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Accuracy of ultrasound in the characterization of superficial soft tissue tumors: a prospective study

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Abstract

Objective

To prospectively evaluate the accuracy of ultrasound in defining the specific nature of superficial soft tissue masses as well as determining malignancy.

Materials and method

Eight hundred twenty-three superficial soft tissue masses were prospectively evaluated with ultrasound by one of five experienced musculoskeletal radiologists. The radiologist at the time of examination provided one to three specific differential diagnoses and the perceived level of confidence with regard to each diagnosis. Clinical and ultrasound diagnoses were compared with the histological diagnosis to determine accuracy. Tumor malignancy was determined by histology or clinical/imaging follow-up.

Results

Histological correlation was present for 219 (26.6%) of the 823 masses. Compared with histology, the accuracy of clinical and ultrasound examination for determining specific tumor type was 25.6% and 81.2% respectively considering all differential diagnoses provided. Radiologists were “fully confident” with the ultrasound diagnosis in 585 (71.1%) of 823 masses overall. In this setting, when compared with histology, the diagnostic accuracy of ultrasound was 95.5%. When the radiologist was “not fully confident,” accuracy was 41.3% for the first differential diagnosis and 60.9% for all differential diagnoses. Diagnostic accuracy improved with increasing radiologist experience. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for identifying malignant tumor were 93.3%, 97.9%, 45.2%, and 99.9% respectively.

Conclusions

One can be “fully confident” at characterizing over two-thirds of superficial soft tissue masses based on ultrasound appearances and, in this setting, diagnostic accuracy is very high. Ultrasound examination is also highly accurate at discriminating benign from malignant superficial soft tissue masses.

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References

  1. Shin YS, Kim YJ, Park IS, Chu YC, Kim JH, Lee HY, et al. Sonographic differentiation between angiolipomas and superficial lipomas. J Ultrasound Med. 2016;35(11):2421–9.

    Article  PubMed  Google Scholar 

  2. Taljanovic MS, Gimber LH, Klauser AS, Porrino JA, Chadaz TS. Omar IM ultrasound in the evaluation of musculoskeletal soft-tissue masses. Semin Roentgenol. 2017;52(4):241–54.

    Article  PubMed  Google Scholar 

  3. Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62(2):247–56.

    Article  PubMed  Google Scholar 

  4. Widmann G, Riedl A, Schoepf D, Glodny B, Peer S, Gruber H. State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue masses. Skelet Radiol. 2009;38(7):637–49.

    Article  Google Scholar 

  5. Doyle AJ, Miller MV, French JG. Ultrasound of soft-tissue masses: pitfalls in interpretation. Australas Radiol. 2000;44(3):275–80.

    Article  PubMed  CAS  Google Scholar 

  6. Hung EH, Griffith JF. Pitfalls in ultrasonography of soft tissue masses. Semin Musculoskelet Radiol. 2014;18(1):79–85.

    Article  PubMed  Google Scholar 

  7. Ritchie DA. Commentary on ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol. 2009;64(6):622–3.

    Article  PubMed  CAS  Google Scholar 

  8. Hwang EJ, Yoon HS, Cho S, Park HS. The diagnostic value of ultrasonography with 5-15-MHz probes in benign subcutaneous lesions. Int J Dermatol. 2015;54(11):e469–75.

    Article  PubMed  Google Scholar 

  9. Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC. Ultrasound of musculoskeletal soft-tissue masses superficial to the investing fascia. AJR Am J Roentgenol. 2014;202(6):W532–40.

    Article  PubMed  Google Scholar 

  10. Ahuja A, Ying M, Yang WT, Evans R, King W, Metreweli C. The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes. Clin Radiol. 1996;51(3):186–90.

    Article  PubMed  CAS  Google Scholar 

  11. Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191(3):646–52.

    Article  PubMed  Google Scholar 

  12. Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology. 2009;250(1):41–9.

    Article  PubMed  Google Scholar 

  13. Bialek EJ, Jakubowski W, Szczepanik AB, Maryniak RK, Prochorec-Sobieszek M, Bilski R, et al. Vascular patterns in superficial lymphomatous lymph nodes: a detailed sonographic analysis. J Ultrasound. 2007;10(3):128–34.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Ying M, Ahuja AT, Evans R, King W, Metreweli C. Cervical lymphadenopathy: sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas. J Clin Ultrasound. 1998;26(8):383–9.

    Article  PubMed  CAS  Google Scholar 

  15. Ahuja AT, Ying M, Yuen HY, Metreweli C. ‘Pseudocystic’ appearance of non-Hodgkin’s lymphomatous nodes: an infrequent finding with high-resolution transducers. Clin Radiol. 2001;56(2):111–5.

