Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses

Lakkaraju, Amit; Sinha, Rakesh; Garikipati, R.; Edward, Sara; Robinson, Philip

doi:10.1016/j.crad.2009.01.012

Cited by 96 publications

(59 citation statements)

References 12 publications

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“…Additionally, some lesions are too deep for reliable examination by ultrasound such as in the pelvis or thigh. Lakkaraju et al have suggested that ultrasound may have utility as an initial triage modality for primary care physicians before referring to a specialist [7]. In their study of 358 consecutive patients with soft tissue masses, ultrasound was used as the initial imaging modality and divided lesions into 8 groups based on characteristics ranging from normal (group 1) to possible sarcoma (group 8).…”

Section: Imaging Studiesmentioning

confidence: 99%

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Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities

Erwteman

Balach

2014

Cancer Treatment and Research

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Benign lesions comprise a majority of soft tissue tumors. It has been estimated that their incidence outnumbers that of malignant tumors by a factor of at least 100 [1]. While history and physical examination can start the diagnostic process, imaging including the use of magnetic resonance imaging can be more helpful. Biopsy of these tumors is sometimes necessary and can be performed in a number of ways, often in conjunction with definitive treatment. Specific diagnostic and treatment strategies for a number of the more commonly encountered benign soft tissue tumors including lipomas, pigmented villonodular synovitis and hemangiomas are reviewed. An algorithm for the management of benign soft tissue tumors is discussed.

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Section: Imaging Studiesmentioning

confidence: 99%

“…Indeterminate masses or possible sarcomas (groups 6-8) were referred for MRI within 14 days. All of the lesions that were initially diagnosed as benign on US, remained benign at final diagnosis, and a total of 1.68 % of the original cohort, were diagnosed with sarcoma [7].…”

Section: Imaging Studiesmentioning

confidence: 99%

Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities

Erwteman

Balach

2014

Cancer Treatment and Research

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“…Recent reports have suggested that ultrasound can be an effective intermediary triage stage prior to any patient being seen in a sarcoma treatment centre. 19 More prospective studies of the impact of such a strategy would be welcome; although ultrasound is not the best diagnostic modality in soft tissue sarcoma, it would be highly effective at triaging two major patient groups shown in Table 1 -those with no soft tissue abnormality and those with cutaneous lipomas. This accounts for over 50% of referrals.…”

Section: Discussionmentioning

confidence: 99%

Does the two-week rule pathway improve the diagnosis of soft tissue sarcoma? A retrospective review of referral patterns and outcomes over five years in a regional sarcoma centre

Pencavel

Strauß

Thomas

et al. 2010

annals

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INTRODUCTION The NHS Cancer Plan was introduced in 2000 and included guidelines for the rapid assessment and referral of cases of suspected malignancy. We wished to assess the efficiency and appropriateness of patients referred under the Department of Health's general practitioner referral guidelines implemented for sarcomas in December 2000. PATIENTS AND METHODS A retrospective case-note review was performed of all patients referred to our regional soft tissue sarcoma unit between 1 January 2004 and 31 December 2008. Patients referred under the two-week guidelines and all patients referred routinely were analysed. The main outcome measures were the total number of patients referred on the basis of the two-week guidelines and the proportion they constitute of all referrals. The referring criteria were noted and compared to the observed criteria recorded. The final histo-logical diagnosis of patients referred on the basis of the two-week guidelines are documented. RESULTS A total of 2746 referrals for suspected sarcoma were made from January 2004 to December 2008. Of these, 154 referrals were made under the two-week rule of which 102 were referred purely on the clinical criteria for suspected soft tissue sarcoma. The remaining patients were referred after non-urgent special investigations indicated the possibility of sarcoma. Twelve patients referred under the two-week rule were proved to have sarcoma, nine after specific investigations including imaging or histological diagnosis. Of the 102 patients referred on clinical suspicion of a sarcoma, two patients had proven soft tissue sarcomas and one patient a cutaneous sarcoma. Between 2004 and 2008, the number of 2-week referrals rose 25-fold but accounted for an increase of less than 1% of the sarcomas treated in this unit. CONCLUSIONS The numbers of all referrals for suspected sarcoma are increasing; however, the rate of increase of 2-week referrals is increasing faster than routine referrals and will exceed it in 2012 if current trends continue. There has not been a commensurate rise in the detection of sarcoma or, more specifically, diagnosis of the deep sarcomas associated with worse prognosis. Current clinical guidelines have essentially had no impact on the early diagnosis and treatment of soft tissue sarcoma, and may negatively impact on the treatment of patients with proven sarcoma by delaying treatment within a regional centre because of redirection of a large number of patients with benign abnormalities to such centres.

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“…Ultrasound has been shown to be an effective triage tool and in conjunction with MRI, most STTs can be characterized with a high degree of sensitivity and specificity as benign, indeterminate or malignant. 4,5,15 However, imaging, particularly ultrasound, can also result in an increased referral rate if performed by inexperienced operators and in unclear clinical pathways, as is demonstrated in our article. For example, small lipomas were referred based on ultrasound scans performed by any qualified provider (AQP), despite clear NICE guidance ( Figure 5).…”

Section: Discussionmentioning

confidence: 84%

Diagnostic triage for sarcoma: an effective model for reducing referrals to the sarcoma multidisciplinary team

Shah

Botchu²,

Ashford³

et al. 2015

BJR

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Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses

Cited by 96 publications

References 12 publications

Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities

Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities

Does the two-week rule pathway improve the diagnosis of soft tissue sarcoma? A retrospective review of referral patterns and outcomes over five years in a regional sarcoma centre

Diagnostic triage for sarcoma: an effective model for reducing referrals to the sarcoma multidisciplinary team

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