Musculoskeletal Soft-Tissue Sarcoma: Quality Assessment of Initial MRI Reports Shows Frequent Deviation from ESSR Guidelines

Soft-tissue sarcomas (STS) are a rare subtype of soft-tissue mass and are frequently misinterpreted as benign lesions. Magnetic resonance imaging (MRI) is the primary recommended type of diagnostics. To assess the quality of primary radiology reports, we investigated whether recommended MRI report elements were included in compliance with European Society of Musculoskeletal Radiology (ESSR) guidelines. A total of 1107 patients were evaluated retrospectively, and 126 radiological reports on patients with malignant STS were assessed for ESSR quality criteria. One or more required sequences or planes were missing in 67% of the reports. In all 126 cases, the report recognized the mass as anomalous (100%). Sixty-eight percent of the reports mentioned signs of malignancy. The majority of reports (n = 109, 87%) articulated a suspected diagnosis, 32 of which showed a mismatch with the final diagnosis (25%). Thirty-two percent of the reports had a misinterpretation of the masses as benign. Benign misinterpretations were more common in masses smaller than 5 cm (65% vs. 27%). Thirty percent of the reports suggested tissue biopsy and 6% recommended referral to a sarcoma center. MRI reports showed frequent deviations from ESSR guidelines, and protocol guidelines were not routinely met. Deviations from standard protocol and reporting guidelines could put patients at risk for inadequate therapy.

[1]  O. Jansen,et al.  Configuration of Soft-tissue Sarcoma on MRI Correlates with Grade of Malignancy , 2021, Radiology and oncology.

[2]  Chencui Huang,et al.  Magnetic Resonance Imaging‐Based Radiomics Nomogram for Prediction of the Histopathological Grade of Soft Tissue Sarcomas: A Two‐Center Study , 2020, Journal of magnetic resonance imaging : JMRI.

[3]  J. Ro,et al.  Retroperitoneal Sarcomas: An Update on the Diagnostic Pathology Approach , 2020, Diagnostics.

[4]  L. Mack,et al.  Surgical management of truncal and extremities atypical lipomatous tumors/well-differentiated liposarcoma: A systematic review of the literature. , 2020, American journal of surgery.

[5]  J. Blay,et al.  Surgery in reference centers improves survival of sarcoma patients: a nationwide study , 2019, Annals of oncology : official journal of the European Society for Medical Oncology.

[6]  J. Blay,et al.  Surgery in reference centers improves survival of sarcoma patients: a nationwide study , 2019, Annals of oncology : official journal of the European Society for Medical Oncology.

[7]  S. Sleijfer,et al.  Corrections to "Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up". , 2018 .

[8]  P Reichardt,et al.  Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2018, Annals of oncology : official journal of the European Society for Medical Oncology.

[9]  A. Takushima,et al.  Liposarcoma Preoperatively Diagnosed as Lipoma: 10-Year Experience at a Single Institution , 2018, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[10]  E. Dick,et al.  Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs , 2017, Skeletal Radiology.

[11]  Chin-Shang Li,et al.  Predictors of residual disease after unplanned excision of soft tissue sarcomas. , 2017, The Journal of surgical research.

[12]  I. Judson,et al.  UK guidelines for the management of soft tissue sarcomas , 2016, Clinical Sarcoma Research.

[13]  C. Krestan,et al.  Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging , 2015, Seminars in Musculoskeletal Radiology.

[14]  C. Krestan,et al.  Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging , 2015, Seminars in Musculoskeletal Radiology.

[15]  S. Bonvalot,et al.  Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. , 2015, Journal of visceral surgery.

[16]  M. Barton,et al.  Unplanned excision of soft-tissue sarcomas: current concepts for management and prognosis. , 2015, The Journal of bone and joint surgery. American volume.

[17]  J. Mayerson,et al.  Diagnosis and Management of Soft-tissue Masses. , 2014, The Journal of the American Academy of Orthopaedic Surgeons.

[18]  M. Schweitzer,et al.  Differentiation of lipoma from liposarcoma on MRI using texture and shape analysis. , 2014, Academic radiology.

[19]  A. Marx,et al.  [Interdisciplinary treatment of soft tissue sarcoma of the extremities]. , 2014, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[20]  B. Manaster Soft-tissue masses: optimal imaging protocol and reporting. , 2013, AJR. American journal of roentgenology.

[21]  F. Traina,et al.  Current Concepts in the Biopsy of Musculoskeletal Tumors , 2013, TheScientificWorldJournal.

[22]  D. Panicek,et al.  Musculoskeletal tumours and tumour-like conditions: common and avoidable pitfalls at imaging in patients with known or suspected cancer , 2013, International Orthopaedics.

[23]  A. Flanagan,et al.  MRI characteristics of lipoma and atypical lipomatous tumor/well-differentiated liposarcoma: retrospective comparison with histology and MDM2 geneamplification , 2013, Skeletal Radiology.

[24]  M. Maguire Early symptoms of bone and soft tissue sarcomas: could they be diagnosed earlier? , 2012, Annals of the Royal College of Surgeons of England.

[25]  G. Gatta,et al.  Rare cancers are not so rare: the rare cancer burden in Europe. , 2011, European journal of cancer.

[26]  J. Blay,et al.  Incidence of Sarcoma Histotypes and Molecular Subtypes in a Prospective Epidemiological Study with Central Pathology Review and Molecular Testing , 2011, PloS one.

[27]  M. Hochman,et al.  Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. , 2009, Radiology.

[28]  C. Cannon,et al.  Soft‐tissue Sarcoma , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[29]  J. Pitcher,et al.  Local Recurrence of Disease after Unplanned Excisions of High-grade Soft Tissue Sarcomas , 2008, Clinical orthopaedics and related research.

[30]  L. Koniaris,et al.  Should Soft Tissue Sarcomas Be Treated at High-volume Centers?: An Analysis of 4205 Patients , 2007, Annals of surgery.

[31]  P. Parizel,et al.  Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients , 2004, European Radiology.

[32]  W. Ward,et al.  Soft-tissue lumps and bumps. , 2003, Instructional course lectures.

[33]  B. O'Sullivan,et al.  Processes and Outcomes of Care for Soft Tissue Sarcoma of the Extremities , 2002, Sarcoma.

[34]  K. Tilling,et al.  Variable management of soft tissue sarcoma: Regional audit with implications for specialist care , 1997, The British journal of surgery.

[35]  A. Giuliano,et al.  The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.