Preoperative Ultrasonographic Evaluation for Malignancy of Soft-Tissue Sarcoma: A Retrospective Study

Abstract

Background:Ultrasonography is useful for distinguishing between benign and malignant soft-tissue tumors. However, no study has focused on its usefulness in the differential diagnosis between low-grade and high-grade soft-tissue sarcomas. We conducted a retrospective study to determine the usefulness of the parameters of ultrasonograph and to develop a practical scoring system for distinguishing between high-grade and low-grade sarcomas.Methods:Twenty-two cases of low-grade and 43 cases of high-grade malignant soft-tissue sarcoma were enrolled. Ultrasonography parameters including the longest diameter, depth of the tumor, echogenicity, tumor margin, and vascularity defined according to Giovagnorio’s criteria were analyzed as factors to distinguish between the two types of sarcoma. Significant factors were entered into a multivariate model to define the scores for distinction according to the odds ratio. The usefulness of the score was analyzed via receiver operating characteristic analyses.Results:In univariate analysis, tumor margin, echogenicity, and vascularity were significantly different between low- and high-grade sarcomas. In the multivariate regression model, the odds ratio for high-grade vs. low-grade sarcoma was 8.8 for tumor margin, 69 for echogenicity, and 8.3 for vascularity. Scores for the risk factors were defined as follows: 1, ill-defined margin; 2, hypoechoic echogenicity; and 1, type IV in Giovagnorio’s criteria. The sum of each score was confirmed by receiver operating characteristic analysis. The area under the curve was 0.95, with a cut-off score of 3, indicating that the scoring system was useful.Conclusion:The ultrasonography parameters of tumor margin, echogenicity, and vascularity are useful for distinguishing between low- and high-grade sarcomas.

Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors

“…Unplanned excisions performed in the other hospital caused tumor contamination, which created the need for a wider reexcision area to obtain a negative surgical margin. 11,21,22 Moreover, univariate analysis of this study showed that the group that needed reconstruction was significantly more likely to have distant metastasis. Some authors reported that larger tumor size was a poor prognostic factor for distant metastasis.…”

The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative

“…Previous groups have reported that more than one‐third of patients with sarcomas who have undergone UE had the presence of “alarm” symptoms before the surgery which may have warranted referral or further diagnostic imaging before surgery . Further, radiographic appearance on ultrasound may demonstrate suspicious features even in small lesions, and core‐needle biopsy has been demonstrated to identify the grade and histological subtype of STS . In the present study, all patients were treated at tertiary or quaternary referral centers after UE with multidisciplinary specialists in the treatment of STS.…”

“…25 Further, radiographic appearance on ultrasound may demonstrate suspicious features even in small lesions, and core-needle biopsy has been demonstrated to identify the grade and histological subtype of STS. [26][27][28][29] In the present study, all patients were treated at tertiary or quaternary referral centers after UE with multidisciplinary specialists in the treatment of STS. This may partially account for the similar DSS and DMFS seen in our study cohorts, but also stresses the need for multimodality therapy in the treatment of STS.…”

Ultrasonographic findings and diagnosis of omental dedifferentiated liposarcoma: a case report

“…Dedifferentiated liposarcomas account for almost 10% of the liposarcomas 22) , and this similar rate was noted between hypoechoic tumor in the previous study and the dedifferentiated liposarcoma supports this hypothesis. In another study, most well-differentiated liposarcomas did not show hypoechoic echogenicity 21) , and hypoechoic echogenicity could be the specific property of high-grade liposarcomas rather than low-grade liposarcomas. Echogenicity of liposarcoma should be determined by its pathological component, though there are no discussions explaining the echogenicity variation of liposarcomas in previous reports.…”

“…According to some reports, echogenicity is not a significant factor while estimating malignancy risk in sarcomas 18,19) . On the other hand, some studies showed that low echogenicity is a characteristic of malignancy risk in soft tissue tumors 20,21) . Liposarcomas can be classified into four types according to the World Health Organization: atypical lipomatous tumor/well-differentiated liposarcoma, myxoid liposarcoma, pleomorphic liposarcoma, and dedifferentiated liposarcoma 22) .…”