What is the role of imaging studies in the workup of soft-tissue tumors?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Over the past two decades, imaging studies (eg, plain radiography, computed tomography [CT], magnetic resonance imaging [MRI], bone scintigraphy, and positron emission tomography [PET]) have contributed greatly to the management of soft-tissue tumors. Although these studies cannot themselves yield a specific diagnosis (except for a few conditions, such as lipoma or liposarcoma), they are extremely useful for defining anatomic location, tumor extent, and involvement of vital structures. [21]

Imaging studies should be obtained before biopsy, for the following reasons:

  • To ensure that a biopsy of a potentially malignant lesion is taken in a manner that will not preclude limb-salvage surgery
  • To prevent the biopsy tract from adversely affecting the capture of anatomic detail by MRI

The relation of the tumor and surrounding normal structures to the planned biopsy site should be evaluated, as should the functional status of the involved limb, signs of lymph node involvement, and any other factors that could compromise optimal surgical or radiation therapy.

Because prognosis is primarily dependent on the disease stage rather than the histologic tumor type, evaluation of local and distant extent is pivotal in the ultimate management of soft-tissue sarcoma. Imaging methods commonly used for such evaluation include plain radiography, CT, MRI, and bone scintigraphy. PET is being used more frequently to assess the metabolic activity and, presumably, the biologic aggressiveness of a lesion. Angiography to evaluate any vascular involvement by soft tissue tumors has essentially been replaced by MRI.

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