The Role of Ultrasound in the Diagnosis of Soft Tissue Tumors

Gómez, Maria Pilar Aparisi; Errani, Costantino; Lalam, Radhesh; Nikodinovska, Violeta Vasilevska; Fanti, Stefano; Tagliafico, Alberto; Sconfienza, Luca Maria; Bazzocchi, Alberto

doi:10.1055/s-0039-3402060

Cited by 15 publications

(4 citation statements)

References 107 publications

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“…Ultrasound represents the initial triage imaging modality for accessible and small suspected soft tissue tumors [ 21 – 24 ]. Ultrasound is highly accurate for diagnosis of specific superficial lesions with typical ultrasound features [ 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?

Noebauer-Huhmann,

Vanhoenacker,

Vilanova

et al. 2023

Eur Radiol

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Objectives Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. Materials and methods A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved. Results Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. Conclusion Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. Clinical relevance The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. Key Points • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy.

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Section: Discussionmentioning

confidence: 99%

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?

Noebauer-Huhmann,

Vanhoenacker,

Vilanova

et al. 2023

Eur Radiol

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“…US has a diagnostic sensitivity and specificity for lipoma in the range of 52%–100% and 86%–100%, respectively (3). The classic sonographic appearance of lipoma can be hyperechoic (20%–52%), isoechoic (28%–60%), or hypoechoic (20%), and will depend on the connective tissue and fat proportion and architecture (2). Herniated lipomas were all hypoechogenic since the fat content, especially in the protruded portion, predominated over connective tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Lipomas are benign tumors composed of mature adipocytes. The global incidence is 1%–2% (1,2), representing the most common benign soft-tissue tumor (50%) (2,3). Lipomas may be located in any region of the body that contains fat, including the subcutaneous soft-tissues, the muscle-skeletal system, and the thoracic abdominal and pelvic cavities (3).…”

Section: Introductionmentioning

confidence: 99%

Herniated superficial lipomas in gluteal and thigh support areas: a special clinical ultrasound presentation

et al. 2022

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Background Lipomas are the most frequent benign tumor. They have been described as soft, well-defined, slow-growing palpable masses, and classified as deep or superficial. Purpose To present the clinical and ultrasound findings of herniated superficial subcutaneous lipoma (HSL), located in pressure/support areas, not previously described. Material and Methods A seven-year retrospective review was performed. Patients with a preoperative high-resolution ultrasound (HRUS) diagnosis of HSL archived in the computational system and histological study information were selected. Results A total of 37 patients (mean age = 46 years) were recruited. The clinical diagnoses were “lipoma” or “suspected lipoma” in just 46% of the cases. This was three times more frequent in women. Tumors were located mainly in the gluteal (38%) and proximal thigh areas (35%). Clinically, all patients showed small, soft, rounded skin nodules. On HRUS, they appear as lipomatous tumors that protruded, compressed, and thinned the covering dermal layer. The subcutaneous portion was bigger than the herniated part, with an iceberg image. Conclusion HSL in support areas have a special clinical ultrasound presentation, not previously described. It is important to recognize them for a proper diagnosis and treatment, especially because they clinically may present as small superficial lesions; however, they are associated with a larger subcutaneous portion (iceberg image). It is probable that an estrogen influence on the adipose tissue can be suspected because of the female predominance.

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“…7 A They normally appear shortly after birth and show a pattern of rapid growth over the first year of life, then become stable, and then start regressing as early as in the second year of life (reflected by decreased perfusion), normally disappearing before puberty. Treatment is usually not necessary but ultimately depends on location, growth, size, and complications, such as bleeding [19].…”

Section: Introductionmentioning

confidence: 99%

The beauty of pediatric musculoskeletal ultrasound

Drakonaki,

Adriaensen,

Simoni

et al. 2024

Rofo

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Ultrasound is a powerful technique in pediatric imaging and musculoskeletal (MSK) imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in pediatric musculoskeletal ultrasound.Cases were collected by members of the Educational Committee of the ESSR (European Society of musculoSkeletal Radiology) and the Pediatric Subcommittee of the ESSR with expertise in musculoskeletal ultrasound.Fifteen clinical entities are discussed based on the features that allow diagnosis by ultrasound.Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing pediatric musculoskeletal ultrasound.

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The Role of Ultrasound in the Diagnosis of Soft Tissue Tumors

Cited by 15 publications

References 107 publications

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?

Herniated superficial lipomas in gluteal and thigh support areas: a special clinical ultrasound presentation

The beauty of pediatric musculoskeletal ultrasound

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