What are the NCCN diagnostic guidelines for soft tissue sarcoma (STS) of the extremities, superficial trunk, or head and neck?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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The National Comprehensive Cancer Network (NCCN) workup for STS of the extremities, superficial trunk, or head and neck includes evaluation and management prior to initiation of therapy by a multidisciplinary team with expertise and experience in sarcoma. [1] The ESMO guidelines concur and recommend referral of all patients with any unexplained deep soft tissue mass, or any superficial soft tissue lesion larger than 5 cm, to a center that specializes in the treatment of STS. [6]

The NCCN guidelines recommend the following as essential aspects of the workup [1] :

  • History and physical examination
  • Adequate imaging of primary tumor for all lesions with a reasonable chance of being malignant
  • Carefully planned core needle (preferred) or open incisional biopsy (may be considered by an experienced surgeon) after adequate imaging; biopsy should be placed along future resection axis with minimal dissection and careful attention to hemostasis, and should establish grade and histologic subtype
  • Imaging studies that include cross-sectional imaging MRI, with or without CT scanning for tumor details, including size and contiguity to nearby visceral structures; additional studies may be warranted in individual situations
  • Ancillary diagnostic methodologies (eg, immunohistochemistry, classical cytogenetics, electron microscopy, molecular genetic testing) as appropriate
  • Chest imaging

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