Soft tissue tumor imaging in adults: whole-body staging in sarcoma, non-malignant entities requiring special algorithms, pitfalls and special imaging aspects. Guidelines 2024 from the European Society of Musculoskeletal Radiology (ESSR).

Objectives: The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls.

Materials And Methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries.

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?

Objectives: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary.

Diagnostic accuracy of ultrasound-guided core needle biopsy versus incisional biopsy in soft tissue sarcoma: an institutional experience.

Core needle biopsy (CNB) is gaining in importance due to its advantages in the matter of patient morbidity, time and cost. Nevertheless, controversies still exist regarding the biopsy technique of choice for the accurate diagnosis of soft tissue sarcoma (STS). This retrospective cohort study compared the diagnostic performance between ultrasound-guided CNB and incisional biopsy (IB), both performed by orthopedic surgeons.

Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence.

Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations.

Individualizing Follow-Up Strategies in High-Grade Soft Tissue Sarcoma with Flexible Parametric Competing Risk Regression Models.

Currently, patients with extremity soft tissue sarcoma (eSTS) who have undergone curative resection are followed up by a heuristic approach, not covering individual patient risks. The aim of this study was to develop two flexible parametric competing risk regression models (FPCRRMs) for local recurrence (LR) and distant metastasis (DM), aiming at providing guidance on how to individually follow-up patients. Three thousand sixteen patients (1931 test, 1085 validation cohort) with high-grade eSTS were included in this retrospective, multicenter study.

Sports activity after soft tissue sarcoma of the lower extremity.

The aim of this case series was to assess sports activity levels in long-term survivors of soft-tissue sarcomas after multimodal treatment including limb salvaging surgical resection and radio-chemotherapy. Thirty-two patients (17 f/15 m) with a mean age of 29 (range 10-44) years at the time of diagnosis and a mean follow-up time of 9 (range 3-21) years following sarcoma were included. Ten patients had been diagnosed with liposarcoma, seven with synovial sarcoma, four with fibrosarcoma, three with undifferentiated pleomorphic sarcomas and the remaining eight patients with different soft-tissue sarcoma entities.

Efficacy of different revision procedures for infected megaprostheses in musculoskeletal tumour surgery of the lower limb.

Purpose: The incidence of recurrent infections in patients following one or two stage revision for infected megaprostheses after resection of bone tumours was investigated. The difference between retaining at least one well fixed stem and a complete removal of the megaprosthesis during a two stage revision was also analysed.

Methods: 627 patients who experienced a replacement of a musculoskeletal tumour by megaprostheses were recorded.

C-reactive protein: An independent predictor for dedifferentiated chondrosarcoma.

Dedifferentiated chondrosarcoma is a rare primary bone malignancy with a very poor prognosis. The aim of the study was to identify pretreatment serum markers as prognostic factors for the overall survival (OS) of patients with dedifferentiated chondrosarcoma. We retrospectively reviewed 33 patients with histologically confirmed dedifferentiated chondrosarcoma treated at our department from 1977 to 2015.

Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?

Background: The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach.

Questions/purposes: In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication?

Methods: Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup.

Computer navigation-assisted surgery for musculoskeletal tumors: a closer look into the learning curve.

Background: Computer navigation-assisted surgery for musculoskeletal tumors has shown to reduce the risk of intra-lesional margins in resection. Experiences with this method are still limited to smaller case series.

Method: We reviewed our first experiences in 24 patients in whom computer navigation-assisted surgery had been performed.

Serum creatinine and albumin predict sarcoma-specific survival in patients with myofibroblastic and fibroblastic sarcomas.

Recent evidence suggests that common prognostic factors predicting disease progression and survival in soft tissue sarcomas (STS) are not applicable to all STS entities, indicating the need for histotype specific evaluation of new prognosticators. This study aimed at evaluating preoperative serum creatinine, albumin, and the albumin-creatinine ratio (ACR) as markers for survival in patients with malignant fibroblastic and myofibroblastic sarcomas. One hundred and thirty-two patients who underwent sarcoma resection have been included.

Oncological and surgical outcome after treatment of pelvic sarcomas.

Background And Objectives: Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.

Methods: Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma.

C-reactive protein as a prognostic factor in patients with chordoma of lumbar spine and sacrum--a single center pilot study.

Study Design: This is a retrospective, diagnostic study, level IV.

