Abstract
Background:Ultrasonography is useful for distinguishing between benign and malignant soft-tissue tumors. However, no study has focused on its usefulness in the differential diagnosis between low-grade and high-grade soft-tissue sarcomas. We conducted a retrospective study to determine the usefulness of the parameters of ultrasonograph and to develop a practical scoring system for distinguishing between high-grade and low-grade sarcomas.Methods:Twenty-two cases of low-grade and 43 cases of high-grade malignant soft-tissue sarcoma were enrolled. Ultrasonography parameters including the longest diameter, depth of the tumor, echogenicity, tumor margin, and vascularity defined according to Giovagnorio’s criteria were analyzed as factors to distinguish between the two types of sarcoma. Significant factors were entered into a multivariate model to define the scores for distinction according to the odds ratio. The usefulness of the score was analyzed via receiver operating characteristic analyses.Results:In univariate analysis, tumor margin, echogenicity, and vascularity were significantly different between low- and high-grade sarcomas. In the multivariate regression model, the odds ratio for high-grade vs. low-grade sarcoma was 8.8 for tumor margin, 69 for echogenicity, and 8.3 for vascularity. Scores for the risk factors were defined as follows: 1, ill-defined margin; 2, hypoechoic echogenicity; and 1, type IV in Giovagnorio’s criteria. The sum of each score was confirmed by receiver operating characteristic analysis. The area under the curve was 0.95, with a cut-off score of 3, indicating that the scoring system was useful.Conclusion:The ultrasonography parameters of tumor margin, echogenicity, and vascularity are useful for distinguishing between low- and high-grade sarcomas.
Highlights
Soft-tissue sarcoma is a rare neoplasm of mesenchymal origin
The ultrasonography parameters of tumor margin, echogenicity, and vascularity are useful for distinguishing between low- and highgrade sarcomas
The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grading system is used for softtissue sarcomas defined by tumor differentiation, mitosis count, and tumor necrosis; this system is commonly the basis for making decisions about the use of chemotherapy and definition of surgical margins [5]
Summary
Differentiation, histological origin, local invasiveness, sensitivity to radiotherapy and chemotherapy, and incidence of local recurrence and metastasis vary significantly, its treatment should be selected on the basis of the nature of the tumor and should be decided on a case-to-case basis [1 - 4]. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grading system is used for softtissue sarcomas defined by tumor differentiation, mitosis count, and tumor necrosis; this system is commonly the basis for making decisions about the use of chemotherapy and definition of surgical margins [5]. No study has focused on its usefulness in the differential diagnosis between low-grade and high-grade soft-tissue sarcomas. We conducted a retrospective study to determine the usefulness of the parameters of ultrasonograph and to develop a practical scoring system for distinguishing between high-grade and low-grade sarcomas
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