Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study



To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses.


Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist (‘fully confident’ versus ‘not fully confident’) about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses.


Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses.


Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses.

Key Points

• In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%.

• Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant.

• Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.

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American College of Radiology


European Society of Musculoskeletal Radiology


Giant cell tumour of tendon sheath


Negative predictive value


Positive predictive value


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The authors state that this work has not received any funding.

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Corresponding author

Correspondence to James F. Griffith.

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The scientific guarantor of this publication is Prof. James Francis Griffith.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Jason Leung from The Chinese University of Hong Kong kindly provided statistical advice for this manuscript.

Jason Leung is one of the authors who has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because patients underwent a clinically indicated ultrasound examination with no additional imaging, procedure, or change in clinical management.

Ethical approval

Institutional Review Board approval was obtained.


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Griffith, J.F., Yip, S.W.Y., Hung, E.H.Y. et al. Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study. Eur Radiol 30, 5894–5903 (2020).

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  • Soft tissue neoplasms
  • Tumour burden
  • Ultrasound imaging
  • Malignancy
  • Data accuracy