Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
Skeletal Radiol. 2020 Jun;49(6):883-892. doi: 10.1007/s00256-019-03365-z. Epub 2020 Jan 3.
To prospectively evaluate the accuracy of ultrasound in defining the specific nature of superficial soft tissue masses as well as determining malignancy.
Eight hundred twenty-three superficial soft tissue masses were prospectively evaluated with ultrasound by one of five experienced musculoskeletal radiologists. The radiologist at the time of examination provided one to three specific differential diagnoses and the perceived level of confidence with regard to each diagnosis. Clinical and ultrasound diagnoses were compared with the histological diagnosis to determine accuracy. Tumor malignancy was determined by histology or clinical/imaging follow-up.
Histological correlation was present for 219 (26.6%) of the 823 masses. Compared with histology, the accuracy of clinical and ultrasound examination for determining specific tumor type was 25.6% and 81.2% respectively considering all differential diagnoses provided. Radiologists were "fully confident" with the ultrasound diagnosis in 585 (71.1%) of 823 masses overall. In this setting, when compared with histology, the diagnostic accuracy of ultrasound was 95.5%. When the radiologist was "not fully confident," accuracy was 41.3% for the first differential diagnosis and 60.9% for all differential diagnoses. Diagnostic accuracy improved with increasing radiologist experience. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for identifying malignant tumor were 93.3%, 97.9%, 45.2%, and 99.9% respectively.
One can be "fully confident" at characterizing over two-thirds of superficial soft tissue masses based on ultrasound appearances and, in this setting, diagnostic accuracy is very high. Ultrasound examination is also highly accurate at discriminating benign from malignant superficial soft tissue masses.
前瞻性评估超声在明确表浅软组织肿块的具体性质和确定良恶性方面的准确性。
由五位有经验的肌肉骨骼放射科医生对 823 例表浅软组织肿块进行前瞻性超声评估。检查时，放射科医生提供一到三个具体的鉴别诊断，并对每个诊断的置信度进行评估。将临床和超声诊断与组织学诊断进行比较，以确定准确性。肿瘤的恶性程度通过组织学或临床/影像学随访来确定。
219 例（26.6%）肿块有组织学相关性。与组织学相比，考虑所有提供的鉴别诊断，临床和超声检查确定特定肿瘤类型的准确性分别为 25.6%和 81.2%。放射科医生对 823 例肿块中的 585 例（71.1%）的超声诊断“完全有信心”。在这种情况下，与组织学相比，超声的诊断准确性为 95.5%。当放射科医生“不完全有信心”时，第一鉴别诊断的准确性为 41.3%，所有鉴别诊断的准确性为 60.9%。诊断准确性随着放射科医生经验的增加而提高。超声识别恶性肿瘤的敏感性、特异性、阳性预测值和阴性预测值分别为 93.3%、97.9%、45.2%和 99.9%。
根据超声表现，我们可以“完全有信心”地对超过三分之二的表浅软组织肿块进行特征描述，在这种情况下，诊断准确性非常高。超声检查也非常准确地区分良性和恶性表浅软组织肿块。
