Duke Cancer Institute, Duke University, Durham, NC, USA.
McMaster University Medical Center, Hamilton, ON, Canada.
Ann Surg Oncol. 2021 Nov;28(12):7903-7911. doi: 10.1245/s10434-021-10091-1. Epub 2021 May 7.
Unlike other sarcoma subtypes, myxoid liposarcoma (MLS) has a propensity for extra-pulmonary metastases. Computed tomography (CT) scan of the chest, abdomen, and pelvis has become an accepted practice for surveillance. However, recent literature suggests that this may be inadequate. This study aimed to assess the ability of current imaging methods to detect metastases adequately in this population.
The study identified 169 patients with MLS diagnosed between 2000 and 2016. The timing and location of metastases, the reasons leading to the MLS diagnosis, and the imaging methods were recorded. The locations of metastases were classified into the following categories: pulmonary, soft tissue, bone, retroperitoneal, intraperitoneal, solid organ, and lymph node.
An initial diagnosis of metastasis was made at presentation with staging CT scan for 3 (10 %) of 31 patients, with a follow-up surveillance CT scan for 15 (48 %) of the patients or with subsequent imaging obtained in response to patient-reported symptoms for 13 (42 %) of the patients. The proportions of patients who had metastases in each location were as follows: soft tissue (84 %), pulmonary (68 %), intraabdominal (48 %), solid organ (48 %), bone (45 %), lymph node (32 %), and retroperitoneal (29 %). Although 14 patients had bone metastases, only 1 patient had a sclerotic/blastic presentation visualized on CT scan, and the diagnosis for the remaining 13 patients was determined by magnetic resonance imaging (MRI).
Due to metastatic disease identified outside surveillance imaging for 58 % of the patients, the diversity of locations, and the significant failure of CT and bone scan to identify bone metastases, this study questioned the adequacy of CT scan for surveillance of MLS. Consideration should be given to the use of whole-body MRI for detection of metastasis in MLS.
与其他肉瘤亚型不同，黏液样脂肪肉瘤（MLS）倾向于发生肺外转移。胸部、腹部和骨盆的计算机断层扫描（CT）已成为一种被接受的监测方法。然而，最近的文献表明，这可能还不够。本研究旨在评估当前影像学方法在该人群中检测转移的能力。
本研究共纳入 2000 年至 2016 年间诊断为 MLS 的 169 名患者。记录了转移的时间和位置、导致 MLS 诊断的原因以及影像学方法。将转移的位置分为以下几类：肺部、软组织、骨骼、腹膜后、腹腔内、实体器官和淋巴结。
31 名患者中有 3 名（10%）在进行分期 CT 扫描时即被诊断为转移，15 名（48%）患者进行了随访 CT 扫描，13 名（42%）患者因患者报告的症状而进行了后续影像学检查。每个部位发生转移的患者比例如下：软组织（84%）、肺部（68%）、腹腔内（48%）、实体器官（48%）、骨骼（45%）、淋巴结（32%）和腹膜后（29%）。尽管 14 名患者有骨转移，但只有 1 名患者在 CT 扫描上显示出硬化/成骨表现，其余 13 名患者的诊断是通过磁共振成像（MRI）确定的。
由于 58%的患者在监测影像学之外发现了转移性疾病，转移部位的多样性，以及 CT 和骨扫描未能识别骨转移的显著失败，本研究对 CT 扫描在 MLS 监测中的充分性提出了质疑。应考虑使用全身 MRI 来检测 MLS 中的转移。
