Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.
BMC Cancer. 2021 Apr 13;21(1):398. doi: 10.1186/s12885-021-08113-y.
Soft-tissue sarcomas (STS) are rare tumors of the soft tissue. Recent diagnostic studies on STS mainly dealt with only few cases of STS and did not investigate the post-therapeutic performance of MRI in a routine clinical setting. Therefore, we assessed the long-term diagnostic accuracy of MRI for detecting recurrent STS at a multidisciplinary sarcoma center.
In all, 1055 postoperative follow-up MRIs of 204 patients were included in the study. MRI follow-up scans were systematically reviewed for diagnostic values (true-positive/-negative and false-positive/-negative results) in detecting recurrences. Pathological reports and follow-up MRIs were set as baseline references.
The median age of the patients was 55.3 ± 18.2 years. Of the patients, 34.8% presented with recurrences. Here, 65 follow-up scans were true positive, 23 false positive, 6 false negative, and 961 true negative. The overall sensitivity and specificity of MRI for detecting recurrences were 92 and 98%, respectively, with an accuracy of 97%. For intramuscular lesions and after surgery alone the sensitivity was higher (95 and 97%, respectively) than for subcutaneous lesions and surgery with additional radiation therapy (83 and 86%, respectively), at similarly high specificities (96-98%). The 6 false-negative results were found in streaky (n = 2) and small ovoid/nodular (n = 4) recurring lesions. The false-positive lesions imitated streaky (n = 14), ovoid/nodular (n = 8), and polycyclic/multilobulated recurring tumors (n = 1). All false-positive results were found in patients in whom the primary tumors were polycyclic/multilobulated in appearance.
MRI shows a high diagnostic accuracy for detecting recurrent STS, with a high sensitivity and specificity. The diagnostic accuracy decreases in subcutaneous lesions and after surgery with radiation therapy, compared to intramuscular lesions and surgery alone. Radiologists should pay particular attention to streaky and small ovoid/nodular recurring lesions and patients with polycyclic/multilobulated primary tumors.
软组织肉瘤（STS）是一种罕见的软组织肿瘤。最近关于 STS 的诊断研究主要涉及少数 STS 病例，并未在多学科肉瘤中心的常规临床环境中研究 MRI 的治疗后表现。因此，我们评估了 MRI 检测复发性 STS 的长期诊断准确性。
共纳入 204 例患者的 1055 例术后随访 MRI。系统地回顾了 MRI 随访扫描在检测复发方面的诊断价值（真阳性/-阴性和假阳性/-阴性结果）。将病理报告和随访 MRI 作为基线参考。
患者的中位年龄为 55.3±18.2 岁。其中 34.8%的患者出现复发。在这些患者中，65 次随访扫描为真阳性，23 次为假阳性，6 次为假阴性，961 次为真阴性。MRI 检测复发的总体敏感性和特异性分别为 92%和 98%，准确性为 97%。对于肌内病变和单纯手术后，敏感性较高（分别为 95%和 97%），而对于皮下病变和手术加放疗，敏感性较低（分别为 83%和 86%），特异性相似（96%-98%）。6 例假阴性结果出现在条纹状（n=2）和小卵圆形/结节状（n=4）复发病变中。假阳性病变模仿条纹状（n=14）、卵圆形/结节状（n=8）和多环/多叶状复发性肿瘤（n=1）。所有假阳性结果均发生在原发性肿瘤呈多环/多叶状外观的患者中。
MRI 对检测复发性 STS 的诊断准确性较高，具有较高的敏感性和特异性。与肌内病变和单纯手术后相比，在皮下病变和手术加放疗后，诊断准确性降低。放射科医生应特别注意条纹状和小卵圆形/结节状复发性病变以及多环/多叶状原发性肿瘤的患者。
