MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value

Yoo, Hye Jin; Hong, Sung Hwan; Kang, Yusuhn; Choi, Ja Young; Moon, Kyung Chul; Kim, Han Soo; Han, Ilkyu; Yi, Minkyong; Kang, Heung Sik

doi:10.1007/s00330-014-3181-2

Cited by 98 publications

(83 citation statements)

References 15 publications

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“…Several studies have demonstrated that an infiltrative growth pattern was significantly related to higher local recurrence rates [7,9,11,12]. Those studies included patients with low-grade MFS at the superficial layer.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the infiltrative growth pattern on magnetic resonance imaging (MRI) has been evaluated in both undifferentiated pleomorphic sarcoma (UPS) and myxofibrosarcoma (MFS) [7–12]. Infiltrative growth has been significantly correlated with poor disease-specific survival, metastasis-free survival, and local control, suggesting that it is a clinical indicator that reflects the aggressive behavior of tumors [7,9–12]. …”

Section: Introductionmentioning

confidence: 99%

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Infiltrative tumor growth patterns on magnetic resonance imaging associated with systemic inflammation and oncological outcome in patients with high-grade soft-tissue sarcoma

et al. 2017

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ObjectiveThe aim of this study was to determine whether the tumor infiltrative growth pattern on magnetic resonance imaging (MRI) was associated with blood inflammatory markers (C-reactive protein; CRP and Neutrophil-lymphocyte ratio; NLR) and survival in patients with high-grade soft-tissue sarcoma (STS).MethodsThe cohort for this retrospective study included 81 patients with a mean age of 63 years. The tumor depth was superficial or deep in 15 and 66 patients, respectively. The mean CRP and NLR were 1.31 mg/dL and 2.81, respectively. The assessment of a peripheral growth pattern which divided into three patterns on MRI was based on the largest midsection of the tumor.ResultsOn MRI scans, diffuse-type, focal-type, and pushing-type growth patterns were observed in 18, 33, and 30 patients, respectively. Superficial high-grade STS were prone to show a focal-type pattern on MRI. There were no correlations between growth pattern type and clinicopathological factors such as age, sex, tumor size, and histological grade. However, the incidence of infiltrative growth was significantly higher in patients with elevated CRP (p = 0.0002). In multivariate analysis, growth pattern and CRP were independent prognostic factors for disease-specific survival, metastasis-free survival. Growth pattern was also related to local tumor control.ConclusionsThere were significant associations between the tumor growth pattern and CRP levels in patients with high-grade soft-tissue sarcoma. An infiltrative growth pattern and elevated CRP may be associated with inferior disease-specific and metastasis-free survival rates in these patients. Therefore, careful post-treatment follow-up should be conducted in such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Infiltrative tumor growth patterns on magnetic resonance imaging associated with systemic inflammation and oncological outcome in patients with high-grade soft-tissue sarcoma

et al. 2017

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“…This infiltrative pattern of MFS and UPS via MRI correlates well with macroscopic or microscopic tumor extension along the fascia or fibrous septa of subcutaneous fat . Furthermore, a study showed that the tail sign on MRI was related to the high local recurrence rates of MFS and UPS …”

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confidence: 65%

“…A recent study described the frequent presence of curvilinear signal extensions from the main mass of MFS, so‐called “tail sign”, using magnetic resonance imaging (MRI), and some other studies also showed that this tail sign was frequently found in both UPS and MFS . This infiltrative pattern of MFS and UPS via MRI correlates well with macroscopic or microscopic tumor extension along the fascia or fibrous septa of subcutaneous fat . Furthermore, a study showed that the tail sign on MRI was related to the high local recurrence rates of MFS and UPS …”

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confidence: 97%

Prognostic significance of microscopic tumor extension in local recurrence of myxofibrosarcoma and undifferentiated pleomorphic sarcoma

