MR imaging in the assessment of residual tumour following inadequate primary excision of soft tissue sarcomas

Davies, A. M.; Mehr, Amin Danandeh; Parsonage, S.; Evans, N.; Grimer, R. J.; Pynsent, Paul

doi:10.1007/s00330-003-2023-4

Cited by 40 publications

(23 citation statements)

References 20 publications

(43 reference statements)

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“…Most studies report residual sarcoma in approximately 50% of patients, but there is a wide range from as low as 24% to as high as 91%. 19–21 Our study, from a prospectively maintained database, identified residual STS in 70% of patients, reinforcing the impression that residual STS is an important problem following unplanned excision.…”

Section: Discussionsupporting

confidence: 66%

“…A 2004 study showed that despite a low negative predictive value, MRI remains useful in identifying the size of residual tumor. 21 Meanwhile, a 2010 study showed residual tumor was not readily distinguished from postoperative change in STS of the hand. 22 Post-surgical changes had the greatest impact on the accuracy of MRI, as surrounding edema, hematoma and seroma create a distorted picture from which it is difficult to exclude macroscopic disease.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of residual disease after unplanned excision of soft tissue sarcomas

Gingrich

Elias

Lee

et al. 2017

Journal of Surgical Research

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Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of re-excision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (1/1/2008 – 9/30/2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity/specificity and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at re-excision. Results Mean age was 52 years, and 63.2% were male. 50% had fragmented unplanned excision. Among patients undergoing re-excision, residual STS was identified in 70%. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (OR 10.59, 95% CI 2.14–52.49, P=0.004 and OR 3.61, 95% CI 1.09–11.94, P=0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7% (95% CI 73.2–95.0%) and 57.9% (95% CI 33.5–79.8%), with an overall accuracy of 78.1% (95% CI 66.0–87.5%). Conclusions 70% of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Predictors of residual disease after unplanned excision of soft tissue sarcomas

Gingrich

Elias

Lee

et al. 2017

Journal of Surgical Research

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“…Furthermore, 700 consecutive patients (310 males and 390 females with a median age of 44 years and age range of 17-81 years) with a soft tissue neoplasm and registered in a large databank for soft tissue tumors between January 2001 and March 2004 were included in the study. All patients underwent magnetic resonance (MR) imaging, generally considered to be the most accurate imaging technique for characterizing and local staging of musculoskeletal tumors [6,7]. A wide range of MRI scanners and protocols were used at the referral hospitals.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, extension and characteristics of fluid-fluid levels in bone and soft tissue tumors

et al. 2006

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The purpose of this study was to determine the prevalence, extension and signal characteristics of fluid-fluid levels in a large series of 700 bone and 700 soft tissue tumors. Out of a multi-institutional database, MRI of 700 consecutive patients with a bone tumor and MRI of 700 consecutive patients with a soft tissue neoplasm were retrospectively reviewed for the presence of fluid-fluid levels. Extension (single, multiple and proportion of the lesion occupied by fluid-fluid levels) and signal characteristics on magnetic resonance imaging of fluid-fluid levels were determined. In all patients, pathologic correlation was available. Of 700 patients with a bone tumor, 19 (10 male and 9 female; mean age, 29 years) presented with a fluid-fluid level (prevalence 2.7%). Multiple fluid-fluid levels occupying at least one half of the total volume of the lesion were found in the majority of patients. Diagnoses included aneurysmal bone cyst (ten cases), fibrous dysplasia (two cases), osteoblastoma (one case), simple bone cyst (one case), telangiectatic osteosarcoma (one case), "brown tumor" (one case), chondroblastoma (one case) and giant cell tumor (two cases). Of 700 patients with a soft tissue tumor, 20 (9 males and 11 females; mean age, 34 years) presented with a fluid-fluid level (prevalence 2.9%). Multiple fluid-fluid levels occupying at least one half of the total volume of the lesion were found in the majority of patients. Diagnoses included cavernous hemangioma (12 cases), synovial sarcoma (3 cases), angiosarcoma (1 case), aneurysmal bone cyst of soft tissue (1 case), myxofibrosarcoma (1 case) and high-grade sarcoma "not otherwise specified" (2 cases). In our series, the largest reported in the literature to the best of our knowledge, the presence of fluid-fluid levels is a rare finding with a prevalence of 2.7 and 2.9% in bone and soft tissue tumors, respectively. Fluid-fluid levels remain a non-specific finding and can occur in a wide range of bone and soft tissue tumors, both benign and malignant. Therefore, they cannot be considered diagnostic of any particular type of tumor, and the diagnosis should be made on the basis of other radiological and clinical findings.

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“…If in doubt, a dynamic contrast-enhanced scan can differentiate rapidly enhancing tumour from scar tissue and the rare entity of radiation-induced pseudomass [9]. Imaging the patient in the first few weeks or months after surgery, particularly following a marginal excision, can be problematic [24]. A false-positive dynamic scan may be seen with young granulation tissue in the early weeks after surgery and a false-negative with the rare poorly vascularized sarcoma that shows slow, late enhancement [9,25].…”

Section: Discussionmentioning

confidence: 97%

The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

et al. 2004

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Fluid collections (seromas) may accumulate at the site of surgery following excision of musculoskeletal soft tissue tumours. The aim of this retrospective study was to review the magnetic resonance (MR) imaging features of postoperative seromas identifying changes over time on follow-up scans. A total of 170 MR scans from 80 patients were reviewed showing one or more seromas. All patients had undergone previous surgery for a musculoskeletal soft tissue tumour. The typical MR appearances of a seroma were shown to be a well-defined oval or rounded (54%) soft tissue mass, arising at the site of previous surgery, with a thin, dark pseudocapsule, surrounding soft tissue oedema (80%), homogeneous contents that are hypointense (relative to adjacent muscle) on T1-weighted images (74%) and hyperintense on T2-weighted and STIR images (79%). Approximately one-quarter of cases revealed atypical features including hyperintense contents on T1-weighted (26%) and/or heterogeneous contents on T2-weighted images (21%), reflecting the breakdown of blood products and organization of the fluid collection. A distinctive fine feathery pattern arising from the inner surface of the seroma or from septations was identified in 10% of cases. In those patients who underwent one or more follow-up scans, the volume of the seromas decreased in 66% cases, remained unchanged in 15% and increased in 19%. Seromas are not an uncommon finding (<10% of cases) following surgery for a soft tissue tumour. The majority of cases show the typical MR features of a fluid collection. The pitfalls in differentiating an atypical seroma from a recurrent soft tissue sarcoma are discussed.

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MR imaging in the assessment of residual tumour following inadequate primary excision of soft tissue sarcomas

Cited by 40 publications

References 20 publications

Predictors of residual disease after unplanned excision of soft tissue sarcomas

Predictors of residual disease after unplanned excision of soft tissue sarcomas

Prevalence, extension and characteristics of fluid-fluid levels in bone and soft tissue tumors

The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

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