Soft-tissue sarcoma in adults: Imaging appearances, pitfalls and diagnostic algorithms - 24/12/22

Doi : 10.1016/j.diii.2022.12.001

Amandine Crombé ^a,^b,^c,^⁎ , Michèle Kind ^b, David Fadli ^a, Marco Miceli ^d, Pierre-Antoine Linck ^b, Giuseppe Bianchi ^e, Andrea Sambri ^f, Paolo Spinnato ^d
^a Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux 33076, France
^b Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France
^c Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400 Talence, France
^d Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
^e Orthopedic Musculoskeletal Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
^f Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, Bologna 40138, Italy

^⁎Corresponding author: Department of Musculoskeletal Imaging, Pellegrin Hospital, 2 place Amélie Raba-Léon, F-33076, Bordeaux, France.Department of Musculoskeletal ImagingPellegrin University HospitalBordeaux33076France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 24 December 2022
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Highlights

•	The radiologist has a pivotal role in the management of patients with suspected soft-tissue sarcoma.
•	Patients with suspected soft-tissue sarcoma must be referred to sarcoma reference center to avoid delayed diagnosis and inadequate surgery with positive margins.
•	Conventional and quantitative MRI helps plan biopsy, anticipate histologic grade, and decide on therapeutic strategy in patients with soft-tissue sarcoma.
•	Distinct practical radiological algorithms are used for the diagnostic management of homogeneous adipocytic tumors and intra-truncal soft-tissue sarcomas.

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Abstract

This article provides an overview of the current knowledge regarding diagnostic imaging of patients with soft-tissue sarcomas, which is a heterogeneous group of rare mesenchymal malignancies. After an initial contextualization, diagnostic flow-chart based on initial radiological findings of soft-tissue masses (with specific focus on adipocytic soft-tissue tumors [STTs], hemorragic STTs and retroperitoneal STTs) are provided considering relevant results from novel researches, guidelines, and experts’ viewpoints, with the aim to help radiologists and clinicians in their practice. Particularly, the central place of sarcoma reference centers in the diagnostic and therapeutic management is highlighted, as well as the pivotal role that radiologists should play to correctly identify patients with soft-tissue sarcoma at the initial stage of the disease. Indications and methods for performing imaging-guided biopsies are also discussed, as well as clues to improve soft-tissue sarcoma grading with conventional and quantitative imaging.

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Keywords : Imaging-guided biopsy, Magnetic resonance imaging (MRI), Soft-tissue sarcomas, Soft-tissue tumors, Ultrasonography

Abbreviations : ¹⁸F-FDG PET, ADC, CE, CI, CINSARC, DCE, DWI, FNCLCC, HR, Ktrans, LFS, MDTB, MFS, M/RC-LPS, MRI, OR, OS, PFS, ROC, STS, STT, SUVmax, UPS, WHO, WI