What are the NCCN imaging guidelines for pleomorphic sarcoma (malignant fibrous histiocytoma) of soft tissue?

Updated: Nov 07, 2018
  • Author: Gregory Scott Stacy, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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The National Comprehensive Cancer Network (NCCN) clinical practice guidelines for STS of the extremities, superficial trunk, or head and neck include the following imaging recommendations [4] :

  • Provide adequate imaging of primary tumor for all lesions with a reasonable chance of being malignant.
  • Imaging studies should include cross-sectional imaging magnetic resonance imaging (MRI) with and without contrast to provide details about the size and contiguity to nearby visceral structures and neurovascular landmarks. The addition of computed tomography (CT) scanning with contrast may be needed.
  • Other studies such as angiography and plain radiography may be warranted in individual situations.
  • For chest imaging, CT without contrast is preferred,
  • PET/CT scan may be useful in staging, prognostication, and grading.
  • For retroperitoneal/intra-abdominal STS, a chest/abdominal/pelvic CT scan is recommended, with or without an abdominal/pelvic MRI.

In concurrence with NCCN, the ESMO–EURACAN (European Society for Medical Oncology–European Reference Network for rare adult solid cancers) clinical practice guidelines on STSs recommend MRI as the main imaging modality in the extremities, pelvis, and trunk. Standard radiographs may be useful to rule out a bone tumor, to detect bone erosion with a risk of fracture, and to show calcifications. CT is used in calcified lesions to rule out a myositis ossificans and in retroperitoneal tumors, where the performance is identical to MRI. Ultrasound may be the first exam, but it should be followed by CT or MRI. [5]

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