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MRI characteristics of lipoma and atypical lipomatous tumor/well-differentiated liposarcoma: retrospective comparison with histology and MDM2 gene amplification

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Abstract

Purpose

To review the reliability of MR imaging features for the purpose of distinguishing lipoma and atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL).

Materials and methods

A retrospective review of 87 patients with histologically proven lipomatous tumors was performed. All underwent MR imaging, assessing lipomatous content, septation, and nodules. The associations between these features and tumor diagnosis based on morphology and the presence or absence of MDM2 amplification were explored. The age of the patient and the size and location of the lesion were also recorded for statistical analysis.

Results

Of the 87 patients, 54 were classified as lipomas and 33 as ALT/WDL. MR identified ALT/WDL with a sensitivity of 90.9 % (CI 74.5–97.6) and a specificity of 37.0 % (CI 24.6–51.3). The positive and negative predictive values were 46.9 % (CI 34.5–59.7) and 86.9 % (CI 65.3–96.6), respectively. The mean age of patients with ALT/WDL was greater (60 years [range 40–83 years]) than those with lipoma (52 years [range 10–79 years]) (p = 0.025). The mean size of ALT/WDL (18.7 cm [range 5–36 cm]) was significantly greater than lipoma (13.9 cm [range 3–32 cm]) (p = 0.003). Features that increased the likelihood of ALT/WDL included: patient age over 60 years, maximal lesion dimension over 10 cm, location in lower limb, and presence of non-fatty areas, by a factor of 2.61–6.25 times.

Conclusions

ALT/WDL and lipoma have overlapping MR imaging characteristics. The most reliable imaging discriminators of ALT/WDL were size of lesion and lipomatous content, but due to the overlap in the MRI appearances of lipoma and ALT/WDL, discrimination should be based on molecular pathology rather than imaging.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK

    Mélanie Brisson, Andrew Clarke & Paul O’Donnell

  2. Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK

    Takeshi Kashima, David Delaney, Roberto Tirabosco & Adrienne M. Flanagan

  3. Institute of Orthopaedics and Musculoskeletal Science, UCL, Stanmore, UK

    Adrienne M. Flanagan & Paul O’Donnell

  4. Clinical Trials Unit, Medical Research Council, London, UK

    Suzie Cro

  5. UCL Cancer Institute, Huntley Street, London, WC1E 6BT, UK

    Adrienne M. Flanagan

Authors
  1. Mélanie Brisson
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  2. Takeshi Kashima
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  3. David Delaney
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  4. Roberto Tirabosco
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  5. Andrew Clarke
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  6. Suzie Cro
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  7. Adrienne M. Flanagan
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  8. Paul O’Donnell
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Correspondence to Paul O’Donnell.

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Brisson, M., Kashima, T., Delaney, D. et al. MRI characteristics of lipoma and atypical lipomatous tumor/well-differentiated liposarcoma: retrospective comparison with histology and MDM2 gene amplification. Skeletal Radiol 42, 635–647 (2013). https://doi.org/10.1007/s00256-012-1517-z

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  • DOI: https://doi.org/10.1007/s00256-012-1517-z

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