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

Lakkaraju, A.; Sinha, R.; Garikipati, R.; Edward, S.; Robinson, P.

doi:10.1016/j.crad.2009.01.012

« Previous Next »Clinical Radiology
Volume 64, Issue 6 , Pages 615-621, June 2009

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

Received 26 September 2008; received in revised form 5 January 2009; accepted 13 January 2009.

Aim

To evaluate the efficacy of ultrasound as a first-line investigation in patients with a clinical soft-tissue mass.

Methods

Three hundred and fifty-eight consecutive patients (155 male, 203 female, mean age 48 years) referred from primary and secondary care with soft-tissue masses underwent ultrasound evaluation. Five radiologists performed ultrasound using a 10–15MHz linear transducer and recorded the referrer diagnosis, history, lesion size, anatomical location and depth, internal echogenicity, external margins (well-defined rim or infiltrative), and vascularity on power Doppler (absent or present, if present the pattern was listed as either linear or disorganized). A provisional ultrasound diagnosis was made using one of eight categories. Benign categories (categories 1–5) were referred back to a non-sarcoma specialist or original referrer for observation. Indeterminate or possible sarcomas (categories 6–8) were referred for magnetic resonance imaging (MRI) within 14 days. Additionally category 8 lesions were referred to the regional sarcoma service. Institutional and regional database follow-up was performed.

Results

Two hundred and eighty-four of the 358 (79%) lesions were classified as benign (categories 1–5). On follow-up 15 of the 284 patients were re-referred but none (284/284) had a malignancy on follow-up (24–30 months). Overall at ultrasound 33 lesions were larger than 5cm, 42 lesions were deep to deep fascia with 20 showing both features. In this subgroup of 95 patients there were six malignant tumours with the rest benign. Seventy-three of the 358 patients underwent MRI; the results of which indicated that there were 60 benign or non-tumours, 10 possible sarcomas, and three indeterminate lesions. Overall six of 12 (6/358, 1.68% of total patients) lesions deemed to represent possible sarcomas on imaging were sarcomas.