Richard James Robinson MBBCh, Presenter: Nothing to Disclose

Amit Lakkaraju MBBS, Abstract Co-Author: Nothing to Disclose

Rajendranath Sinha MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

Sara Edward MBBS, Abstract Co-Author: Nothing to Disclose

Philip Robinson MBChB, Abstract Co-Author: Nothing to Disclose

Soft tissue masses are a common cause of patient presentation in family and hospital practice. The differential diagnosis of these masses is wide and varies from benign to aggressively malignant pathology. Using our experience with 358 patients we show that ultrasound can be used as an accurate, accessible and inexpensive first line investigation to identify patients that require rapid and more accurate lesion characterisation with MRI from those that can be followed up clinically.

358 Ultrasound examinations requested by family and hospital clinicians were prospectively evaluated. Examinations were performed by experienced musculoskeletal radiologists with size, location and ultrasound diagnosis recorded. Each examination was graded according to the concern of malignancy in that patient to one of 4 groups. 1) Benign- return to referring practitioner, 2) Benign- referral to non sarcoma specialist, 3)Indeterminate- further lesion characterization with MRI, 4) Referral to regional sarcoma service. Each lesion was then correlated with any further imaging, pathological specimen following resection or re-referral over the following 2 year period.

Of 358 ultrasound examinations, 278 referrals were from family practitioners and 80 from Hospital doctors. Most common 5 ultrasound diagnoses were lipoma (n=123), normal (n=57), cysts (n=42), atypical lipoma (n=25), vascular lesions (n=15) and sarcomas (n=15). 283 cases were considered benign and returned to referrer and 75 cases went on to MRI and/or sarcoma referral. MRI was performed in 61 of these patients with confirmation of benign process in 44 cases. 5 lesions remain indeterminate and are undergoing clinical follow up. 12 lesions where thought aggressive on MRI. Pathological correlation confirmed 7 malignant lesions in these patients. No patients from the group returned to the care of the non sarcoma specialist has re-presented in a 2 year period.

Ultrasound allows rapid evaluation of patients with soft tissue masses. In the majority of cases a soft tissue sarcoma can be excluded allowing reassurance, treatment or more appropriate referral. If findings are indeterminate or concerning patients can be fast tracked for further imaging and clinical evaluation.

Ultrasound is a cost effective, accurate, and accessible method for triage of soft tissue masses directing patients to the most appropriate management pathway.

Robinson, R, Lakkaraju, A, Sinha, R, Edward, S, Robinson, P, Ultrasonography: An Effective Method for Triage of Soft Tissue Masses.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6011582.html