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.

Occurrence and prognosis of lymph node metastases in patients selected for isolated limb perfusion with soft tissue sarcoma

“…In the absence of clear recommendations, systematic lymph node dissection during ILP is performed in our academic center. However, according to results of this series and other retrospective studies, it could be considered to perform a RLND for high risk sarcomas (rhabdomyosarcoma, angiosarcoma, clear cell sarcoma, epithelioid sarcoma, synovial sarcoma) and not only during ILP procedures 26 , 29 .…”

“…The fact that some STS subtypes are at high risk for nodal involvement should be included in treatment planning. For sarcomas with potentially high lymph node involvement risk, an active detection of lymph node metastases may be evaluated preoperatively (sentinel lymph node biopsy, MRI/CT or PET-CT) 29 . Unfortunately, given the small number of patients in the present series, conclusions and recommendations cannot be drawn for "high-risk" histologies.…”

Is fat suppression in T1 and T2 FSE with mDixon superior to the frequency selection-based SPAIR technique in musculoskeletal tumor imaging?

“…Mentioned in the European Society of Musculoskeletal Radiology guidelines for soft tissue tumor imaging [19] and practiced in many tumor centers is the use of T2-weighted images both with and without fat saturation. The possibility to save time by using both the water-only and in-phase reconstructions from the same Dixon acquisition to replace these sequences was beyond the scope of the current study.…”

Spatially Specific Liposomal Cancer Therapy Triggered by Clinical External Sources of Energy

“…In the clinical management of cancer, MFs are used primarily with contrast agents to diagnose and stage tumors. The technique is commonly used in cases where the tumor is made of softer tissue, as MRI scans provide images that enhance soft tissue contrast [124]. Aside from MRI, one of the best-known uses of magnetism in cancer is alternating magnetic field (AMF) induced hyperthermia.…”