Schulte M, von Baer A, Schultheiss M, Scheil-Bertram S
Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädische Chirurgie, Diakoniekrankenhaus Rotenburg.
Ultraschall Med. 2010 Apr;31(2):182-90. doi: 10.1055/s-0028-1109917. Epub 2010 Mar 19.
Malignant soft tissue tumours appear infrequently in comparison to benign lesions. Clinical misdiagnosis leads to inadequate or delayed therapy in many cases of soft tissue sarcoma. The present study explores the question if ultrasonography as a widely-used diagnostic tool allows for a discrimination of benign and malignant soft tissue tumours.
In a prospective study over a period of 8 years 224 histologically ascertained solid soft tissue tumours, thereof 120 sarcomas and 27 aggressive benign lesions were investigated by B-mode and colour Doppler sonography. The echotexture was analysed computer-based using the parameters echogenicity, homogeneity and vascularisation in all lesions.
Different tumour groups showed typical patterns of echotexture, which enabled a classification using 6 categories, distinguishing homogenous hyperechoic, heavily inhomogeneous and homogenous hypoechoic lesions, each group linked to an elevated or low vascularisation. Implementation of the proposed classification revealed a sensitivity in the detection of soft tissue sarcomas and aggressive benign lesions of 94.4 % with a specificity of 79.7 % and an accuracy of 89.7 %.
Ultrasonography allows for a determination of the diagnostic and therapeutic procedure in soft tissue tumours. Due to the fact that soft tissue sarcomas present hypervascularised almost exclusively, predominantly homogenous hypoechoic, rarely homogenous hyperechoic, and aggressive benign tumours present homogenous hypoechoic predominantly, such patterns require a biopsy prior to further surgical therapy. However, in homogenous hyperechoic lesions displaying a low blood flow either a primary resection or a conservative treatment with follow-up examinations can be discussed depending on clinical findings and history of the patient. Although the group of heavily inhomogeneous tumours within our collective consisted of benign lesions exclusively, biopsy should be recommended in theses cases in order to exclude a soft tissue sarcoma.
与良性病变相比，恶性软组织肿瘤相对少见。在许多软组织肉瘤病例中，临床误诊会导致治疗不足或延迟。本研究探讨超声作为一种广泛使用的诊断工具是否能够区分良性和恶性软组织肿瘤。
在一项为期8年的前瞻性研究中，对224例经组织学确诊的实性软组织肿瘤进行了研究，其中包括120例肉瘤和27例侵袭性良性病变，采用B超和彩色多普勒超声进行检查。使用回声性、均匀性和血管化参数，通过计算机对所有病变的回声纹理进行分析。
不同肿瘤组显示出典型的回声纹理模式，可分为6类，包括均匀高回声、高度不均匀和均匀低回声病变，每组与血管化程度升高或降低相关。所提出的分类方法在检测软组织肉瘤和侵袭性良性病变方面的敏感性为94.4%，特异性为79.7%，准确性为89.7%。
超声可用于确定软组织肿瘤的诊断和治疗方案。由于软组织肉瘤几乎均表现为血管化增强，主要为均匀低回声，很少为均匀高回声，而侵袭性良性肿瘤主要表现为均匀低回声，因此，在进一步手术治疗前，这些模式需要进行活检。然而，对于均匀高回声且血流较低的病变，可根据患者的临床表现和病史讨论是否进行一期切除或保守治疗并进行随访检查。尽管我们研究中的高度不均匀肿瘤组仅由良性病变组成，但在这些病例中仍建议进行活检以排除软组织肉瘤。
