) 8 . Another study assessing ultrasonography reported that hypervascularity was more frequently observed in MPNSTs than in BPNSTs (89% [41 of 46] vs 59% [49 of 83], P = 0.03) 9 . However, no study has compared the vascularity between low-grade and high-grade MPNSTs.…”

“…8 Another study assessing ultrasonography reported that hypervascularity was more frequently observed in MPNSTs than in BPNSTs (89% [41 of 46] vs 59% [49 of 83], P = 0.03). 9 However, no study has compared the vascularity between low-grade and high-grade MPNSTs. Although dynamic contrast-enhanced MRI was not evaluated in the present study, our results might suggest that high-grade MPNSTs have a hypervascular nature compared with low-grade MPNSTs.…”

Investigations on ultrasonography in the diagnosis of nodular localized cutaneous neurofibroma

“…These features result in misdiagnosis as cystic lesions. 7 The "rat tail sign" is the most specific characteristic in diagnosing neurogenic tumors on ultrasound. It can be recognized easily when the tumor occurs in large nerve.…”

“…On ultrasound, most NLCNs presented as fusiform (27/43, 62.8%), well‐defined (42/43, 97.7%), encapsulated (39/43, 90.7%), anechoic (34/43, 79.1%), homogeneous lesion (39/43, 90.7%) with enhancement of posterior echo (29/43, 67.4%), and avascularity (37/43, 86.0%). These features result in misdiagnosis as cystic lesions 7 …”

Malignant and Benign Peripheral Nerve Sheath Tumors in a Single Center

“…MRI remains the preferred imaging method for evaluating the tumor site, lesion degree, and growth, 11 but it is expensive, time‐consuming, and has contraindications. Different MRI findings of MPNSTs and the diagnostic efficacy of MRI in differentiating MPNSTs and BPNSTs 1,12 have been previously reported; however, few studies have reported the ultrasonic parameters of MPNSTs and BPNSTs and constructed a practical scoring system to distinguish them 13,14 . Additionally, studies reporting the diagnostic efficacy of a combination of clinical and ultrasound features with MRI are still scarce.…”