Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging

Abstract

Soft tissue sarcomas are rare, but early, accurate diagnosis with subsequent appropriate treatment is crucial for the clinical outcome. The ESSR guidelines are intended to help radiologists in their decision-making and support discussion among clinicians who deal with patients with suspected or proven soft tissue tumors. Potentially malignant lesions recognized by ultrasound should be referred for magnetic resonance imaging (MRI), which also serves as a preoperative local staging modality, with specific technical requirements and mandatory radiological report elements. Radiography may add information about matrix calcification and osseous involvement. Indeterminate lesions, or lesions in which therapy is dependent on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist sarcoma center, where an interdisciplinary tumor group, with a specialized pathologist, radiologist, and the surgeon are involved. In sarcoma, a CT scan of the chest is mandatory. Additional staging modalities are entity-specific. There are no evidence-based recommendations for routine follow-up in surgically treated sarcomas. However, we would recommend regular follow-up with intervals dependent on tumor grade, for 10 years after the initial diagnosis.

Characterization of small, deeply located soft-tissue tumors: Conventional magnetic resonance imaging features and apparent diffusion coefficient for differentiation between non-malignancy and malignancy

“…Characterizing STTs with regard to their histopathologic nature-whether they are benign or malignant-based on imaging studies is crucial in the management of these lesions, and for suggesting the next clinical step, including biopsy. Several reports have recommended biopsy for STTs with a diameter larger than 5 cm, deep location, and interval growth, or when a definitive diagnosis cannot be made with imaging studies; however, currently, there are no established indications for STT biopsy [1][2][3][4].…”

MRI imaging of soft tissue tumours of the foot and ankle

“…Ultrasound (US) evaluation of soft tissue lesions is useful in the initial triaging of soft tissue lesions. US can demonstrate the cystic nature of some benign conditions such as ganglions or synovial cysts and may also be diagnostic in some other benign lesions such as superficial lipoma (if stable over 6 months), Morton neuroma, foreign body granuloma and plantar fibromatosis [2]. However, it should be used with caution as it may be difficult to interpret and can be associated with a delay in diagnosis of malignant lesions [3].…”

“…However, it should be used with caution as it may be difficult to interpret and can be associated with a delay in diagnosis of malignant lesions [3]. Magnetic resonance imaging (MRI) evaluation should follow on from US in any case where there is a reasonable chance of malignancy, where a lesion is incompletely evaluated, and in any lesion which is > 5 cm, crosses or lies deep to the superficial fascia or occurs at a site of previous resection [2].…”

Local recurrence of soft tissue sarcoma: a radiomic analysis

“…According to the American College of Radiology (ACR) Appropriateness Criteria guidelines, MRI is the most appropriate imaging test for LR surveillance of malignant or aggressive musculoskeletal soft-tissue tumors 8. However, data informing the appropriate use of MRI in the surveillance setting are conflicting 5,8,9. Indeed, MRI can differentiate local recurrence from post-surgical seroma, hematoma, inflammation and scarring, but some post-operative changes in the surgical bed can be similar to those of recurrence with conventional T1-weighted, T2- weighted, and post-contrast sequences posing diagnostic dilemmas especially when sarcoma recurrence has low signal intensity on fluid-sensitive images 1,8, 9, 10, 11.…”