Patkar S, Gulia A, Juvekar S, Rekhi B, Puri A
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2016 Jul-Sep;53(3):408-411. doi: 10.4103/0019-509X.200670.
Often, it is difficult to assess the presence of residual disease after an unplanned excision in soft-tissue sarcomas. Inadequate excision leads to disease recurrence and inferior oncological outcomes while unnecessary excision may lead to additional surgical procedures with inherent morbidity and increased cost of treatment. There is a paucity of literature comparing the preoperative imaging findings with the final histopathology report to accurately assess the presence of residual disease.
The clinical details of 55 patients who had oncological scar excision after unplanned prior excision were retrieved. Histopathological evaluation of scar was compared with presurgery magnetic resonance imaging (MRI) for the presence of residual disease. Sensitivity, specificity, and positive and negative predictive value (NPV) of MRI for detection of residual disease were calculated.
On MRI, residual disease was seen in 28 cases, no disease in 24 cases whereas findings of three patients were indeterminate. On final histopathology, residual disease was present in 30 (55%) patients whereas no residual tumor was seen in 25 (45%) patients. Two patients in whom MRI suggested the presence of residual disease had no tumor on final histopathology. No evidence of residual disease was reported in MRI of 24 patients. Of these, twenty patients were confirmed to have no tumor on final histopathology, whereas four patients had a residual tumor. Sensitivity: 86.66%, specificity: 90.90%, positive predictive value (PPV): 92.85%, NPV: 83.33%.
MRI can aid in preoperative planning by identifying the site and extent of the previous surgery. It has a high PPV (92%) for detection of residual disease. However, a negative scan (NPV 83%) does not reliably exclude the presence of residual disease.
软组织肉瘤进行计划外切除术后，通常难以评估残留疾病的存在情况。切除不充分会导致疾病复发和肿瘤学预后较差，而不必要的切除可能导致额外的手术操作，带来固有的发病率并增加治疗成本。比较术前影像学检查结果与最终组织病理学报告以准确评估残留疾病存在情况的文献较少。
检索了55例先前计划外切除术后进行肿瘤性瘢痕切除患者的临床资料。将瘢痕的组织病理学评估结果与术前磁共振成像（MRI）进行比较，以确定是否存在残留疾病。计算MRI检测残留疾病的敏感性、特异性、阳性预测值和阴性预测值（NPV）。
在MRI上，28例可见残留疾病，24例未见疾病，3例患者的检查结果不确定。最终组织病理学检查显示，30例（55%）患者存在残留疾病，25例（45%）患者未见残留肿瘤。2例MRI提示存在残留疾病的患者最终组织病理学检查未发现肿瘤。24例患者的MRI报告未显示残留疾病证据。其中，20例患者最终组织病理学检查证实无肿瘤，4例患者有残留肿瘤。敏感性：86.66%，特异性：90.90%，阳性预测值（PPV）：92.85%，阴性预测值（NPV）：83.33%。
MRI可通过确定先前手术的部位和范围来辅助术前规划。其检测残留疾病的阳性预测值较高（92%）。然而，扫描结果为阴性（NPV 83%）并不能可靠地排除残留疾病的存在。