Song

Lee

et al. 2018

Pathology International

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Myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) frequently display infiltrative growth into the adjacent normal soft tissue. In this study, we aimed to determine whether the microscopic extension into surrounding normal tissue can influence the local recurrence of MFS and UPS. A total of 42 cases (22 MFS and 20 UPS) were examined. The length of the microscopic extension was measured from the edge of the main tumor mass to the end of infiltration. The length of 5.5 mm was selected as the optimal cut-off value that could predict local recurrence using the receiver operating characteristic (ROC) curve and Youden index. Longer length of microscopic extension was significantly correlated with the status of resection margin (P = 0.032). The group with longer length of microscopic extension (>5.5 mm) had significantly worse recurrence-free survival than the group with shorter length of microscopic extension (≤5.5 mm) (P = 0.000). Multivariate analysis revealed that the length of microscopic extension was independent predictors of recurrence-free survival (P = 0.018). In conclusion, microscopic extensions at the edge of the main mass into the surrounding normal tissue were observed in most MFS and UPS patients, and the length of microscopic extension was associated with local recurrence.

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“…The high rate of local recurrence is thought to be related to the infiltrative nature of these tumors (10)(11)(12), which can be reflected in their unusual appearance on magnetic resonance imaging (MRI): In contrast to the focal and mass-like appearance of most soft tissue sarcomas (13), MFS can present as an infiltrative lesion with variable presence of a well-defined mass (4,9,14). This range of imaging appearance can be classified as infiltrative, focal, or mixed ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Pattern of Recurrence of Myxofibrosarcoma is not Associated with Pattern at Presentation or Rate of Delayed Diagnosis

et al. 2016

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Background: The tendency of myxofibrosarcoma (MFS) to have a non-nodular appearance on magnetic resonance imaging (MRI) may present a challenge in detection of local recurrence. Appropriate index of suspicion of expected imaging appearance can alleviate this challenge. Objectives: Our objectives were to determine if: 1) imaging pattern at recurrence is associated with delayed diagnosis, and 2) appearance at recurrence can be predicted based on appearance at presentation. Patients and Methods: A retrospective cohort study was performed. Two analysis groups were used: patients with recurrence captured on MRI (objective 1) and patients with MRI prior to resection and at recurrence (objective 2). Three radiologists scored images independently and in consensus as infiltrative (tail-like spread), focal (absence of spread), or mixed. Consensus results were used for analysis with Fisher's exact test. Results: There was substantial agreement among the 3 readers (k = 0.72, 95% confidence interval: 0.59 -0.85). Half of all infiltrative cases were associated with a delay in diagnosis, compared to 10% of mixed or focal cases; however, there was no statistically significant association between infiltrative pattern at recurrence and delayed diagnosis (P = 0.08). In 70% of cases, recurrence had the same appearance as presentation, suggesting a trend; however, there was no association between appearance at baseline and recurrence (P = 0.1). Conclusion: Imaging appearance at baseline does not reliably predict imaging appearance at recurrence. Therefore, a high index of suspicion for the infiltrative pattern is required in assessment of post-operative MRIs in patients with MFS.

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MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value

Abstract: • The tail sign was a common MRI feature of myxofibrosarcoma and undifferentiated sarcoma. • The tail sign may be associated with worse local recurrence-free survival • Radiologists should be aware of this MRI finding and inform the surgeon.

Cited by 98 publications

References 15 publications

Infiltrative tumor growth patterns on magnetic resonance imaging associated with systemic inflammation and oncological outcome in patients with high-grade soft-tissue sarcoma

Infiltrative tumor growth patterns on magnetic resonance imaging associated with systemic inflammation and oncological outcome in patients with high-grade soft-tissue sarcoma

Prognostic significance of microscopic tumor extension in local recurrence of myxofibrosarcoma and undifferentiated pleomorphic sarcoma

Pattern of Recurrence of Myxofibrosarcoma is not Associated with Pattern at Presentation or Rate of Delayed Diagnosis

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