A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

Yohei Asano,Hiroko Ikeda,Shinji Miwa,Hiroyuki Tsuchiya,Takayuki Nojima,Katsuhiro Hayashi,Akihiko Takeuchi,Kentaro Igarashi,Yoshihiro Araki,Hirotaka Yonezawa,Sei Morinaga,Norio Yamamoto

doi:10.1038/s41598-021-04004-1

Yohei Asano, Hiroko Ikeda + Show 10 more

Open Access

https://doi.org/10.1038/s41598-021-04004-1

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Abstract

This study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine lipomas and 56 ALT/WDLS were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (> 11 cm), thick septa (> 2 mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0–16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.

Highlights

Adipocytic tumors are the most common soft tissue tumors, and the frequency of lipoma and atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) is high in clinical practice[1]
We evaluated the diagnostic accuracy of various findings in some examinations and aimed to develop a combined scoring system based on the accuracy of each finding for the preoperative differential diagnosis between ALT/ WDLS and lipoma
If preoperative differential diagnosis between ALT/WDLS and lipoma is easy in ALT/WDLS patients, surgical resection is recommended before dedifferentiation[1]

Summary

Introduction

Adipocytic tumors are the most common soft tissue tumors, and the frequency of lipoma and atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) is high in clinical practice[1]. ALT and WDLS are classified as intermediate (locally aggressive) and malignant tumors, respectively, and they have a high risk of local recurrence than lipoma[7]. As they may undergo dedifferentiation and become malignant tumors[8], some patients need wider resection margins while still avoiding dysfunction. The preoperative differential diagnosis between ALT/WDLS and lipoma is critical for the determination of the resection margin. We evaluated the diagnostic accuracy of various findings in some examinations and aimed to develop a combined scoring system based on the accuracy of each finding for the preoperative differential diagnosis between ALT/ WDLS and lipoma

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