Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong.
Eur Radiol. 2020 Nov;30(11):5894-5903. doi: 10.1007/s00330-020-07002-5. Epub 2020 Jun 26.
To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses.
Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist ('fully confident' versus 'not fully confident') about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses.
Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses.
Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses.
• In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%. • Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant. • Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.
探究超声在深部软组织肿块的性质和恶性可能性方面的诊断准确性。
对 579 例深部软组织肿块进行前瞻性超声检查。不包括先前有 MRI 或 CT 检查的肿块。在超声检查后，记录报告放射科医生对肿块性质的可能诊断（“完全有信心”与“无完全信心”）以及对超声诊断的信心程度。临床和超声诊断与 134 例（23%）肿块的组织学诊断进行比较。
与组织学相比，当考虑所有鉴别诊断时，临床和超声对肿块类型的诊断准确性分别为 47%和 88%。放射科医生对 579 例肿块中的 436 例（75%）有完全信心，在这种情况下，与组织学可比较的病例，诊断准确性为 96%。对于其余放射科医生无完全信心的肿块，与组织学相比，第一鉴别诊断的准确性为 58%，所有鉴别诊断的准确性为 80%。对于识别恶性肿瘤，超声的敏感性、特异性、阳性预测值和阴性预测值分别为 97%、58%、67%和 99%。在所有深部软组织肿块中，超过一半的病例仅通过超声即可进行充分的诊断评估。
超声在深部软组织肿块的特征和恶性识别方面具有一定价值。如果当地实践模式有利，超声可作为深部软组织肿块诊断评估的一线检查。
在 75%的病例中，放射科医生可通过超声完全有信心地对深部软组织肿块的性质进行分类，而对于那些与组织学可比较的完全有信心病例，超声的诊断准确性为 96%。
超声可以正确识别几乎所有恶性深部软组织肿块，但也会将一些良性肿块视为可能恶性。
在超过一半的深部软组织肿块中，仅通过超声即可进行充分的影像学诊断评估。