Background: It appears to be necessary to identify prognostic markers for individual risk estimation for progression and survival in patients with chordoma, a rare disease. Are pre-operative serum levels of C-reactive protein (CRP) associated with disease progression and survival?

Methods: Survival rates of 24 patients (18 males, 6 females) (mean age 67 years (SD ± 16; range 20-85 years); minimum follow-up 2 years, mean follow-up 5 years (SD ± 5; range 2-19 years)) with chordoma of the lower spine and sacrum were assessed with a focus on pre-operative CRP levels.

Superficial desmoid tumors: MRI and ultrasound imaging characteristics.

Objectives: To describe the imaging characteristics of superficial desmoid tumors using magnetic resonance imaging (MRI) and high-resolution sonography (HRUS).

Methods: We retrospectively examined 18 patients (12 females and 6 males) with histologically proven superficial desmoids. Fourteen patients received MRI examinations, while 12 patients were examined with HRUS.

Outcome after Reconstruction of the Proximal Tibia--Complications and Competing Risk Analysis.

Background And Objectives: The proximal tibia (pT) is a common site for bone tumors. Improvements in imaging, chemotherapy and surgical technique made limb salvage surgery the treatment of choice. Yet, reconstructions of the pT have been associated with less favorable outcome compared to other parts of the extremities.

Elevated serum creatinine and low albumin are associated with poor outcomes in patients with liposarcoma.

Low serum albumin levels and impaired kidney function have been associated with decreased survival in patients with a variety of cancer types. In a retrospective cohort study, we analyzed 84 patients with liposarcoma treated at from May 1994 to October 2011. Uni- and multivariable Cox proportional hazard models and competing risk analyses were performed to evaluate the association between putative biomarkers with disease-specific and overall survival.

Hemoglobin, alkalic phosphatase, and C-reactive protein predict the outcome in patients with liposarcoma.

Data on prognostic biomarkers in soft tissue sarcomas are scarce. The aim of the study was to define prognostic markers in patients with a liposarcoma, a subtype of sarcoma derived from adipose tissue. We restrospectively reviewed 85 patients with liposarcoma treated at our department from May 1994 to October 2011.

Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results.

Objectives: To test the feasibility and accuracy of MR-guided soft tissue tumour biopsy at 3T, using the dynamic contrast-enhanced (DCE) information from staging MRI for intralesional targeting.

Methods: After obtaining written informed consent for this institutional review board-approved study, 53 patients with suspected soft tissue tumours prospectively underwent preoperative staging MRI at 3T, including DCE, and subsequent MR-guided core needle biopsy. In 44/53 cases, DCE was heterogeneous and was used for intralesional biopsy targeting.

Initially localized synovial sarcoma in adults: a retrospective single-center analysis of 26 patients registered at the Department of Oncology, University of Vienna between 2004 and 2013.

Background: Synovial sarcoma is a rare subgroup of all soft-tissue sarcomas. The aim of this retrospective single-center analysis was to investigate the outcome of patients with initially localized disease.

Patients And Methods: Twenty-six patients were enrolled in this retrospective single-center analysis.

Primary malignant tumours of the scapula--a review of 29 cases.

Purpose: Primary malignant bone tumours of the scapula are very rare. Apart from limited small series and some case reports, international literature on flat bone sarcoma is exiguous and not much is known about the oncological outcome.

Methods: A retrospective analysis of 29 patients diagnosed with a primary malignant tumour of the scapula was performed.

Peripheral nerve tractography in soft tissue tumors: a preliminary 3-tesla diffusion tensor magnetic resonance imaging study.

Introduction: This diffusion tensor magnetic resonance imaging (DTI) study aimed to clarify the relationship of peripheral nerves and soft tissue tumors (STTs) in 3D to optimize subsequent treatment.

Methods: Twenty-six consecutive STT patients (histologically malignant, n=10; intermediate, n=3; and benign, n=13) underwent 3-Tesla MRI using an echoplanar DTI sequence. Deterministic tractography was performed.

Comparison of metal on metal versus polyethylene-ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy.

Purpose: We report the results of a consecutive series of 12 cases with haemophilic hip arthropathy treated with uncemented total hip arthroplasty (THA). Our hypothesis was that THA results in the haemophilic group would be inferior to those in the nonhaemophilic group.

Methods: The clinical histories of 12 consecutive THAs in eight patients (all men) with hereditary bleeding disorders (haemophilia A and B and von Willebrand disease) were reviewed retrospectively.