Hauwanga Wilhelmina N, McBenedict Billy, Goh Kang Suen, Yau Ryan Chun Chien, Thomas Anusha, Alphonse Berley, Ahmed Yusuf A, Yusuf Walaa H, Devan Jeshua N, Alsiddig Hind A, Ahmed Abdelwahab, Lima Pessôa Bruno
Cardiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA.
Neurosurgery, Fluminense Federal University, Niterói, BRA.
Cureus. 2024 Oct 31;16(10):e72784. doi: 10.7759/cureus.72784. eCollection 2024 Oct.
Soft tissue sarcomas are malignant tumors characterized by heterogeneity and are associated with a high mortality rate. Histopathological grading is considered a pivotal factor in prognostication and treatment planning. While core needle biopsy exhibits high accuracy in determining tumor histology, it fails in some cases, potentially misclassifying high-grade tumors as low-grade. Magnetic resonance imaging (MRI) has been evaluated as an adjunctive tool for predicting histopathological tumor grade. This systematic review and meta-analysis evaluated MRI features capable of distinguishing high-grade from low-grade tumors in patients with soft tissue sarcoma. A literature search was carried out in PubMed, Embase, and Cochrane Central in May 2024. The following features were evaluated for both low-grade and high-grade tumors: tumor size, heterogeneity on T2, presence of necrotic areas, margin definition on T1, and post-contrast peritumoral enhancement. Statistical analysis was conducted using the OpenMeta[Analyst] software (Providence, RI: Brown University), applying random effects models for pooled analyses with a 95% confidence interval (CI) based on the inverse variance method. A total of four studies, involving 343 patients categorized by tumor grade (high-grade or low-grade), who underwent MRI, were included in the analysis. The meta-analysis found similar incidences of tumor sizes less than 5 cm in both high-grade and low-grade tumors (22.7%; 95% CI: 10.3-25% vs. 27%; 95% CI: 2.7-51.2%) and tumor sizes greater than 5 cm (71.3%; 95% CI: 64-78.6% vs. 52%; 95% CI: 23.6-80.5%). High-grade tumors showed a higher incidence of post-contrast peritumoral enhancement compared to low-grade tumors (66%; 95% CI: 43-89% vs. 26%; 95% CI: 4.6-47.4%) as well as heterogeneity on T2 greater than 50% (72.4%; 95% CI: 49.3-95.4% vs. 25.4%; 95% CI: 5.2-56%). Additionally, high-grade tumors had a lower incidence of the absence of necrotic signal compared to low-grade tumors (28.8%; 95% CI: 8.5-49.1% vs. 68%; 95% CI: 57.5-78.6%). Our findings suggest that post-contrast peritumoral enhancement, presence of necrotic areas, and heterogeneity on T2 greater than 50% are MRI features associated with high-grade tumors in soft tissue sarcoma. Tumor size, however, does not appear to be a reliable indicator for differentiating tumor grade.
软组织肉瘤是具有异质性的恶性肿瘤，且死亡率很高。组织病理学分级被认为是预后评估和治疗规划的关键因素。虽然粗针活检在确定肿瘤组织学方面具有很高的准确性，但在某些情况下会失败，可能将高级别肿瘤误分类为低级别肿瘤。磁共振成像（MRI）已被评估为预测组织病理学肿瘤分级的辅助工具。本系统评价和荟萃分析评估了能够区分软组织肉瘤患者高级别和低级别肿瘤的MRI特征。2024年5月在PubMed、Embase和Cochrane Central进行了文献检索。对低级别和高级别肿瘤均评估了以下特征：肿瘤大小、T2加权像上的异质性、坏死区域的存在、T1加权像上的边界清晰度以及增强后肿瘤周围强化情况。使用OpenMeta[Analyst]软件（罗德岛普罗维登斯：布朗大学）进行统计分析，应用随机效应模型进行汇总分析，基于逆方差法计算95%置信区间（CI）。共有四项研究纳入分析，涉及343例按肿瘤分级（高级别或低级别）分类且接受了MRI检查的患者。荟萃分析发现，高级别和低级别肿瘤中肿瘤大小小于5 cm的发生率相似（22.7%；95%CI：10.3 - 25%对27%；95%CI：2.7 - 51.2%）以及肿瘤大小大于5 cm的发生率相似（71.3%；95%CI：64 - 78.6%对52%；95%CI：23.6 - 80.5%）。与低级别肿瘤相比，高级别肿瘤增强后肿瘤周围强化的发生率更高（66%；95%CI：43 - 89%对26%；95%CI：4.6 - 47.4%）以及T2加权像上异质性大于50%的发生率更高（72.4%；95%CI：49.3 - 95.4%对25.4%；95%CI：5.2 - 56%）。此外，与低级别肿瘤相比，高级别肿瘤无坏死信号的发生率更低（28.8%；95%CI：8.5 - 49.1%对68%；95%CI：57.5 - 78.6%）。我们的研究结果表明，增强后肿瘤周围强化、坏死区域的存在以及T2加权像上大于50%的异质性是软组织肉瘤中与高级别肿瘤相关的MRI特征。然而，肿瘤大小似乎不是区分肿瘤分级的可靠指标。