    Article  PubMed  CAS  Google Scholar 

  16. Tregnaghi A, De Candia A, Calderone M, Cellini L, Rossi CR, Talenti E, et al. Ultrasonographic evaluation of superficial lymph node metastases in melanoma. Eur J Radiol. 1997;24(3):216–21.

    Article  PubMed  CAS  Google Scholar 

  17. Griffith JF, Chan DP, Kumta SM, Chow LT, Ahuja AT. Does Doppler analysis of musculoskeletal soft-tissue tumours help predict tumour malignancy? Clin Radiol. 2004;59(4):369–75.

    Article  PubMed  CAS  Google Scholar 

  18. Bodner G, Schocke MF, Rachbauer F, Seppi K, Peer S, Fierlinger A, et al. Differentiation of malignant and benign musculoskeletal masses: combined color and power Doppler US and spectral wave analysis. Radiology. 2002;223(2):410–6.

    Article  PubMed  Google Scholar 

  19. Morii T, Kishino T, Shimamori N, Motohashi M, Ohnishi H, Honya K, et al. Differential diagnosis between benign and malignant soft tissue masses utilizing ultrasound parameters. J Med Ultrason (2001). 2018;45(1):113–9.

    Article  Google Scholar 

  20. Fletcher CD. The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification. Histopathology. 2014;64(1):2–11.

    Article  PubMed  Google Scholar 

  21. Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, et al. Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136(1):e203–14.

    Article  PubMed  Google Scholar 

  22. Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med. 2013;32(8):1443–50.

    Article  PubMed  Google Scholar 

  23. Kim SY, Chung HW. Small musculoskeletal soft-tissue lesions: US-guided core needle biopsy—comparative study of diagnostic yields according to lesion size. Radiology. 2016;278(1):156–63.

    Article  PubMed  Google Scholar 

  24. Clark TC, Kimbrell B, Girard N, Hansford BG. Bilateral multifocal lower extremity localized soft tissue amyloidomas: case report with ultrasonographic characterization. Skelet Radiol. 2017;46(12):1783–9.

    Article  Google Scholar 

  25. Rahmani G, McCarthy P, Bergin D. The diagnostic accuracy of ultrasonography for soft tissue lipomas: a systematic review. Acta Radiol. 2017;6(6):1–6.

    Google Scholar 

  26. Wortsman X. Sonography of dermatologic emergencies. J Ultrasound Med. 2017;36(9):1905–14.

    Article  PubMed  Google Scholar 

  27. Zhang JZ, Zhou J, Zhang ZC. Subcutaneous angioleiomyoma: clinical and sonographic features with histopathologic correlation. J Ultrasound Med. 2016;35(8):1669–73.

    Article  PubMed  Google Scholar 

  28. Catalano O, Alfageme Roldan F, Scotto di Santolo M, Solivetti FM, Wortsman X. Color Doppler sonography of merkel cell carcinoma. J Ultrasound Med. 2018;37(1):285–92.

    Article  PubMed  Google Scholar 

  29. Catalano O, Alfageme Roldan F, Solivetti FM, Scotto di Santolo M, Bouer M, Wortsman X. Color Doppler sonography of extradigital glomus masses. J Ultrasound Med. 2017;36(1):231–8.

    Article  PubMed  Google Scholar 

  30. Preell-Mazzini J, Barton MD Jr, Conway SA, Temple HT. Unplanned excision of soft-tissue sarcomas: current concepts for management and prognosis. J Bone Joint Surg Am. 2015;97(7):597–603.

    Article  Google Scholar 

  31. Chiou HJ, Chou YH, Chiu SY, Wang HK, Chen WM, Chen TH, et al. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color doppler ultrasonography. J Chin Med Assoc. 2009;72(6):307–15.

    Article  PubMed  Google Scholar 

  32. Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol. 2009;64(6):615–21.

    Article  PubMed  CAS  Google Scholar 

  33. Belli P, Costantini M, Mirk P, Maresca G, Priolo F, Marano P. Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses. J Ultrasound Med. 2000;19(12):823–30.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong

    Esther H. Y. Hung, James F. Griffith, Stefanie W. Y. Yip, Marina Ivory, Jeremiah C. H. Lee, Alex W. H. Ng & Cina S. L. Tong

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  1. Esther H. Y. Hung
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  2. James F. Griffith
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  3. Stefanie W. Y. Yip
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  4. Marina Ivory
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Correspondence to James F. Griffith.

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Hung, E.H.Y., Griffith, J.F., Yip, S.W.Y. et al. Accuracy of ultrasound in the characterization of superficial soft tissue tumors: a prospective study. Skeletal Radiol 49, 883–892 (2020). https://doi.org/10.1007/s00256-019-03365-z

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  • DOI: https://doi.org/10.1007/s00256-019-03365-z

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